Robots are machines that perform the same tasks with precision. The definition of a robot most relevant to surgery is by Davies: "A powered computer controlled manipulator with artificial sensing that can be programmed to move and position tools to carry out a range of surgical tasks."

Robotic Surgery is the use of Robots to perform surgical procedures. The robot's role is not to replace the surgeon but to enhance the surgeon's innate abilities while under close supervision. This should be reassuring to the public with regard to safety and standard of care, plus the surgeons and other healthcare professionals. Robots can even improve surgical outcomes. Robotic systems are best described as ‘‘extending human capabilities’’ rather than ‘‘replacing human surgeons.’’

Surgery now uses robotic and image processing systems in order to interactively assist the medical team, both in planning the surgical intervention, and in its execution. The objective of this new technique is to enhance the quality of surgical procedures by minimizing their side effects (smaller incisions, lesser trauma, more precision), thus increasing patient benefit while decreasing the surgical cost. These techniques are being successfully introduced in several areas of surgery: neurosurgery, orthopedics, micro-surgery, cardiovascular and general surgery etc.

Classification:

Today, there are three types of surgical operation techniques. The first one is the traditional data flow model, in which surgeon directly contacts with the patient and sensorial inputs are synchronized. The second type, called “laparoscopic surgery” or “keyhole surgery”, is performed through ports which enable to view the operative area in a video screen. A camera, that passes though one port, should be held by robotic system is able to provide interactive assistance/guidance and to constrain the movements of the surgeon in order to perform, with the desired precision, the possibly pre-defined procedure (ex: neurosurgical biopsy). In some cases, the robot may have an autonomous behavior in order to realize a dedicated and fixed part of the procedure (ex: thighbone drilling for artificial hip installation).

Technology and Issues:

One reason surgical applications are progressing quickly is the large technology base that has been developed in robotics research in the past three decades. Results in mechanical design, kinematics, control algorithms, and programming that were developed for industrial robots are directly applicable to many surgical applications. Robotics researchers have also worked to enhance robotic capabilities through adaptability (the use of sensory information to respond to changing conditions) and autonomy (the ability to carry out tasks without human supervision). The resulting sensing and interpretation techniques that are proving useful in surgery include methods for image processing, spatial reasoning and planning, and real-time sensing and control.

Fundamental research areas of robotics surgery are: the modeling of de-formable organs, planning and simulation of robotics procedures, safe & real-time integration with augmented reality.

As for tele-operated robots, the surgeon through a master console benefits from an enhanced (sometimes 3D) vision of the organs. In addition, augmented reality would allow the overlay, in real-time, of the pre-operative data of the patient during the intervention. The surgeon movements may be reduced to increase precision, and smoothed to avoid hand tremor by virtue of a decoupled master/slave unit.

Robotic tele-surgery is now a reality, performed with the surgeon in the United States and the patient in France. High speed linkups via telephone or satellite are required to reduce the delay of data

variable beats of the heart, so that the image that is fed to the surgeon is still, consequently eliminating cardiopulmonary bypass. Other advances will occur in imaging, virtual reality integration, haptic sensation feedback, and superior data transfer, allowing "tele-mentoring" to occur. Conclusion:

The use of information and robotics technologies provided many advances in the field of surgery. Today surgery has the capability of realizing our dreams. Still robotic systems are only at the beginning

a surgeon or a robotic arm. This arm is controlled by the operating surgeon for visualization. In the last one, the surgeon is outside the operating room. Patients’ inputs and surgeon’s outputs are all electronically conducted by the help of robotics technology.

Surgical robots can be classified into active or passive. A passive robot would be used to position a fixture appropriately and then be switched off, to be followed by the surgeon inserting his instruments. An example of this would be a robot to help position a device for guiding neurosurgical biopsy needles. By contrast, an active robot would actually move the tools. These include laparoscopic camera holders, tele-manipulators, and robots used for burring out tissue.

Tele-surgery is an application of telemedicine in which a surgeon at distance performs the operation by manipulating the hands of a robot by consulting a surgeon at the operating site.

Different Phases:

Three main steps can be pointed out in a general robotic surgery intervention: data acquisition and subsequent planning, intra operative assistance, and post-operative patient control. In the pre-operative phase, a patient dependent model of the rigid (ex: bones), and de-formable (ex: the heart) anatomical entities involved in the surgical act have to be built. For this, several medical imagery techniques (MRI, Scanner, Ultrasonic etc.) are used, where the anatomical structures are detected, located and modeled. In the same time, the mechanical model of the robotic system is fused in an overall geometric model. This will be used to describe and simulate the different potential problems that may occur during the intervention.

The results obtained in the planning phase are then calibrated and put in correspondence with patient in intra-operative situation. As a consequence, the transmission to less than 300 milliseconds, and an assistant surgeon still needs to be present with the patient in order to make the incisions and insert the robot arms.

The world's first transoceanic surgery performed in 2001, September 7 by Gagner, who was assisted by French surgeon Jacques Marescaux. The operation was named Operation Lindbergh, took 55 minutes.


The public need to be made aware of the various aspects and applications of these systems. Safety features are built in, for example when the camera is moved by the surgeon, or when the surgeon takes his head away from the console (for example, to have a sip of coffee), the instruments freeze, and the system enters a standby mode.

Major concern is having safe and robust software. Several efforts in computer science have been devoted to develop modular and safe control mechanisms of software components used in robotic systems.

Pressed by incentives to cut costs, and marketplace competition to make surgery easier on patients, medical and biotech companies are focusing on new tools for "non-invasive" surgery. In some cases, technology developed for space exploration and military use is transported to the medical world.

Robots are expected to make surgery safer, cheaper and recovery much faster. Robots may also eliminate some operating room personnel with the goal being to allow "solo surgery" - a doctor operating with only an anesthesiologist and nurse on operations that now require two or three doctors and several nurses. But mostly the idea is to do surgery with the smallest incision possible.

Conventional bypass heart surgeries will require stopping the patient's heart. But researchers expect to put computer robotics to work to be able to operate on the moving, beating heart. Improvements in visual and motor synchronization of tele-manipulators will ensure that surgery can be performed on the beating heart. The robot arms will move relative to the

of their lifecycle. All these show the use of robotics technologies is only limited by surgeons’ imagination and engineers’ skills. Contributor: Satish kumar TVA is working with ITMagic Company Ltd, Seoul, South Korea as project manager.