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da Vinci Surgical System from Intuitive Surgical

Ever been operated on by a robot? Intuitive Surgical’s da Vinci surgical system isn’t autonomous by any means, but the surgeon certainly isn’t holding the scalpel in his or her hand.

This coming Tuesday (February 12) at 6:00PM EST on www.OR-Live.com Christine McCarty, MD, chair of cardiac surgery at PinnacleHealth, will perform minimally invasive double vessel bypass surgery on a beating human heart shown using this robotic system on a live webcast. (webcast link)

The da Vinci system has electromechanical arms for holding a dual lens, dual 3-CCD sensor camera (for depth perception), and all the tools required for surgery from Intuitive Surgical (most called EndoWrist Instruments) including scalpels, needle holders, scissors, graspers, cauterization tools and other instruments. Although the specifics are not detailed, each arm sends force feedback to the controls and the camera produces what Intuitive Surgical calls a 3D image.

I’ve seen laparoscopic knee surgery performed first-hand in the OR and watched the surgeon and surgical nurse hand-off instruments to each other throughout the procedure and look across the patient to the TV screen. The specific tools explained to me at the time were the camera, irrigation and cutting/suction tool. There was very little blood and required very few stitches to close up each small incision.

The da Vinci website lists that the robotic system provides a surgeon with better visualization, dexterity, precision and control than traditional minimally invasive procedure. The surgeon can sit while looking through the 3D image display directly in front of him with his arms straight forward. I would also imagine that the static hold of a robotic arm would greatly reduce fatigue on the surgeon’s hands.

The benefits of the surgeon are important, but hospitals won’t purchase the equipment unless patients create a demand. The draw for patients are even smaller than previous laparoscopic surgery techniques, leading to (hopefully) less pain, scarring, blood loss which implies a shorter hospital stay and a faster recovery to normalcy. The separate da Vinci surgery website gives compelling testimonials and diagrams.

The system has up to four electromechanical arms to hold up to four swappable instruments, allowing what Intuitive Surgical calls Solo Surgery. The term Solo Surgery may suggest that telesurgery, or long distance surgery may be possible. However, Intuitive Surgical states that although the system is theoretically capable of long distance surgery, it is not the focus of the company and is not currently available.

This product takes into consideration all the users of the product — the surgeon, patient, nurses, and many others — to try to improve the quality of life. The device is a highly mechanical, electrical and software driven device that also hopefully incorporates design and usability, suiting the needs of the users. The da Vinci Surgical System is at the crosshairs of mechatronics.

I remember thinking in my childhood about whether someday robots would do our jobs better than we can. Intuitive Surgical insists that the robot is an increased precision device directly controlled by the surgeon’s own touch and that scripts or any automation is not utilized. In the future, I think this will change. For example, one thing that comes to mind is a robot that performs a perfect stitch of correct tightness — possibly leading to less tissue damage by avoiding strangulating tissue when sutures are too tight.

I wonder when a surgical procedure will be on an equivalent of the TV show How It’s Made.