Surgical robots to leave no doubt that future is now in the operating theatre

Brussels 24 May 2000The afternoon session at Health Care 2000 was reserved for a talk on the use of robots in the operating theatre by Dr. Albert Dewint, president of the Flemish Society for Hospital Instrumentation Technicians (VVZ). Dr. Dewint, who also works as a physician at the Academic Hospital St. Jan in Bruges, presented the audience with an overview of the existing potential in surgical robot technology. The robot has left the laboratory and conquered a spot in the operating room, standing next or opposite to the surgeon, or just hanging from the ceiling above the patient body. Serving as a third arm, the robot is able to receive instructions from the surgeon in order to accurately position an instrument. This technological magician even outperforms the human expert in a series of complex actions to remove bone tissue, located via 3D patient image data.

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The very first robots in medical history were applied to introduce a stereotactic frame on the patient's skull, thus enabling the clinical team to place electrodes and to localise the exact position in the brain which needed surgical intervention. In 1905, at the start of the 20th century, the technique is tried out and refined with monkeys, serving as test animals. Only by 1947, this method is used for humans. Dr. Dewint explained how this procedure allows to make accurate X-ray images of the patient's brain. As a result, the surgeon is able to precisely locate the lesion on the image and perform the right measurements. A probe is then placed at the exact spot on the skull in order to enter the brain. Often, auxiliary tools are fixed onto the stereotactic frame. At present, the frame is used with a scanner to store the patient data into the computer. The newest trend consists in working without a frame to locate the points of reference.

Dr. Dewint gave a series of examples where the data processing is performed by the robot which also handles the probe. Minerva, the Swiss robot built in 1993, is able to drill a hole in the patient's skull to insert the probe. Before the robot is starting the surgical actions, the patient is installed into a CT-scanner while wearing a stereotactic frame. The whole procedure is followed via a monitor. Instead, the Neuromate robot is working without the aid of a stereotactic frame. The MKM constitutes yet another example of accurate reference focusing abilities while managing the surgical microscope. Unlike the other models, the SurgiScope robot is operating while hanging above the surgery table.

Currently, there equally exists a stereotactic biopsy table for mammography, featuring a hole in the middle that enables the doctor to examine a woman's breast far more easily because of its pending position. Locating and probing a tumour close to the ribs can be performed without any difficulty. Caspar is a robot specialised in orthopaedic surgery, such as hip prosthesis implants. In the pre-operative planning phase, an image scan is made to determine the right size for the implant design, as well as the exact location for insertion of the three screws. The technique implies the use of a digitising probe in order to sense multiple points on the bony surface of the pelvis. As such, the robot is able to calculate the drilling tracks in the bone, as Dr. Dewint pointed out.

In turn, the AESOP insurgery robot is applied for minimally invasive surgery. Since the surgeon only has a limited overview of the operative field and only two hands to work with, the robot is assisting as a third arm in this type of surgical intervention. The physician can pass his commands to the robot by means of the voice-controlled endoscope positioning system. The Zeus robot, used for minimally invasive cardiology procedures, and the Da Vinci system are both managed from a distance by the surgeon who sits at a control panel in the corner of the operating room. The Zeus system is able to execute the tiniest and most subtle movements, and thus extremely suitable to perform surgery on a beating heart. The speaker smiled as he defied the astonished expression on the faces of the audience. It seems as if the future in surgery already has come indeed.


Leslie Versweyveld

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