Intuitive Robots - Article

INTUITIVE ROBOTS
Marching into the Operating Room
By Sara Pentz

Just imagine having kidney removal surgery at 9:00 a.m. one morning and eating lunch the next day at home feeling relatively robust, relaxed and pain free. That scenario is the present reality at UCI Medical Center in Orange, California, where the use of the robotic da Vinci^® Surgical System allows surgeons to perform complex operations in less time, with less bleeding, less pain, less hospital stay and much less trauma to the body of the patient.

Actually, the device promises to transcend surgery beyond the limits of the human hand. "Robotic systems are expected to become the surgeon’s most valuable tool," explains Dr. Ralph Clayman, chairman of the UCI Medical Center Department of Urology. “The practice of surgery has changed,” he adds. “It has become less morbid, less dangerous and more patient-friendly with equivalent results.”

The da Vinci robot, created by Intuitive Surgical®, was the first operative surgical robotic system in the world cleared by the United States Food and Drug Administration. Its unique robotics provide the doctor with mechanical hands and unprecedented vision, precision and dexterity during surgery performed through incisions no wider than a fingertip. The da Vinci is the first totally intuitive—meaning instinctive or having a natural tendency—laparoscopic surgical robot in existence. It mimics what one would do naturally in one of the most complex settings of human endeavor. The da Vinci Surgical System provides the surgeon with 3-D imaging of the operating field and intuitive hand movement. Traditional laparoscopic surgery has only 2-D imaging, and the movement of instruments is counter-intuitive—similar to doing surgery while looking into a mirror.

During the surgery the physician sits at an ergonomically-designed consol a few feet from the patient. His head is comfortably supported, as he looks through highly-magnified opticals at the patient’s surgical site in 3-D. He uses hand and foot pedals to maneuver the surgical tools. The robotic device addresses the problem of neck and back pain often suffered by surgeons who spend long hours hunched over an operating table. Even the steadiest hands can’t match those of the surgical robot. The da Vinci system is programmed to compensate for the muscle fatigue and related hand tremors that sometimes develop when surgeons perform long operations.

"Having robotic-assisted surgery, the surgeon positions the robot’s three mechanical arms over the patient. One arm holds a miniature camera, which is inserted through an opening no larger than the diameter of a pencil. The camera transmits highly-magnified 3-D images to the console. The robot’s other two arms hold miniature surgical instruments, which are inserted into another puncture-sized port of entry. Surgeons use their thumbs and index fingers to grasp joystick-like handles on the console that can be rotated, tilted, advanced or retracted.

The da Vinci system gives doctors unprecedented control over the tiny instruments they use during minimally-invasive surgery. The surgeon’s view of the operating field is enhanced by zoom-in/zoom-out capabilities, which, when coupled with the motion-scaling feature of the robotic system, allow the surgeon to perform very fine reconstructive and dissection procedures. The robotic controls enable surgeons to make natural hand movements so that procedures feel more like open surgery. Cables, replicating the manner in which the wrist is maneuvered by tendons, guide the robotic arms. "It’s as instinctive and as comfortable as driving a car," says Clayman.

Right now UCI surgeons are using the da Vinci system for minimally-invasive procedures in urology, gastroenterology, pediatrics, cardiothoracic surgery, vascular surgery and gynecology. The da Vinci robotic technology consequently aids in reducing trauma, postoperative pain and surgical complications for patients—but maintaining the operating flexibility of open surgery. Certain procedures are too difficult to perform with standard minimally-invasive techniques. Robotics changes that.

Unlike conventional surgery, the doctor’s hands never touch the robotic instruments. Large motions made by the surgeons are translated into micro-movements at the surgical site. Now doctors have more depth perception and the ability to use pitch and yaw robotically-driven hand movements. ** STOP **Repetitive or add some of info to second par. above. As well, certain safety features are built into the system. “In every respect this robot makes the surgeon comfortable,” explains Dr. Clayman. “He doesn’t even need a mask, a gown or gloves.

Eventually, the robotic system can be operated from a separate room or a separate country and, in effect, perform surgery via uplink to a satellite that beams down on the other side of the world. The practical import is that surgeons at a base camp during war could operate on a soldier or sailor at sea. That way the patient does not have to be evacuated and the doctor’s time is used more efficiently. “We will save the taxpayer money and it will potentially save lives. It’s a big change in the assault on the body needed to render a surgical cure for disease,” adds Dr. Clayman.

“Having a robotics-assisted surgical system establishes UCI Medical Center as a leader in minimally invasive surgery," says Dr. Clayman. "We already have surgeons at UCI who are internationally renown leaders in developing minimally invasive techniques in their specialties. Now we also have the very latest in technology." In 1990, Dr. Clayman performed the world’s first laparoscopic nephrectomy—the removal of the kidney through an opening the size of a dime. Until then, the procedure involved a large incision and occasionally the removal of a rib to extract the kidney. Since then, Dr. Clayman and others have applied minimally invasive surgical techniques to dozens of other procedures.

Additionally, UCI Medical has a da Vinci teaching robot used to educate surgical residents and medical students in the technology. Today, the physician must first learn how to be a surgeon and then learn how to manipulate the robots. It is not an easy science or technique to learn and requires sensitive coordination.

In line with that philosophy, Dr. Clayman has pulled together with others an astonishing complex of equipment to teach these procedures to physicians throughout the county as well as recertify them for robotic procedures. With an unusual no-strings-attached underwriting from Tokyo-based, Yamanouchi Pharmaceutical Co., Ltd., UCI Medical is on the leading edge of advanced education for such instruments as Intuitive Surgical’s (NASDAQ ISRG) unique da Vinci robot. “We began the teaching post-graduate program in July 2003,” explains Dr. Clayman. “Because of Yamanouchi’s underwriting, urology doctors come here free of charge to enhance their knowledge. Otherwise it would cost up to $10,000 per doctor. Our educational program is beginning to have an impact. We are booked through October 2004.”

Other medical manufacturing companies have joined the underwriting team to assist the teaching center financially or with donated equipment. ‘This generosity allows us to help doctors cross the educational gully from maximum open surgery to this minimally invasive surgery,” explains Dr. Clayman. Intuitive Surgical® created the da Vinci Surgical System based on foundational robotic surgery technology developed at Stanford Research. In addition to developing its own fundamental technologies, Intuitive later acknowledged key contributions through relationships with IBM, MIT and Johnson & Johnson.

With all that superpower behind it, this marvelously efficient intuitive da Vinci robot, fashioned of metal, glass and mechanical pulleys, has brought to the operating room a peace of mind for both the patient and the surgeon—a never before imagined possibility in our lifetime.

###