|
Minimally invasive spine surgery
has recently been advanced with the use of endoscopes, improvements
in camera equipment and advances in medical robotics. The
advantages to the patient are less pain, smaller incisions,
fewer complications and a more rapid return to normal activity
when compared to conventional surgery. Surgeons are now
able to remove a ruptured disc using a small endoscope,
repair a painful disc using electro thermal energy and fuse
a painful degenerated disc with the aid of a miniature camera
and incisions no larger than ½ inch. Robotics and computers
are now playing an expanding role in assisting the surgeon
in these minimally invasive procedures.
The idea of robotics in surgery
got its start in the military. The idea was to develop technology
where a surgeon could perform an operation from a remote
location on an injured soldier in the battlefield. This
concept has evolved into robotics to enhance surgical performance.
In this instance, a robotic arm called Endowrist performs
the procedure with the surgeon guiding the robotic arm from
a location in or adjacent to the operating room. The surgeon
sits at a station peering at a monitor that shows a magnified
view of the surgical field. A computer mimics and enhances
his hand movements. The computer in this instance makes
the movements more precise by dampening even a tiny tremor
in the surgeon's hands, which might increase the difficulty
in performing procedures under high power microscopic magnification.
Examples of such procedures
now being performed that were extremely difficult if not
impossible before this technology are fallopian tube repair
in women, microsurgery on the fetus, and minimally invasive
coronary bypass surgery. The Zeus robot made by Computer
Motion and a similar device, the Endowrist made by Intuitive
Surgical are now in clinical trials for the above-mentioned
procedures. Even with the robot to enhance the surgeon's
ability, a great deal of practice is required to master
the technique.
Robots are also used to help
in performing tasks, which are either boring or fatiguing
for humans. This idea formed the basis to develop Aesop,
a voice-activated robotic arm that holds the camera and
endoscope assembly for the surgeon during an endoscopic
procedure. Not only does this reduce the need for a person
to be required to do this task, but in most instances Aesop
does a better job by moving precisely where the surgeon
commands the robot, providing a rock-steady image and never
fatiguing. To do all this, the surgeon must first make a
voice card of all the commands so that the robot can recognize
the command with minimal chance of error in interpretation
of the voice signal. Once this is done the surgeon must
repeat the command in a similar speaking voice. If the surgeon's
voice raises or becomes angry, the robot usually stops responding.
One might think that in this instance the robot is acting
to program the surgeons' behavior.
 |
| |
Aesop
is a voice -activated robotic arm that holds
the camera and endoscope assembly for the
surgeon during an endoscopic procedure.
|
|
|
Hermes, or Voice Activated
Operating Room, allows the surgeon to command adjustments
in the camera such as light intensity, raising and lowering
the operating table, turning power sources on and off and
even making an outside phone call when consultation is needed.
In the very near future it is expected that the patients'
diagnostic studies such as MRI and CAT scans will be transmitted
to a flat panel monitor in the operating room for the surgeon
to review during the procedure.
|
|
|
Hermes,
or Voice Activated Operating Room, allows the surgeon
to command adjustments in the camera such as light
intensity, raising and lowering the operating table,
turning power sources on and off and even making an
outside phone call when consultation is needed.
|
Computers are also being used
in image guidance systems to give the surgeon real time
images and allow him to navigate to the specific location
on the spine. The surgeon can use digital information obtained
before surgery such as MRI or CAT scans or use real time
fluoroscopic x-rays to develop a three dimensional image
of the spine with the exact location of a probe placed on
the spine. This technology has been shown to minimize errors
in placement of pedicle screws that are sometimes used to
fix the spine. It is also expected that this technology
will expand to allow more precise targeting of the problem
with minimal incisions and fewer surgical complications.
The use of robotics and computers
in minimally invasive spine surgery has resulted in more
accurate surgical procedures, shortened operative time and
fewer complications. It is expected that Computer Enhanced
Image Guidance Systems will improve the precision of these
procedures as a result of real time 3-D imaging at the time
of the surgery. Diagnostic studies will be digitally transmitted
to the operating room and projected to monitors to further
aid the surgeon in performing the correct procedure with
minimal trauma to the patient.
One vivid image we have of
computers and artificial intelligence comes from the computer
Hal in 2001, A Space Odyssey. We can't resist thinking of
robots as possessing human qualities. In fact, the Aesop
robot has been programmed to give the surgeon a compliment.
When the surgeon feels he or she has done a good job, the
surgeon voices the command "compliment" at the end of the
surgical procedure. Aesop will then respond, "You are a
great surgeon". Even robots know that compliments go a long
way.
|
