Optimisation of an articulated instrument for enhanced dexterity in minimally invasive therapy

Twenty-first century surgery using twenty-first century technology: Surgical robotics

INTRODUCTION

The "Nintendo" surgery revolution, which began in 1987, has impacted every surgical specialty. However, our operating rooms remain isolated worlds where surgeons use awkward, primitive, rigid instruments with suboptimal visualization. We need "smart instruments," "smart technology," and "smart imaging." Is surgical robotics the answer?

METHODS

We provide an analysis of current surgical technology and skills, propose criteria for what the next generation of surgical instruments and technology should achieve, and then examine the evolution and current state of surgical robotic solutions, assessing how they answer future surgical needs. Finally we report on the U.S. Military's early experience with surgical robotics and the lessons learned therein.

RESULTS

Current surgical robotic technology has made remarkable progress with miniaturization, articulating hand-imitating instruments, precision, scaling, and three-dimensional vision. The specialty-specific early clinical applications reviewed are promising, but they do have limitations. Surgical robotics offers enormous military application potential. Needed future refinements are identified, including haptics, communications, infrastructure, and information integration.

CONCLUSIONS

Laparoscopic surgery is a transition technology, constrained by instrument, equipment, and skill limitations. Surgical robotics or, more properly, computer-assisted surgery may be the key to the future. The operating room of the future will be an integrated environment with global reach. Surgeons will operate with three-dimensional vision, use real-time three-dimensional reconstructions of patient anatomy, use miniaturized minimally invasive robotic technology, and be able to telementor, teleconsult, and even telemanipulate at a distance, thus offering enhanced patient care and safety.

Manipulation in laparoscopic surgery: overview of impeding effects and supporting aids

Within a Dutch research program on minimally invasive surgery, a large literature survey has been carried out. This article describes the state of the art in research on manipulation in laparoscopy. It gives an overview of factors impeding the surgeon and technical developments designed to overcome these problems. Starting from the year 1991, a large number of journals, proceedings, patents, and books have been consulted. The survey was completed with a thorough MEDLINE search. The impeding effects have been subdivided into two groups: transformation of spatial and grasping movements of the hand. The article gives an overview of these effects and of supporting aids that have been developed. The studies show that many aids are based on a technology-driven rather than a clinically-driven approach. The development of simple instruments that can be used for a large range of tasks instead of only one is still a very important topic of research.