Surgery has been around for thousands of years. Ever since man has felt pain, man has looked to surgery for relief. It started as a crude hole in the skull, and has evolved into techniques using lasers and robots. One cutting-edge present technology that this paper will explore is the da Vinci Surgical Robotic System [1], which is being used at Johns Hopkins [2]. This system performs minimally invasive cardiac surgery; it makes the cuts more precise and saves lives. In the future, robotic surgery will become more advanced, as sensory feedback in the da Vinci system could be a future breakthrough that could revolutionize the whole concept of robotic surgery.
We envision an improved da Vinci system, with sensory feedback, very precise laser scalpels, and a fully robotic surgery, which will simply be supervised by the surgeon. This approach would lead to less pain, shorter recovery time and a more precise surgery. The system consists of a surgeon console, a computerized control system, three arms that hold tools (such as scalpels, scissors, or electrocautery instruments), and a fiber optic camera. The surgeon is seated at a set of controls and looks through two eye holes at a 3-D image of the procedure, while maneuvering the arms with two foot pedals and two hand controllers. The console uses the surgeon’s hand motions to move to robotic hands inside the patient’s chest cavity.
While doing this, the camera gets detailed pictures of the heart and the structures of the heart. This surgical procedure has repaired over 300 mitral valves, and over 150 atrial septic defect closures. It is most commonly used for prostatectomies, cardiac valve repair and gynecologic surgical procedures. The director of the Johns Hopkins Cardiac Surgical Research program, Dr. Yuh believes that “ bestowing the sense of touch” to the da Vinci system would help the cardiac surgeons do more safe and effective surgeries.
The da Vinci system uses the amount of pressure that one exerts on the system to more effectively make more precise incisions, and more efficient cuts [2]. However the present technology is quite limited. Modern robotic surgery is still more invasive then we’d like. Also, the FDA has shown discomfort with the da Vinci System [8]. They know that the system will allow the surgeon to operate more precisely, but they’ve shown concern.
They doubt the safety of the system because if something happens and it stops working, there will be a lot of trouble that the surgeon couldn’t fix. However, on July 11, 2000, the FDA officially declared the system safe, and since then hospitals could use the da Vinci system to perform minimally invasive repair surgical procedures. We would want to make it safer for the future. History Surgical procedures were first performed in the Neolithic Age, as early as 8000 BC. It started out as trepanation, the procedure in which a hole is drilled into the skull to relieve pressure on the brain. There were carvings found in Egypt dating back to 2500 BC that describe modern surgical circumcision, castration, lithotomy, and amputation.
There are also Ancient Egyptian medical texts that provide instructions for surgical procedures such as repairing broken bones and mending wounds. In ancient India, the Hindus surgically treated bone fractures and performed the removals of bladder stones, tumors, and infected tonsils. They are also credited with the development of plastic surgery during the 2000s BC. In the 4th century BC, Hippocrates published descriptions of various surgical procedures. Over the next few millennia, more and more research and advancements in surgery were achieved. The French surgeon Guy de Chauliac published Chirurgia Magna (Great Surgery) in 1316, which describes surgeries, including the repair hernias and the treatment of fractures.
Chirurgia Magna is really the text that made surgery become a serious science. There were a great deal of discoveries in surgery in the 16th, 17th, and 18th centuries, many of which was done by Ambroise Pare, a French surgeon now known as the father of modern surgery. Pare started the method of ligating (tying off) arteries to control bleeding, instead of the outdated method of cauterizing (searing) the bleeding part with a red-hot iron. However, most surgery was restricted to procedures that didn’t penetrate deeply into the skin because it caused too much pain to open the abdomen, chest, or skull. In 1846 anesthesia was used by William Morton, a dentist. Morton is credited with the discovery of surgical anesthesia, but Crawford W.
Long used anesthesia in 1842 to remove tumors but didn’t publish his results until 1849. Meanwhile, the ancient Chinese have been using anesthesia 1600 years before the Europeans. Hua Tuo, a famous Chinese physician during the Eastern Han and Three Kingdoms era, was the first person to perform surgery with the aid of anesthesia. Surgeons began performing new types of surgery on the abdomen, brain, and spinal cord in the late 1800s.
Blood groups A, B, and O were discovered by Austrian pathologist Karl Landsteiner which allowed transfusions, and blood banks were started in 1937. There were more technological advances to permit surgeons to perform increasingly complex and difficult operations. The heart-lung machine was developed in 1953 by American surgeon John Gibbon for easier surgery on organs [3]. The operating microscope was developed in the 1950s providing surgeons with a way to perform operations on body structures like the inner ear and the eye, and recently enabling surgeons to reattach the vessels from severed limbs to the body (Microsurgery). The first kidney transplants were performed in the 1950s, and surgery was officially modernized when the first heart transplant was performed by South African physician Christiaan Barnard in 1967. Future Technology Robotic surgery is currently at a very primitive stage.
There is much advancement planned by many scientists and roboticists, and by now it would seem that any boundaries are that of the imagination. In twenty years, surgery will be less invasive, less painful, and more precise. The Robot Assisted Minimally Invasive Cardiac Surgery will be used in more hospitals. The materials for the da Vinci system would be less expensive, so more could be made and sold. The system will also be made more modular.
Robotic research at Johns Hopkins is currently taking place, led by Dr. David Yuh, to develop robotic sensory feedback capabilities, meaning the surgeon manipulating the system would be able to “ feel” the organs, and it would feel more like real surgery. Dr. Yuh thinks that this would allow surgeons to perform delicate operations more safely and efficiently. He is also developing methods for training residents in the use of the da Vinci system with mathematical modeling, which he hopes will lead to improved surgical techniques and trained robotic surgeons.
2] Another thing that would make the surgery more effective would be laser robotic surgery. Laser scalpels, which cut the tissue with laser light energy, are currently being used manually[4]. The da Vinci system with lasers would be very effective and precise, especially with the sensory feedback allowing the surgeon to know exactly what he is doing. The most effective future technology would be the robot performing most of the surgical tasks itself, while a surgeon is merely supervising [5]. Femtosecond laser is a topic that is being researched now, and will be discussed in more detail later.
Perhaps that can be implemented into the da Vinci system. The precision of the laser pulse combined with the dexterity of the robotic arms would create a very non-invasive, effective surgery. These lasers are so precise that they can repair individual cells. This can make some kinds of surgery incredibly precise, so that patients may have less painful and more successful recoveries. [6] The president of Carillion (the first medical center to use robotic surgery) Edward Murphy, said “ This is part of our vision for the region. Investments in technologies such as the da Vinci™ system, and future advances from the Carillion Biomedical Institute will position the Roanoke Valley as a leader in the development of tomorrow’s healthcare technology.
” The system is a huge advancement, but surgeons believe that the technology is still evolving and will become more capable with time. [8] The University of Southern California (USC) is conducting research on robotic surgery. It is developing a Robotic Surgery Institute and Laboratory that will research robotic surgery on all surgical specialties that could benefit like general surgery, pediatrics, urology and orthopedics. Dr. Vaughn Starnes, a physician, said, “ Robotic surgery is going to revolutionize cardiothoracic procedures, and it is exciting that USC has the leading program in Los Angeles for this technology. Robotic surgery truly represents the next advance in heart surgery.
” [5] Breakthroughs Femtosecond laser pulse is a topic that is being researched now. [6] Biomedical applications of low-energy near infrared femtosecond laser pulses are provided by compact, turn-key: sapphire lasers. Applications include ultrahigh resolution optical diagnostics, gene therapy by optical targeted transfection of cells, and ultraprecise laser therapy. Scientists have used the femtosecond laser to selectively disrupt the cytoskeletal network of fixed and live bovine capillary endothelial cell using these laser pulses. This will make cell surgery possible. [9] Femtosecond laser was first used in biology as primarily a tool for imaging.
Nowadays, there is increased usage to manipulate and ablate nanoscale structures in living cells. Femtosecond laser pulses are focused with aperture objectives. Multiphoton absorption can be induced with the laser. This process generates very high concentrations of free electrons in the focal volume, which results in blation of the material. High penetration depth into tissues is possible, because the wavelength of an ultra short laser is near infrared.
The amount of laser radiation that is absorbed in regions outside the focus is insignificant. Some of the things we may do are using the laser to reconstruct damaged cells. [6] Another interesting new breakthrough is the new applications of the da Vinci system robotic surgery. It has just begun to be used in cardiac surgery to make it as least intrusive as possible. This reduces the risks of infections and other complications in the surgery and recovering processes.
Rather than having the surgeon standing at the side of the patient, the surgeon comfortably seats there at the computer, and the movement of the surgeon’s hand is detected and transferred to the motion of robotic “ hands” that does the cutting and sewing. Because the surgeons’ hands aren’t touching the patient, this makes the situation more sterile. Surgeons with less skilled hand motion may do better, because they can control the motion of the robotic more precisely than that of their own hands. Design Process We’ve had many ideas that we rejected many ideas along the way before arriving at our final future technology. We knew that it would be about biology and surgery from the start. We were very interested in biotechnology and advances in medicine.
One of the ideas that we rejected was to use nanobots in nanosurgery. Nanobot are miniature robots that can enter into the bodies of people and execute many tasks. This seemed to a very promising topic at first. There can be robots that enter into the blood stream and aid white blood cells to fight off bacteria and virus.
The nanobots may also deliver medicine to cells and repair damages to specific cells. The nanobots may be equipped to perform surgery on individual cells. They may have tiny lasers that can be used to repair cellular structures. We rejected this idea because we doubt that it would actually get very far in 20 years. Genuine nanobots have not yet been created, but there has been considerable advancement toward their development in recent years.
The nanobots would be too expensive to be used practically. They would not have as much of an impact as surgery on the macro-scale. We also got much more into the da Vinci system. Another idea was a laser that can go through some things but not others. This was a fantasy idea that we had. We wanted a laser that can completely go through the skin without affecting it at all then cut the necessary parts underneath.
We thought this would be a great idea that would dramatically decrease recovery time. However, it doesn’t appear feasible and will break laws of physics. We also had the idea of incorporating Artificial Intelligence into the robotic surgery system. Perhaps there can be a computer program that just does the surgery itself without the supervision of the surgeons. The robots would already be preprogrammed to be able to perform the surgeries by themselves.
This would greatly increase the efficiency of surgeries. Much more people would be able to get low cost surgeries, and the procedure would become a lot faster. However, it was rejected because surgeons are people, and people are much more flexible than a computer program. Any error could occur caused by a glitch in the program. By the time that you turn off the machine to fix it, there may be a critical medical problem.
For this reason it is simply too dangerous to use practically. We rejected this idea because we doubt that it would actually get very far in 20 years. There aren’t any actual working programs yet. A surgeon operating the system is always better than a program mindlessly accomplishing a task. Our final idea is the laser scalpel in da Vinci system.
The laser scalpel is what it sounds like: a scalpel that utilizes laser light to cut through tissues. It is incredibly precise and is already used a lot. This idea wasn’t abandoned; we ended up thinking about the da Vinci system that uses the laser scalpel. We put this idea into our report.
The laser scalpel would be incorporated into the da Vinci system instead of being hand-held to increase accuracy. It is better than the other ideas because it is feasible, interesting, and can improve the surgical process greatly. Unlike the stem cells, there aren’t any controversies about morals. Unlike nanobots and the AI program, this can make a big change in society in 20 years.
The AI program can also involve serious complications. Our fantasy idea just did not work out. So clearly this is the best choice for our group. Consequences The most obvious future consequence of the da Vinci robot system is it will save lives. It’s more dexterous and less invasive than human surgeons. This would allow easier and more successful surgery.
That means surgery would be less painful and the recovery time would be greatly reduced. The constant advancements of the system are making the system better at performing all types of surgery. Soon almost all of the surgeries performed by da Vinci will be successful, and manual surgery will slowly become obsolete. For the most part, with the right advancements and applications of the surgical system, the da Vinci will have very positive consequences in the future of surgery.
There are, however, arguments against the system. Being a robot, it could break down in the middle of a surgery. It’s expensive and not quite as safe as manual surgery. It would take incredible advancements to make the system at all useful, because it needs to be certain that it won’t break down. A human, whom doesn’t break down, is currently more efficient because however dexterous or minimally-invasive the robot is, it won’t be as reliable as the human.
Also the system is hard to control. For a robot, it is very easy to control, but it isn’t nearly as easy as manual surgery. This can be overcome with more training of surgeons in robotic surgery and new technology that can increase the controllability. Another negative consequence of the robot is it will be new to the surgeons. The surgeons who’ve been performing manual surgery for years won’t be ready to use this completely different technique, and if the new surgical interns immediately learn how to use the robot, they won’t be prepared to manually operate when the system isn’t available. However, with the introduction of robotic surgery, the surgeons would be divided into two more groups: “ robot” surgeons and “ manual” surgeons.
With this concept, the “ robot” surgeons would treat the more important cases, and the “ manual” surgeons would treat the smaller cases. These downsides are very small compared to the incredible advantages that the system would have. It could take a few years for the necessary advancement of the system to be made, and once it’s done the system could perform miracles in surgery that the manual surgeons could never perform. It’s already performed numerous successful prostatectomies, gastric bypasses, and other complex surgery procedures, and could get to the point where every surgery is successful.
With this kind of surgical advancements, it would be hard for the hospitals to say no to the system. Surgery has come a long way from its crude beginnings. There was much advancement in the past centuries. In the next twenty years, we plan to develop surgery further in order to make it less invasive. That means it would be less painful and the recovery time would be greatly reduced.
We decided to combine the best of the present technologies to make something that would improve the lives of many people tremendously in the next twenty years. We decided to incorporate the laser scalpel into the da Vinci robotic surgery system. This would make the jobs of surgeons a lot easier and less tiring. That means they can concentrate and think more clearly while operating on the patient, decreasing the chances of medical malpractice.
With the surgery being more efficient and precise, the recovery time of the patients would decrease. Not only is this more comfortable for the patients, but this also means that the hospital would have more room to accept other patients. With high production rate, more people can get the medical treatment they need at a cheaper cost. This technology is good for everyone, both the patients and the doctors. With so many great benefits, the da Vinci system with laser scalpel is certainly something we should work to get in every hospital in the future. This proposal will change surgery because of its non-invasiveness, dexterity and natures in improvement.
What we have proposed is perfectly feasible, and we think that by the year 2028, these ideas could easily become common practice. Bibliography 1. Da Vinci Surgery – Minimally invasive robotic surgery with the da Vinci Surgical System. http://davincisurgery. com/index.
aspx? id= it&gclid= CIHntceDqJACFRGCGgodCGVl8w. 2. ROBOT-ASSISTED MINIMALLY-INVASIVE CARDIAC SURGERY AT JOHNS HOPKINS HOSPITAL. http://www. hopkinsmedicine.
org/CardiacSurgery/PatientCare/robot. html. 3. History of Surgery. http://www.
medicalbooks. com/skin-surgery. html. 4.
Laser Scalpel – TIME. 1973. http://www. time. com/time/magazine/article /0, 9171, 904021, 00. html.
5. University of Southern California Cardiothoracic Surgery. http://www. cts. usc. edu/rsi-future.
html. 6. Garcia, Martin; Romero, Aldo; Jeschke, Harald. 2005. Nanosurgery in Carbon Nanotubes: Efficient Elimination of Pentagon-Heptagon Defects Using Femtosecond Laser Pulses.
ttp://adsabs. harvard. edu/abs/2005APS.. MARW27008G. 7.
Robotic Surgery. Carillion. 2006. http://www.
carilion. com/Community/SitePage /SitePage. asp? App= SitePages&docid= 18E9EB61EBE44F5CA9EF74950FE50F6D. 8.
FDA. Computer-Assisted Surgery: an update. 2005. http://www. fda.
gov/fdac/features /2005/405_computer. html. 9. Nanosurgery in live cells using ultrashort laser pulses. A.
Heisterkampa et al. 2005. http://spie. org/x648. xml? product_id= 590467. 10.
Nano Surgery. Purity Medical Products. http://www. puritymedicalproducts.
com/nano-surgery. htm.
