Page 442 - Biomedical Engineering and Design Handbook Volume 2, Applications

420 SURGERY

14.4.3 Robotic Systems for Human Augmentation
The emphasis in surgical assistant robots is the use of these systems cooperatively to enhance
human performance or efficiency in surgery. Much of the past and current work on surgical
augmentation 67,70,73,121–125 has focused on teleoperation. There is considerable interest in the use of
master-slave manipulator systems to improve the ergonomic aspects of laparoscopic surgery. Figure 14.22
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shows a typical example (the Da Vinci system 122 marketed by Intuitive Surgical). In this case, three
slave robots are used. One holds an endoscopic camera and two others manipulate surgical instru-
ments. In the case of the Da Vinci, the surgical instruments have high dexterity wrists, as shown in
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Fig. 14.22b Other systems with varying degrees of complexity (e.g., the Zeus system marketed by
Computer Motion) are also in use, and this area of application may be expected to grow in the future.
Although the primary impact of teleoperated robots in surgical applications over the next years
will probably be in applications in which the surgeon remains close to the patient, there has also been
considerable interest in remote telesurgery. 70,126,127 In addition to the design issues associated with
local telesurgery, these systems must cope with the effects of communication delays and possible
interruptions on overall performance.
The manipulation limitations imposed by human hand tremor and limited ability to feel and con-
trol very small forces, together with the limitations of operating microscopes have led a number of
groups to investigate robotic augmentation of microsurgery. Several systems have been developed
for teleoperated microsurgery using a passive input device for operator control. Guerrouad and
Vidal 128 describe a system designed for ocular vitrectomy in which a mechanical manipulator was
constructed of curved tracks to maintain a fixed center of rotation. A similar micromanipulator 129
was used for acquiring physiological measurements in the eye using an electrode. While rigid
mechanical constraints were suitable for the particular applications in which they were used, the
design is not flexible enough for general-purpose microsurgery and the tracks take up a great deal of
space around the head. An ophthalmic surgery manipulator built by Jensen et al. 130 was designed for
retinal vascular microsurgery and was capable of positioning instruments at the surface of the retina
with submicrometer precision. While a useful experimental device, this system did not have suffi-
cient range of motion to be useful for general-purpose microsurgery. Also, the lack of force sensing
prevented the investigation of force/haptic interfaces in the performance of microsurgical tasks.

A B
FIGURE 14.22 Telesurgical augmentation system: In this “telepresence” system the surgeon sits at a control console [(a) foreground] and
manipulates a pair of “master” robot arms while “slave” robots [(a) background and (b)] mimic his motions inside the patient’s body. 122
(Photos courtesy Intuitive Surgical Systems.)