Robotics in thoracic surgery 1: Pulmonary and mediastinal disease

While robotics and automation have been used in science and industry for over three decades, there have been few applications of this technology within the medical field. Two major forces have resulted in the application of robotics in medicine: (1) the quest of the military to provide remote expert surgery by means of robots in the field, and (2) the shortcomings of video-endoscopic techniques of the 1980s and 1990s when applied to more complex surgical procedures. Both instances have required better binocular visualization coupled with enhanced dexterity and remote instrument manipulation. While a number of surgical robotic systems have been proposed, the first practical surgical robot was the Green Telepresence Surgery System. This system was designed to restore to the surgeon the native and intuitive abilities that were lost with laparoscopic and thoracoscopic surgery: 3D visualization, dexterous precise surgical instrument manipulation, and the sense of touch from input of force feedback sensory manipulation. Furthermore, this system was designed to provide the expertise of a surgeon anywhere worldwide through telesurgery. The significant features of the Green Telepresence Surgery System were incorporated into the da Vinci surgical robot. The da Vinci system (Intuitive Surgical, Mountain View, CA) consists of three main components: (1) the surgical console with two master controls and an integrated 3D display stereo viewer, (2) the surgical cart with a camera arm and up to three instrument arms, and (3) the vision cart, which contains camera and image processing equipment (Figure 11.1). While seated at the surgical console, the surgeon operates by placing his or her fingers in the masters and moving them within the console. The instruments within the surgical field are aligned with the masters. There is natural and predictable instrument movement within the operative field. The relationship of the masters to the instruments within the surgical field coupled with 3D visualization ensures hand–eye coordination and orientation as well as natural operative feel found in open surgery. The 3D visualization is provided by a stereo viewer that is provided for the surgeon's head. Open surgery techniques that are employed by the surgeon's hands are instantly converted into minimally invasive surgical movements at the surgical site.