Robotics in General Surgery€¦ · Robot vs Laparoscopy ... Ergonomics . Ergonomics. Conceptualization Dr. Fisher circa 1987 Dr. Brown circa 2018. Birth of Robotic Surgery ... Evolution

Robotics in General SurgeryDAVID M BROWN, MDGENERAL SURGERYDIRECTOR OF ROBOTIC SURGERYCOLUMBIA SURGICAL SPECIALISTS

Dessert Menu

► Robot vs Laparoscopy► Telesurgery Concept► Early Development to Maturity► Case Videos► What’s next…

Robotic Discussion Point

► Does this greater technology create advantages that are worth the greater

cost?

Robot vs Laparoscopic Technology

► Instruments ► Camera► Surgeon Control

► Lack of Bedside Operator ► Lack of tactile feedback

7 degrees of freedom

Ergonomics

Ergonomics

Conceptualization

Dr. Fisher circa 1987

Dr. Browncirca 2018

Birth of Robotic Surgery

► SRI International and DARPA

► Battlefield application► MEDFAST

SRI: Green Telepresence Surgery System

Computer Motion

► Worked with NASA► AESOP, ‘92

► Automated Endoscopic System for Optimal Positioning

► Voice controlled

► First FDA approved surgical robot

► ZEUS, ‘96

Truly Remote Surgery

► “The Lindbergh” Surgery► 68F, Cholecystectomy

► ZEUS system

► 9/7/01

► NY to France

► $

Intuitive

► Lenny► Extension of SRI technology

► Mona, ’97► First to have interchangeable sterile instruments

► First Robotic Surgery► Dr. Jaques Himpens, MD

► Belgium, 3/3/97

► Cholecystectomy

► Publication refused

da Vinci

► Stand-alone cart► No more stylish glasses► Dual camera endoscope► New master manipulators

► FDA approval► ’97-visualization/retraction► ‘00- full instrumentation

Merger of Competitors

► 2003► Lawsuits of patents in US and

Europe► ZEUS phased out

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

Dual Console

No Hard Feelings

► Haptic feedback not utilized currently ► PHANToM

► MIT

► Force Feedback to Surgeon

► “visual force feedback”

Case Videos*

► Hernias, Gallbladders, and Colons

► *Videos not presented at actual speed…unfortunately

Epigastric Hernia with Mesh

► 2min video

Hernias in Hernias

► 2:07 min video

Hernias Closure with Mesh

► 1:40 min video

Bilateral Inguinal Hernias

► 2:53 min video

Completion Cholecystectomy

► 2:14min video

Right Colectomy with Anastomosis

► 3:27 min video

Where To Go From Here

da Vinci Systems Installed

Return of Competition

► Senhance Surgical Robot System► Force feedback

► Eye-tracking

► Virtual Incision► 2 pound robot

► Operates entirely within the body

Questions/Discussion