Question

Commercial surgical robots have been in clinical use since the mid-1990s, supporting surgeons in various tasks. In the past decades, many systems emerged as research platforms, and a few entered the global market. This paper summarizes the currently available surgical systems and research directions in the broader field of surgical robotics. The widely deployed teleoperated manipulators aim to enhance human cognitive and physical skills and provide smart tools for surgeons, while image-guided robotics focus on surpassing human limitations by introducing automated targeting and treatment delivery methods. Both concepts are discussed based on prototypes and commercial systems. Through concrete examples the possible future development paths of surgical robots are illustrated. While research efforts are taking different approaches to improve the capacity of such systems, the aim of this survey is to

assess their maturity from the commercialization point of view.

discuss the advantages and disadvantages to the patient and the surgeon of a specific robotic surgery.

Answer 1

Robotic surgery, or robot-assisted surgery, allows doctors to perform many types of complex procedures with more precision, flexibility and control than is possible with conventional techniques. Robotic surgery is usually associated with minimally invasive surgery procedures performed through tiny incisions. This design, which has come to be known as "Leonardo's Robot," was probably made around the year 1495 but was rediscovered in the 1950s. da Vinci was intrigued by mechanics and automation. He developed a number of mannequins including a mechanical knight.

Robotic surgery is a type of minimally invasive surgery. “Minimally invasive” means that instead of operating on patients through large incisions, we use miniaturized surgical instruments that fit through a series of quarter-inch incisions. When performing surgery with the da Vinci Si—the world’s most advanced surgical robot—these miniaturized instruments are mounted on three separate robotic arms, allowing the surgeon maximum range of motion and precision. The da Vinci’s fourth arm contains a magnified high-definition 3-D camera that guides the surgeon during the procedure.

The surgeon controls these instruments and the camera from a console located in the operating room. Placing his fingers into the master controls, he is able to operate all four arms of the da Vinci simultaneously while looking through a stereoscopic high-definition monitor that literally places him inside the patient, giving him a better, more detailed 3-D view of the operating site than the human eye can provide. Every movement he makes with the master controls is replicated precisely by the robot. When necessary, the surgeon can even change the scale of the robot’s movements: If he selects a three-to-one scale, the tip of the robot’s arm will move just one inch for every three inches the surgeon’s hand moves. And because of the console’s design, the surgeon’s eyes and hands are always perfectly aligned with his view of the surgical site, minimizing surgeon fatigue.

Advantages of daVinci Robotic Prostatectomy
There is relatively less pain and faster recovery compared to open surgery. Furthermore, the 3-D imaging and the Endowrist technology makes the surgery more accurate and precise than open or standard non-robotic laparoscopic prostate surgery. This results in higher chance for cancer cure, more precise dissection of nerve bundles and preservation of erectile function.

There is also less blood loss and shorter hospital stay. Patients usually stay 1 to 2 days in the hospital, followed by 2-3 weeks of recovery at home before resuming all normal activities. Many patients return to work and sports activities such as running, weight lifting, golf, tennis within two weeks after surgery.

Nerve Sparing Prostatectomy is accomplished with high degree of accuracy. Patients have an excellent chance at maintaining their sexual function, thus avoiding long term impotency. Bladder Neck Sparing techniques can also be used. This allows faster recovery of urinary control. Subsequently, patients regain bladder control very quickly after DVP.

As with open surgery, this technique is highly effective and offers a high chance of cure from prostate cancer. Some urologists would argue that surgery results in the highest chance of cure from prostate cancer. DaVinci Robotic Laparoscopic Prostatectomy (DVP) achieves rapid removal of PSA from blood stream, and provides accurate information on the true stage and grade of the cancer, including the status of lymph node involvement.

The patient will know if he is cancer free within a month after surgery, as opposed to up to two years after radiation. Upon removal of the prostate gland and the cancer, the PSA rapidly drops and reaches an undetectable level within a month. Therefore, the patient can rest assured of his cancer free status very early after surgery.

Because this surgery is minimally invasive, many of the disadvantages associated with open surgery are alleviated. Patients are relatively pain free. There is relatively much less chance of bleeding complications. daVinci Prostatectomy is an excellent surgery for Jehovah's Witnesses with prostate cancer. Those who want to avoid the need for transfusion, are excellent candidates for this procedure, since it is associated with minimal blood loss. Furthermore, return of bladder control, resolution of incontinence, and return of erections generally occur rapidly.

Disadvantages of daVinci Robotic Prostatectomy
This procedure is highly technical. Most physicians performing prostate surgery have not been trained in this procedure. Therefore, it is not available at all locations, requiring the patient to travel to an experienced surgeon and robotic surgery center. It is recommended that these procedures be performed by urologic surgeons trained in oncologic surgery with extensive laparoscopic and robotic surgical experience. It is recommended that the surgeon performing robotic laparoscopic prostatectomy have done at least 200 of these procedures. The procedure should be done at centers of excellence, supporting high tech robotic programs. Although adverse effects are rare, they could include incontinence, erectile dysfunction, possible formation of blood clots in the leg veins, and infection.