Page 19 - Swsthya Winter Edition Vol 1 Issu 3 DEC 2020 Circulation copy BP

SURGERY
Role of Robotics

in urology

Rohit Bhattar 1
Thiagrajan Nambirajan 2

1 Robotic Urology fellow, Wirral University teaching hospital
2 Consultant urologist, Wirral University teaching hospital
Introduction:

Leonardo da Vinci is credited for the first drawn ‘humanoid
robot’, known as Leonardo’s Robot in 1495. This robot could
do a number of activities and it was operated by pulleys
(1)
and cables . The term ‘robot’ comes from the Czech word and tremor-filtering ability. The robotic systems have better
‘robota’, which translates as ‘forced work’. It was introduced ergonomic control with less surgeon fatigue and strain along
in 1920 by the Czech playwright; novelist and journalist with stereo-optic vision and a three-dimensional image and
(2)
Karel Capek in his hit play Rossum’s Universal Robots .
are undeniably appropriate for surgeries in constrained
spaces, for example, prostatectomies (1-6) .
The first digitally programmed robot, the Unimate, was
installed in New Jersey, in 1961 which worked on a General Paediatric urologic surgeries and female urology have also
motor assembly line. Since then, Robots have been used noticed an increased adoption of robotic applications. In
in various industries such as manufacturing, packing, this article, we will endeavour to cover robotic surgical
transport, space programs, laboratory research, surgery etc. applications in urology and ongoing advances in these
By definition, a surgical robot has an artificial sensing that strategies.
is manipulated and controlled by computer which can be
reprogrammed to carry out a wide range of surgical tasks.
Robotic platforms:
The field of urology has become progressively innovation
driven and in this way has been on the cutting edge of careful (A) Da Vinci Robotic system:
advanced mechanics (3) . Modern robotic surgical systems
can be categorized as master-slave systems, precise-path It is the most popular commercial robotic system. It has
systems, or intern-replacement systems. On-line robotic three components namely surgeon console, patient cart
systems, also known as Master slave systems, the most with robotic arms and vision cart. The first da Vinci system
recognizable sort, were created from starting examinations was launched in 1999. A fourth instrument arm was added
in "telepresence" medical procedure financed by the US in 2003. In 2006, the da Vinci S version, offering the high-
Department of Defence. Urology has grasped the utilization definition vision to surgeons, was released. The da Vinci
of robotic surgical systems in a developing number of clinical Si model was introduced in 2009 with an isocyanine
applications, which were intended to recreate the surgeon’s green fluorescence (Fire-FlyTM technology) and finger-
(7)
(4)
movements continuously inside the operated field . Year based clutch mechanism . Dual console of the da Vinci Si
(8,9)
1985 has witnessed the first recorded use of a robot-assisted representing an ideal training platform during surgery .
surgical procedure when the PUMA 560 robotic surgical A new model of da Vinci named Xi was brought to market
arm was used in a neurosurgical biopsy (5) . Since then, in 2014 with a peculiar feature of 8 mm camera that can be
the most commonly utilized robotic gadget is the da Vinci used at any of the four ports (camera hopping). Along with
which was release in 1997 and approved by Food and Drug this table motion technology (surgical table can be moved
Administration (FDA) in July 2000. This robot comprises without undocking the robotic arms) is also a part of this
(9)
of three or four arms, one of which is utilized to hold and new robotic version .
control the laparoscopic camera while the others are utilized
to control specific laparoscopic instruments with endo-wrist (B) CMR
(6)
innovation that permits 7 degrees of movement .
CMR Surgical is a Cambridge based British medical
Since its introduction into surgical practice, Robot has technology company that produces a robotic surgery system
become an integral part of urological practice. Subsequently, called Versius. It was known as Cambridge Medical Robotics
(10)
Robotics has been used to perform various urologic but changed its name to CMR Surgical in March 2018 .
procedures including radical prostatectomies, cystectomies, On 30 september 2020, CMR Surgical has announced the
nephrectomies, adrenalectomies and pelvic floor procedures. introduction of Versius, at the Frimley Health, first hospital
Like all advances there is a trade-off between the advantages of UK to use Versius in Urology, as well as in Colorectal
(11)
and downsides. General drawbacks include the high costs surgery . CMR Surgical claims Versius to be more flexible
and lack of haptic feedback. and versatile, having independent modular arms which
(12)
On the other hand, most eminent benefits are the manual are "quick and easy to set up" . However, well designed
dexterity of the instruments alongside movement scaling randomised trials are still needed to compare this robotic
system with the gold standard da Vinci system.
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