Robotics and Remote Surgery: Next Step
Telesurgery is still in its infancy and significant challenges pervade including technical aspects, surgical robotic platforms, cost-effectiveness, and mostly data transfer speed. The potential benefits of telesurgery have become clearer with telementorin
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Jacques Marescaux and Michele Diana “All glory comes from daring to begin.” Eugene F. Ware
Introduction Surgery has been practiced for thousands of years, and there is evidence of some embryonic form of surgery that goes back to prehistory, with clues of rudimental procedures such as skull burr holes. Hippocrates (480–390 BC) defined surgery as the therapeutic activity performed by means of the “hands.” As a character, the surgeon has been surrounded by some sort of mysticism since he/she would “touch” the sacred and secret nature of the human body, with his/her bare hands. In the Middle Ages, surgery was banned by medical academies in Europe, and surgical acts were pursued only by men whose activities required craftsmanship (e.g., barbers, butchers, bonesetters) with outstanding manual skills but who were often ignorant about anatomy or physiology. Nineteenth-century discoveries in the fundamental fields of antisepsis and anesthesia enabled the wider use of surgery to treat diseases. The twentieth century has seen the addition of thrilling new technologies to the operating room such as electrocautery. They have enabled the
J. Marescaux, M.D., F.A.C.S., (Hon.) F.R.C.S., (Hon.) J.S.E.S. (*) • M. Diana, M.D. Department of Digestive and Endocrine Surgery, IRCAD (Research Institute against Digestive Cancer), 1, place de l’Hôpital, 67091 Strasbourg, France e-mail: [email protected]; [email protected]
surgeon to perform more complex procedures while concurrently reducing surgical risks. Throughout the evolution of surgery, the physical presence and the real tactile abilities of the operating surgeon have been a constant. The advent of minimally invasive endoscopic surgery (MIES) techniques in the mid-1980s is considered one of the most groundbreaking surgical innovations. MIES has been the first step towards a successful surgeon-patient distancing process. MIES respects the therapeutic principles of open surgery with reduced surgical trauma since the surgical field is created through small skin incisions and visualized by high-definition cameras and the organs are manipulated with micro-instruments. With the hands of the surgeon away from the patient’s body, surgical trauma is reduced, and outcomes are undeniably better with fewer surgical site infections [1, 2], less pain and fewer hernias [3], and improved cosmetic outcome. However, MIES is not straightforward, and the surgeon is faced with some totally new challenges [4] for (1) reduced depth perception due to the 2D vision offered by the flat screen, (2) loss of haptic proprioception due to hand-eye disconnection, (3) limited field of view, and (4) reduced tactile sensation which is possible with laparoscopic instruments. Robotic science offers specific innovations to facilitate MIES. The da Vinci® system (Surgical Intuitive) is a commercial surgical robotic platform equipped with a binocular camera that provides a stereoscopic, tenfold magnified, and high-resolution view. It also offers a haptic interface, which allows the surgeon
K.C. Kim (ed.
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