is a surgical approach in which long-shafted instruments are inserted through
small incisions to access targeted anatomy. Compared with traditional open
procedures, laparoscopy has revolutionized surgical treatment by shortening
recovery time with less pain and fewer adhesions, resulting in better post-operative
quality of life. However, manual laparoscopy has several limitations, including
lack of depth perception, poor camera control, limited degrees of freedom for
the instrument tips, and inverted hand-instrument movements. These limitations
lead to unnatural and painful surgical postures that result in surgeon fatigue.
Robotic-assisted laparoscopy, such as the da Vinci system, allows the surgeon to
sit at a stereo console and remotely control endoscopic instruments via a patient-side
robot. The da Vinci system consists of three components: the surgeon console, a
patient-side cart that holds the instruments, and the image processing
equipment. The system's 3-D visualization provides depth perception, and the
wrist-like articulations of the miniaturized instruments improve surgeons'
dexterity and range-of-motion. The system also improves control by reducing
hand tremor and providing motion scaling. The ergonomic instrument-hand-eye
alignment and intuitive instrument movement can also reduce surgeon training
time in comparison to using manual laparoscopy.
The da Vinci
system is based on foundational robotic surgery
technology developed at SRI (formerly known as Stanford Research Institute). Intuitive Surgical
relationships with IBM, Massachusetts Institute of Technology, and Heartport
Inc. to further develop the system. The FDA has cleared the da Vinci for a range
of general, thoracic, urological, gynecological, head and neck, and cardiac
procedures in both adults and children.
da Vinci Explained
Vinci system requires up to five small (<1 cm) incisions for insertion of
the two surgical manipulators and a camera. The da Vinci patient-side cart
holds the instruments docked to the patient as surgical assistants stand over
the patient. Meanwhile, the surgeon can operate the system while seated across
the room at the console, where the look and feel of the open surgery is replicated.
The surgeon performs movements using masters (which help translate surgery
motions). The surgeon's fingers grasp the master controls below the display
with wrists naturally positioned relative to his or her eyes. The surgeon's
movements are then translated into precise, real-time robotic movements inside
robotic masters are controlled by the surgeon through wrist, hand and finger movements,
just as with a typical open surgery. A full range of optional EndoWrist
Instruments are also provided for the system. These instruments are designed
with seven degrees of motion that exceed the dexterity of the human wrist. Each
instrument has a specific surgical mission such as clamping, suturing and
patient-side cart houses the two robotic arms and one endoscope arm, which
duplicate the surgeon's movements. The laparoscopic arms pivot at the operating
port, eliminating the use of the patient's body wall for leverage, thus
minimizing tissue and nerve damage. Supporting surgical team members install
the correct instruments, prepare the port in the patient, and supervise the
laparoscopic arms and tools being used.
The da Vinci surgical system incorporates
high-end motion control technologies so that every motion provides the smooth,
accurate movements reminiscent of a skilled surgeon - even at slow, calculated
speeds. Each da Vinci S HD System contains more than 30 motors manufactured by Maxon Precision Motors
. These motors
are located at the heart of each manipulator.
Maxon motors provide the inputs and outputs to the da Vinci System. Through a series of feedback controls, the
motors and encoders receive inputs from the surgeon, are translated in
real-time through the console electronics, and provide output signals to the
motors in the manipulators. In turn, the manipulators exert forces back through
the console electronics to the surgeon's hands.
motors are designed with rare earth magnets in their stators and incorporate an
ironless rotor design that eliminates magnetic cogging, even at slow operating
side cart employs motors referred to as masters to distinguish their dual role.
The slave side, or manipulator motors, require the same precision, but also
need to be able to be backdriven while an assistant surgeon moves the end
effectors into position. The motors exhibit low hysteresis at the instrument
the more than 30 motors used by Intuitive's engineers in the da Vinci system,
are the RE 25 motor, some with and some without encoder feedback; RE 13 mm
motors equipped with GP 13 series gearheads and 13 mm magnetic encoders; and RE
35 series motors with third-party encoders.
motors are key to each da Vinci system critical performance characteristic
tests, including friction, backlash and compliance profiles, as well as a range
of sensor feedback monitoring, says Mike Prindiville, manager, manufacturing engineering
for Intuitive Surgical.
Although the prevalence of robotic-assisted,
minimally invasive surgery has increased tremendously, training opportunities remain
relatively limited. Because comprehensive practice and experience is necessary
in order to develop proficiency with a sophisticated tool such as the da Vinci system, the development of training
aids for robotic surgery is critical in helping meet the demand for this technique.
At the Nebraska Biomechanics Core
Facility in the HPER Biomechanics Lab. at the University of Nebraska at Omaha,
a group of Ph.D. students work with the Robotic Surgical Lab. at the
university's medical center to develop a computer training program for robotic
surgery where new surgeons can learn how to use this advanced technology.
Two training platforms have been developed with National
LabVIEW graphical programming software. The first is designed
for monitoring and recording a surgeon's performance during a training program
and ensuring that the surgery is performed using the correct movements. This
training platform also incorporates visual real-time feedback to show trainees
how much force they apply on the training task or animate tissue. This visual
feedback helps trainees reduce tissue damage inflicted during the procedure.
LabVIEW was also used to create a
working environment for robotic surgery training in virtual reality. This
second training platform offers flexibility to conduct research by collecting
data and adjusting training tasks in the virtual simulator via Ethernet.
Virtual robotic surgical training allows multiple surgeons to train
simultaneously using software instead of actual medical equipment. This process
provides problem-based training protocols for new surgeons to learn robotic
All of the data communications on
the da Vinci robotic surgical system is acquired via TCP/IP using NI's USB-6009
data acquisition board to connect to the electromyography system and
electrogoniometers. These connections acquire physiological measurements, such
as muscle activations and joint angles, from the surgeons. Using this data,
researchers and medical personnel can objectively evaluate surgical proficiency
before and after the robotic surgical training protocol.