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Robotic Surgery

The history of robotics in surgery begins with the Puma 560, a robot used in 1985 by Kwoh et al to perform neurosurgical biopsies with greater precision.6,11 Three years later, Davies et al performed a transurethral resection of the prostate (TURP) using the Puma 560.12 This system eventually led to the development of PROBOT, a robot designed specifically for transurethral resection of the prostate. The Probot was first used for TURP by Dr. Wickham and group in 1988 at Guy’s Hospital London. The system consists of on-line imaging and three dimensional prostate model construction and a surgeon computer interphase with a counterbalanced mounting frame which is linked to a computer controlled robot.

While PROBOT was being developed, Integrated Surgical Supplies Ltd. of Sacramento, CA, was developing ROBODOC, a robotic system designed to machine the femur with greater precision in hip replacement surgeries.1 ROBODOC was the first surgical robot approved by the FDA. In 1992, the first robotic hip replacement was performed in Germany at Trauma Hospital, Hamburg. They reported performing 143 hip replacements using the RoboDoc in 2007.The University of Lausanne, Switzerland developed the Minerva robot for neurosurgery, and was the first system to provide image guidance in real-time. This allowed the surgeon to change trajectory as the brain moved thus, resulting in frameless stereotaxy.

Also in the mid-to-late 1980’s a group of researchers at the National Air and Space Administration (NASA) Ames Research Center working on virtual reality became interested in using this information to develop telepresence surgery.1 This concept of telesurgery became one of the main driving forces behind the development of surgical robots. In the early 1990’s, several of the scientists from the NASA-Ames team joined the Stanford Research Institute (SRI). Working with SRI’s other robotocists and virtual reality experts, these scientists developed a dexterous telemanipulator for hand surgery. One of their main design goals was to give the surgeon the sense of operating directly on the patient rather than from across the room. While these robots were being developed, general surgeons and endoscopists joined the development team and realized the potential these systems had in ameliorating the limitations of conventional laparoscopic surgery.

The US Army noticed the work of SRI, and it became interested in the possibility of decreasing wartime mortality by “bringing the surgeon to the wounded soldier—through telepresence.”1 With funding from the US Army, a system was devised whereby a wounded soldier could be loaded into a vehicle with robotic surgical equipment and be operated on remotely by a surgeon at a nearby Mobile Advanced Surgical Hospital (MASH). This system, it was hoped, would decrease wartime mortality by preventing wounded soldiers from exsanguinating before they reached the hospital. This system has been successfully demonstrated on animal models but has not yet been tested or implemented for actual battlefield casualty care.

Several of the surgeons and engineers working on surgical robotic systems for the Army eventually formed commercial ventures that lead to the introduction of robotics to the civilian surgical community.1 Notably, Computer Motion, Inc. of Santa Barbara, CA, used seed money provided by the Army to develop the Automated Endoscopic System for Optimal Positioning (AESOP), a robotic arm controlled by the surgeon’s voice commands to manipulate an endoscopic camera. Shortly after AESOP was marketed, Integrated Surgical Systems (now Intuitive Surgical) of Mountain View, CA, licensed the SRI Green Telepresence Surgery system. This system underwent extensive redesign and was reintroduced as the Da Vinci surgical system. Within a year, Computer Motion put the Zeus system into production. Currently the Da Vinci system is the most popular robotic surgical system used in US hospitals.

At the Center for Reproductive Medicine and Robotic Surgery, Dr. Jacob is involved in research as well as teaching other doctors in this cutting edge technology. He is a national proctor for GYN robotic surgery. In the past 2 years, Dr. Jacob has performed more than 250 robotic cases, of which 50 cases were complex myomectomies with the weight of the fibroids removed being > 250 grams. About 80 cases were resection of advanced stage endometriosis which is a major cause of infertility as well as cause severe pelvic pain, dyspareunia and poor quality of life.

Robotic myomectomy with in-situ “remote morcellation” of fibroids total weight 1300 grams. Patient was a 29 year old female with 32 weeks size uterine fibroids.

Please click the link to see videos of robotic surgery performed by Dr. Jacob

Resection of advanced stage endometriosis using "Fire Fly"

Complex stage 4 Endometriosis surgery

Endometriosis

Complex multiple myomectomies done with robot

Simple myomectomy using the robot

complex hysterectomy with in-situ morcellation of fibroids

Introduction to CRMRS and simple hysterectomy done using Da Vinci robot