Robotic Surgeons

The first generation of surgical robots are already being installed in a number of operating rooms around the world. These aren't true autonomous robots that can perform surgical tasks on their own, but they are lending a mechanical helping hand to surgeons. These machines still require a human surgeon to operate them and input instructions. Remote control and voice activation are the methods by which these surgical robots are controlled.

Types of instruments used by the da Vinci Surgical System

Robotics are being introduced to medicine because they allow for unprecedented control and precision of surgical instruments in minimally invasive procedures. So far, these machines have been used to position an endoscope, perform gallbladder surgery and correct gastroesophogeal reflux and heartburn. The ultimate goal of the robotic surgery field is to design a robot that can be used to perform closed-chest, beating-heart surgery. According to one manufacturer, robotic devices could be used in more than 3.5 million medical procedures per year in the United States alone. Here are three surgical robots that have been recently developed:

• da Vinci Surgical System
• ZEUS Robotic Surgical System
• AESOP Robotic System

On July 11, 2000, the U.S. Food and Drug Administration (FDA) approved the da Vinci Surgical System, making it the first robotic system allowed to be used in American operating rooms. Developed by Intuitive Surgical, da Vinci uses technology that allows the human surgeon to get closer to the surgical site than human vision will allow, and work at a smaller scale than conventional surgery permits. The $1 million da Vinci system consists of two primary components:

• A viewing and control console
• A surgical arm unit

In using da Vinci for gallbladder surgery, three incisions -- no larger than the diameter of a pencil -- are made in the patient's abdomen, which allows for three stainless-steel rods to be inserted. The rods are held in place by three robotic arms. One of the rods is equipped with a camera, while the other two are fitted with surgical instruments that are able to dissect and suture the tissue of the gallbladder. Unlike in conventional surgery, these instruments are not directly touched by the doctor's hands.

Photo courtesy Intuitive Surgical. Surgeon's view when using the da Vinci Surgical System

Sitting at the control console, a few feet from the operating table, the surgeon looks into a viewfinder to examine the 3-D images being sent by the camera inside the patient. The images show the surgical site and the two surgical instruments mounted on the tips of two of the rods. Joystick-like controls, located just underneath the screen, are used by the surgeon to manipulate the surgical instruments. Each time one of the joysticks is moved, a computer sends an electronic signal to one of the instruments, which moves in sync with the movements of the surgeon's hands.

Another robotic system that is close to being cleared by the FDA is the ZEUS System, made by Computer Motion, which is already available in Europe. However, both the da Vinci and ZEUS systems must receive governmental approval for each procedure that a surgeon plans to use it for. The $750,000 ZEUS has a similar setup to that of the da Vinci. It has a computer workstation, a video display, and hand controls that are used to move the table-mounted surgical instruments. While the ZEUS system has not yet been cleared for American use beyond clinical trials, German doctors have already used the system to perform coronary bypass surgery.

The ZEUS system employs the assistance of the Automated Endoscopic System for Optimal Positioning (AESOP) Robotic System. Released by Computer Motion in 1994, AESOP was the first robot to be cleared by the FDA for assisting surgery in the operating room. AESOP is much simpler than the da Vinci and ZEUS systems. It's basically just one mechanical arm, used by the physician to position the endoscope -- a surgical camera inserted into the patient. Foot pedals or voice-activated software allow the physician to position the camera, leaving his or her hands free to continue operating on the patient.