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Robotics in General SurgeryDAVID M BROWN, MDGENERAL SURGERYDIRECTOR OF ROBOTIC SURGERYCOLUMBIA SURGICAL SPECIALISTS
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Dessert Menu
► Robot vs Laparoscopy► Telesurgery Concept► Early Development to Maturity► Case Videos► What’s next…
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Robotic Discussion Point
► Does this greater technology create advantages that are worth the greater
cost?
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Robot vs Laparoscopic Technology
► Instruments ► Camera► Surgeon Control
► Lack of Bedside Operator ► Lack of tactile feedback
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7 degrees of freedom
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Ergonomics
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Ergonomics
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Conceptualization
Dr. Fisher circa 1987
Dr. Browncirca 2018
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Birth of Robotic Surgery
► SRI International and DARPA
► Battlefield application► MEDFAST
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SRI: Green Telepresence Surgery System
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Computer Motion
► Worked with NASA► AESOP, ‘92
► Automated Endoscopic System for Optimal Positioning
► Voice controlled
► First FDA approved surgical robot
► ZEUS, ‘96
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Truly Remote Surgery
► “The Lindbergh” Surgery► 68F, Cholecystectomy
► ZEUS system
► 9/7/01
► NY to France
► $
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Intuitive
► Lenny► Extension of SRI technology
► Mona, ’97► First to have interchangeable sterile instruments
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► First Robotic Surgery► Dr. Jaques Himpens, MD
► Belgium, 3/3/97
► Cholecystectomy
► Publication refused
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da Vinci
► Stand-alone cart► No more stylish glasses► Dual camera endoscope► New master manipulators
► FDA approval► ’97-visualization/retraction► ‘00- full instrumentation
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Merger of Competitors
► 2003► Lawsuits of patents in US and
Europe► ZEUS phased out
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Evolution of Da Vinci System
1999 January 2006 April 2014 May 2017 May 2018April 2009
OS2Da Vinci S®
OS4Da Vinci Xi®
OS4Da Vinci X®
OS4Da Vinci SP®*
OS3Da Vinci Si®
OS1Da Vinci®
Operating System
Network
Analytics
Platform Integration
Simulator
Advanced vision
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Dual Console
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No Hard Feelings
► Haptic feedback not utilized currently ► PHANToM
► MIT
► Force Feedback to Surgeon
► “visual force feedback”
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Case Videos*
► Hernias, Gallbladders, and Colons
► *Videos not presented at actual speed…unfortunately
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Epigastric Hernia with Mesh
► 2min video
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Hernias in Hernias
► 2:07 min video
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Hernias Closure with Mesh
► 1:40 min video
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Bilateral Inguinal Hernias
► 2:53 min video
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Completion Cholecystectomy
► 2:14min video
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Right Colectomy with Anastomosis
► 3:27 min video
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Where To Go From Here
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da Vinci Systems Installed
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Return of Competition
► Senhance Surgical Robot System► Force feedback
► Eye-tracking
► Virtual Incision► 2 pound robot
► Operates entirely within the body
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Questions/Discussion