Minimally invasive surgery has played an important role in urologic surgery, with the widespread and frequent application of extracorporeal (shockwave lithotripsy), endoscopic, and laparoscopic techniques. Over the past decade, the introduction of robotic assistance has significantly altered the landscape of laparoscopic surgery in urology and will likely continue to play an important role in the future.
Despite the variety and complexity of operations achievable with traditional laparoscopy, major limitations included the two-dimensional vision and instrumentation with restricted degrees of freedom as well as reduced tactile feedback (haptics). Thus, initial efforts were limited to extirpative or ablative procedures, while technically demanding reconstruction requiring suturing and intracorporeal knot tying was limited primarily to highly experienced or specialized surgeons.
The concept of having an apparatus to aid or augment what is possible with the human hand is not new. The term robot is derived from the Czech word robota, meaning “work” or “forced labor,” and was introduced by the writer Karel Capek. Isaac Asimov coined the term robotics, although the definition of a robot is quite varied. Critical elements of a robot include programmability, flexibility, and ability to interact with the environment. Thus, most robots are computerized systems with mechanical capabilities.
With respect to surgical robots, there are those that are shared control (robot is primarily an assistant, such as a camera holder), telesurgically controlled, and supervisor-controlled. The first robot utilized in urology was the PROBOT, an example of the last type where the robot performed transurethral resection of the prostate based on directions programmed into the controlling computer. The currently used robots are telesurgical primary—secondary systems, wherein the surgeon controls the robotic arms during the procedure from a remote console and the robot is merely an instrument; thus, given the lack of automation, procedures performed with these machines may be better categorized as robotic-assisted surgery.
Computer Motion Inc. developed both AESOP (automated endoscopic system for optional positioning), which controlled the endoscope using either voice or hand/foot control, and the ZEUS surgical system, consisting of three robotic arms attached to the operating table controlled remotely by the surgeon. In 2003, the company was acquired by Intuitive Surgical Inc., which was founded in 1995 and had developed the da Vinci surgical system, composed of a surgeon console, video tower and computer, and patient-side cart with three or four robotic arms.
Figure 11–1 shows the da Vinci system. It is currently the most widely utilized surgical robot with approximately 5000 units in operation worldwide. The surgeon sits at the console, where an immersive, three-dimensional view of the surgical field is provided. Control of the instruments is achieved via free-moving finger controls, which translate the physical motion of the fingers and wrists into electrical signals and computerized such that the robotic arms mirror these movements ...