A brief history of surgical robots
In January this year, reports were published of the first robotic laparoscopic procedure to be completed without human assistance, so we’re entering interesting times! In this article we look at how robotics in medicine came about and what they bring to modern healthcare facilities.
The race to build an artificial surgeon
The use of automation in surgery was pioneered by NASA and DARPA in the 1970s – organizations with large budgets and a requirement to treat astronauts and soldiers in inaccessible locations. Despite the brainpower and cash behind these early ideas, they didn’t win the robot race.
The first robot to actually conduct surgery made its debut in California in 1985 and was called PUMA 560. Developed by Unimation as a standard six-axis industrial robotic arm, PUMA was designed for work in the factories of General Motors. Surgeon Yik San Kwoh and his colleagues used it to place a needle for a brain biopsy, a task which is often complicated by tremors in a human hand. Reassuringly, later PUMAs were developed specifically with surgical tasks in mind.
In 1994, AESOP was certified for use in the operating theater. Developed by Computer Motion, AESOP was a robotic arm, controlled by a foot pedal, which assisted surgeons in correctly orienting a traditional laparoscope. Later generations encompassed voice control before being superseded by the company’s ZEUS robot in 1998. ZEUS included instrument control as well as camera control and was the first surgical robot to be used in a remote-site operation, enabling a doctor in New York to perform a cholecystectomy on a patient in France.
Modern surgical robots
2000 saw the entry of the Da Vinci surgical system into the US medical market. Just over 20 years later, the system, developed by California-based Intuitive, has now carried out over 10 million procedures, and 55,000 surgeons in 67 countries are trained to use it[1]. Designed as a modular unit, the system can be easily re-located around hospitals and customized with tools for a wider range of minimally-invasive surgical operations. Surgeons benefit from a miniaturized surgical camera giving high-definition 3D vision and a magnified view, and wristed instruments that are designed to help with precise dissection and reconstruction deep inside the body.
In 2018, CMR Surgical unveiled its Versius system which recently passed the milestone of performing 1000 keyhole operations including hysterectomies, cholecystectomies and cancer resection. Developed in the UK, Versius, like Da Vinci, also offers advanced imaging and dexterous control, but its open console and ergonomic design is intended to reduce the risk of fatigue and back pain in users. Allowing greater comfort through longer procedures, the system supports surgeon and patient wellbeing in one platform.
Future developments for robotics in surgery
What does the future look like for surgical robots? A collaboration of researchers from Harvard and Boston institutes are working on tiny soft “spider” robots which literally get under the skin of patients. The Microfluidic Origami for Reconfigurable Pneumatic/Hydraulic (MORPH) devices will be made of silicone and have 18 degrees of freedom, enabling them to “crawl” inside the human body and promise “an entirely new approach to endoscopy and microsurgery”[2].
First-class vision for surgical robots
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[1] https://isrg.intuitive.com/news-releases/news-release-details/intuitive-reaches-10-million-procedures-performed-using-da-vinci
[2] https://wyss.harvard.edu/news/soft-multi-functional-robots-get-really-small/
