ROBOTIC SURGERY
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It has been nearly 20 years since the first appearance of robotics in the operating room. In that time, much progress has been made in integrating robotic technologies with surgical instrumentation, as evidenced by the many thousands of successful robot-assisted cases. However, to build on past success and to fully leverage the potential of surgical robotics in the future, it is essential to maximize a shared understanding and communication among surgeons, engineers, entrepreneurs, and healthcare administrators.
Surgical robotics is a new technology that holds significant promise. Robotic surgery is often heralded as the new revolution, and it is one of the most talked about subjects in surgery today. Up to this point in time, however, the drive to develop and obtain robotic devices has been largely driven by the market. There is no doubt that they will become an important tool in the surgical armamentarium, but the extent of their use is still evolving.
A convincing illustration of how humans and robots can work together to improve surgery is that of retinal repair. Retinal surgery requires precise positioning of a laser, within 25 μm of a target, in order to avoid damaging retinal blood vessels. If a retinal vessel is damaged, a retinal hematoma and subsequent blindness may occur. The unaided human hand cannot reliably direct a surgical instrument to within <100 μm of its target. Furthermore, as the surgeon becomes fatigued, an intention tremor develops that further decreases accuracy. Finally, the eye itself has a natural motion of 200 Hz and acts as a moving target. The combination of these factors creates an operative situation that lacks the precision needed, but is well within the capabilities of current robotic technology. Robotic systems have been developed for this application to overcome human limitations. Using computer integration, the motion of the eye can be tracked and the eye made to appear stationary; moreover, the surgeon's tremor can be filtered. The end result is a system that can position a laser to within 10 μm of a target, thus making it 10 times more accurate than an unaided human hand. This scenario demonstrates how the synergy between robot and surgeon can result in improved task performance.
To fully leverage this promising technology for surgical intervention, and to continue relevant innovation, it is essential that there be communication and mutual understanding among surgeons, engineers, entrepreneurs, and healthcare administrators. On the clinical side, this starts with an open mind toward resolving the unmet clinical need or the unsolved clinical problem and a willingness to evaluate promising technologies as a means for achieving resolution
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