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Robotic-assisted surgery

Growing old happens to us all, and with this, the possibility of requiring an operation to alleviate pain, restore health, and extend life increases.

Photo by Alex Knight from Pexels

This month close family members of two of the VenCat team required urgent medical procedures, both were carried out using robots.
My father was one of these patients, and when I first heard that he would be going under the knife, I was surprised to hear that his surgeons would be using a robot. It was all sounding very futuristic and, because of this, quite unnerving.
Having not heard of robotic-assisted surgery before, I incorrectly assumed it was a very new thing. Robotics in the use of surgery, although not commonplace, has been happening for many years. The first documented procedure was carried out in 1985 when the PUMA 560 robotic surgical arm was used in a delicate neurosurgical surgery.

Development has been ongoing since then, with a significant advancement made in 2000 with the da Vinci® robots, developed by American firm Intuitive, which allowed for less contact between exposed interior tissue and the surgical device, significantly reducing infection risk.

The da Vinci® surgical system was one of the first robotic-assisted, minimally invasive surgical techniques cleared by the FDA. Today a family of da Vinci® systems and technologies is used by surgeons in 67 countries around the world.

The benefits of using robotic systems within surgeries include: 

  • Greater precision
  • Reduced risk of infection
  • Less room for error
  • Faster recovery times
  • Shorter in-patient times in hospital
  • In today's COVID-19 climate, robotic surgery allows for "COVID protected" surgery to be offered to patients.

Robotic surgery is a successful option in many intricate and general surgical procedures. With the possible applications of Robotic surgery being extensive, it is at the forefront of surgery precision development. 

Below are a few companies that, with funding and partners, are leading the development of these surgery robots:



AsensusSurgical Inc (previously TransEnterix) has developed the Senhance Surgical Robotic System, competition to the da Vinci® system, with CE approval for use in Europe and FDA approval. 

The distinguishing features of this system include

      • an open remote control console capable of 3D-HD through the use of 3D glasses
      • an eye-tracking system for camera control
      • three laparoscopic robotic arms on separate carts (as opposed to the single cart seen in the da Vinci® system)
      • laparoscopic handles with six degrees of freedom to control laparoscopic robotic instruments
      • haptic force feedback to the surgeon provided through the laparoscopic handles
The Senhance System
Photo courtesy of AsensusSurgical Inc

In Europe, the system is licensed for use in abdominal, pelvic and thoracic procedures, excluding cardiac surgery. To date, clinical trials have shown the Senhance system to be safe and efficacious in minimally invasive surgery (1) .



CMR Surgical has developed Versius, another rival to the da Vinci® system.  

Versius has more light-weight, compact, individually mounted robotic arms, so it should be more flexible and versatile than existing robots, allowing for easy set-up and portability across theatres. 

Overview of the Versius surgical robotic system. (A) Schematic overview of Versius. (B) An image of the operational setup of Versius. BSU,bedside unit.

The system comprises

  • a Versius surgeon console
  • a Versius visualization bedside unit (BSU),
  • up to four Versius instrument BSUs,
  • Versius endoscopes, camera, instruments, cables and sterile drapes.

The surgeon interacts with the system through the hand controllers and feedback on the surgeon console, including the surgeon head-up display (HUD), which displays the three-dimensional (3D) video from the endoscopic camera together with a display overlay

Although designed for use in gynaecology, upper GI surgery, colorectal and urology, surgeons could use it within a broader range of operations.

 

 

 


Netherlands-based 
MicroSure has developed the world's first clinically available CE-certified surgical robot for microsurgery, named MUSA.

 

Key features include:

Microsure’s MUSA
      • It scales down motion seamlessly and filters out tremor to keep a steady hand at any time throughout every microsurgical procedure.
      • The use of joysticks as controls while working in an ergonomically comfortable position. Allowing for a better posture, solving issues related to pain and fatigue.
      • Five minimally invasive robot-assisted (MIRO) arms that attach to the operating table rails. These allow operating table repositioning without undocking the robot or interrupting the surgery.
      • A 3D-HD monitor with 3D glasses with the control mechanism gives the controller the sense of touching the patient. 
      • An AutoPointer that projects an image onto the patient to guide optimal port placement.

Early last year Microsure announced the closure of their Series B funding round.
The new funding and this new partnership with investors will specifically help MICROSURE to power the next phase of their growth strategy on clinical sites expansion, looking to increase its industrialization effort as the development of the next step in their product and supply chain strategy, as well as diving into the commercial stage.

"There is an exploding global demand for robotic solutions in surgery to help caregivers harness the power of technology to make faster, better and more affordable procedures." said Microsure CEO, Ilker Soydan, PhD. "Our strategic partnership with some of the most respected and knowledgeable local and regional tech investors in Europe will accelerate our growth in this critical market."

So what can we expect in the future of Robotic surgery? 

Removing human contact during surgery may be taken to the next level with next-generation medical robotics and robotic surgery systems capable of functioning at greater distances between the surgeon's control console and the patient side table robotics. This would allow robotic surgery to be conducted with patients in a nearby "clean room," reducing or eliminating the intraoperative infection risk. 

Dr Hachach-Haram, a member of the Royal College of Surgeons' Commission on the Future of Surgery, said that robots might do some surgery elements independently in the future.
"Surgeons will remain in control, but as we develop the human-robot interface, there may be simple parts of an operation, such as suturing or closing a wound that may be automated."

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