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Robotic Surgery
Devices in Surgical
Specialties
João Pádua Manzano
Lydia Masako Ferreira
Editors
Rafael Silva de Araújo
Associate Editor
123
Robotic Surgery Devices in Surgical Specialties
João Pádua Manzano • Lydia Masako Ferreira
Editors
Rafael Silva de Araújo
Associate Editor
Robotic Surgery Devices
in Surgical Specialties
Editors
João Pádua Manzano
Department of Surgery
Universidade Federal de São Paulo
São Paulo, Brazil
Lydia Masako Ferreira
Plastic Surgery Department
Universidade Federal de São Paulo
São Paulo, Brazil
ISBN 978-3-031-35101-3 ISBN 978-3-031-35102-0 (eBook)
https://doi.org/10.1007/978-3-031-35102-0
© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature
Switzerland AG 2023
This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether
the whole or part of the material is concerned, specically the rights of translation, reprinting, reuse of
illustrations, recitation, broadcasting, reproduction on microlms or in any other physical way, and
transmission or information storage and retrieval, electronic adaptation, computer software, or by similar
or dissimilar methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication
does not imply, even in the absence of a specic statement, that such names are exempt from the relevant
protective laws and regulations and therefore free for general use.
The publisher, the authors, and the editors are safe to assume that the advice and information in this book
are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the
editors give a warranty, expressed or implied, with respect to the material contained herein or for any
errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional
claims in published maps and institutional afliations.
This Springer imprint is published by the registered company Springer Nature Switzerland AG
The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland
Preface
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In the last few decades, surgical procedures have seen remarkable advancements
through disruptive technologies. The introduction of minimally invasive techniques
in surgery has revolutionized the way surgical procedures are performed, allowing
for faster recovery times, less pain, and fewer complications for patients. The next
step in this evolution is robotic-assisted surgery, which is expanding rapidly and has
the potential to be the most signicant advance in surgery for generations to come.
The current robotic platform, the Da Vinci system, is the product of an evolution
that began with the US Department of Defense’s efforts to provide advanced surgical
care to frontline soldiers from remote locations. The system’s enhanced dexterity,
based on an anthropomorphic model that mimics the human hand’s range and
freedom of movements, has allowed both average and skilled surgeons to push the
envelope in the complexity of minimally invasive procedures. The robotic approach
has now permeated essentially every specialty in surgery.
The true potential of robotic surgery lies in two new dynamics between patient
and surgeon. The master-slave relationship, where the surgeon is remote from the
patient and controls a slave patient cart that is attached to the patient, enables
telepresence and will have a profound impact on delivering complex care to remote
locations from a command center. It will also dramatically facilitate professional
education and collaborative surgery. The digital interface, which allows the
collection and manipulation of data that can be used for diagnostic or interventional
purposes, represents an even greater potential.
Currently, the robotic approach has permeated practically all surgical specialties.
This book is the rst comprehensive overview of the role of robotic surgery devices
in all surgical specialties. It is intended to give a historical perspective of the
evolution and applications of robotic surgery in each surgical specialty. In
recognition of the importance of understanding emerging technology and future
robotic platforms, this book also provides an overview of the potential impact of
this technology on the future of surgery.
Each chapter in this book is written by recognized leaders in their eld, examining
specic applications of robotic surgery in a surgical specialty. The authors provide
detailed technical aspects of each existing platform and the surgical procedures
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Preface
performed using this technology, as well as the results of these techniques. The
editors appreciate the participation of these expert surgeons in this effort, and we
hope that this comprehensive resource will advance the practice of robotic surgery.
São Paulo, Brazil JoaoPaduaManzano
São Paulo, Brazil RafaelSilvade Araújo
São Paulo, Brazil LydiaMasakoFerreira
Contents
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History of Robotic Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Lydia Masako Ferreira, Rafael Silva de Araújo,
and Catherine Maureira Oyharçabal
Robotic Devices in Aesthetic Plastic Surgery . . . . . . . . . . . . . . . . . . . . . . . . 9
Marco Aurélio Faria Correa
Features and Knacks of Robotic Keyhole Cardiac Surgery . . . . . . . . . . . . 31
Ryuta Seguchi, Norihiko Ishikawa, and Go Watanabe
Robotic Surgery Devices in Lobectomy for Lung Malignancies
with the da Vinci Xi Surgical System . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Makoto Oda and Rurika Hamanaka
Robotic Devices in Urology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
Marcio Covas Moschovas, João Pádua Manzano, and Vipul Patel
Robotic Devices in Surgery of the Digestive System . . . . . . . . . . . . . . . . . . 73
Bruno Zilberstein, Danilo Dallago De Marchi, Andrea Vieira Martins,
Rodrigo Moises de Almeida Leite, and Gustavo Guimarães
Robotic Devices in Head and Neck Surgery . . . . . . . . . . . . . . . . . . . . . . . . . 101
Andressa Teruya Ramos and Renan Bezerra Lira Lira
Robotic Devices in Pediatric Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
Adriano Almeida Calado and Daniel G. DaJusta
Robotic Devices in Knee Orthopedic Surgery . . . . . . . . . . . . . . . . . . . . . . . 127
Marco Kawamura Demange and Camila Maftoum Cavalheiro
Robotic Devices in Upper Limb Orthopedic Surgery
and Microsurgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137
Jose Carlos Garcia Jr
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Contents
Robotic Devices in Hip Orthopedic Surgery . . . . . . . . . . . . . . . . . . . . . . . . 147
Marco Aurelio Silverio Neves, Fabio Zego,
and Osvaldo Guilherme Nunes Pires
Robotic Systems in Ophthalmologic Surgery . . . . . . . . . . . . . . . . . . . . . . . . 161
Marina Roizenblatt, Ali Ebrahini, Iulian Iordachita,
and Peter Louis Gehlbach
Robotic Devices in Gynecology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175
Renato Moretti-Marques, Mariana Corinti, Vanessa Alvarenga-Bezerra,
Luisa Marcella Martins, and Mariano Tamura Vieira Gomes
Robotic Devices in Neurosurgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203
Paulo Porto de Melo
Robotic Microsurgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209
Onuralp Ergun, Ahmet Gudeloglu, and Sijo J. Parekattil
New Platforms in Robotic Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 225
Gustavo Cardoso Guimarães
Single-Port . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233
Dorival Duarte Jr., Artur de Oliveira Paludo,
Leonardo Martins Caldeira de Deus, Milton Berger,
João Pádua Manzano, and André Kives Berger
Future of Robotic Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 243
Rafael Silva de Araújo, João Pádua Manzano, and Lydia Masako Ferreira
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 251
History ofRobotic Surgery
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LydiaMasakoFerreira, RafaelSilvade Araújo,
andCatherineMaureiraOyharçabal
The rst appearance of species currently described as “robots” refers to the work
“Iliad” by Homer, book XVIII, from the fth century . In it, it was found the
activity of creating beings made of metal and gold with their own movement
designed by the god of metallurgy, Hephaestus, to serve him in his tasks. In the
course of history to the present day, the image of these beings has acquired different
features, moving between heroes and villains in different scenarios of prosperous
futures or fanciful dystopias [1].
Despite the description in the Antiquity period, the rst time that the term “robot”
was used comes from the Czech play “Rossum’s Universal Robots,” written in 1920
by Karel Capek. According to the translation of the play in the work Rossum’s
Universal Robots (Tchápek, 2010, p.16), it is described that the word robot comes
from the Church Slavonic term rob, which means slave, and that as a feminine noun
in the Czech spelling robota, it translates to forced labor or strenuous physical
labor. Thus, in the theatrical work, the word robota was used to refer to metal
beings with an image similar to man and which translates to “servants” whose
destiny and function was previously established: to fulll what human beings had
not had the ability or intention to perform [2, 3].
It can be seen during the play that the boring activities dedicated to the dozens of
replicas allowed human beings more time to dedicate themselves to other intellectual activities, to leisure, and to idleness. In the end, Tchápek describes the awakening of the robots’ consciousness in his narrative, which face their dominators with
the saying: “The human stage is outdated. A new world has begun! The government
of robots!”[3].
L. M. Ferreira (*) · R. S. de Araújo
Plastic Surgery Department, Universidade Federal de São Paulo, São Paulo, Brazil
C. M. Oyharçabal
University of Mogi das Cruzes, São Paulo, SP, Brazil
© The Author(s), under exclusive license to Springer Nature
Switzerland AG 2023
J. P. Manzano, L. M. Ferreira (eds.), Robotic Surgery Devices in Surgical
Specialties, https://doi.org/10.1007/978-3-031-35102-0_1
1
2
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L. M. Ferreira et al.
What at rst was just a science ction dream that brought alternative realities and
extraordinary battles in the eld of Literature gradually brought new tools to human
daily life, especially with the advancement of technologies and innovations. In the
eld of medicine, in the 1980s, there were already specic computer systems that
guided certain procedures, such as the case of Robodoc for hip replacement surgeries
in orthopedics or the Programmable Universal Machine for Assembly (PUMA) 200
for performing neurosurgical biopsies. During this period, based on a proposal
made by the United States Army (USA), the spark was lit for the insertion and
idealization of the use of robotic machinery in surgical elds [4, 5].
The main idea of this request was based on the possibility of allowing the arrival
of medical aid in military camps of difcult access, changing the previous paradigm
of transferring the injured soldier to the nearest hospital and bringing the new
concept of taking the operating room to the support unit. In this way, it was hoped
to change the precept from “Golden Hour” to “Golden Minute,” allowing for
immediate intervention and improving the survival of seriously injured soldiers [5, 6].
The pioneering prototypes depended on previous studies by researchers at the
National Aeronautics and Space Administration (NASA) and Scott Fisher, who
developed a screen attached to the face through a helmet to allow a three-dimensional
(3D) virtual environment. For the creation of a telepresence device, engineer Dr.
Phil Green from the Stanford Research Institute (SRI), a program funded by the US
government, Colonel Richard Satava, and other members of the SRI team developed
what was called a “telepresence surgery system,” also known as the “SRI system,”
consisting of a surgeon’s workstation and a remote surgical unit [7].
This public initiative prototype contained a pair of instrument handlers at the
surgeon’s station that transmitted their movements to the remote surgical unit
attached to the patient. These gauntlets did not contain an articulating wrist and
therefore allowed movement in only four degrees of freedom compared to the seven
possible degrees of being performed by the human hand. They were positioned
below a mirror in order to give the illusion that the instrument handles in the
surgeon’s hand were attached to the tips projected in the image seen on a monitor.
As there was a simple video system, this phase required the use of polarized light
glasses to create a 3D image [7].
In the remote surgical unit, instruments could be changed through a twist lock
mechanism, making it possible to use needles, intestinal forceps, scalpels, and
electrocautery. A point that differentiates the SRI system from current ones is the
presence of tactile feedback from force sensors in the distal portion of the
instruments, which transmitted sensations to the surgeon and prohibited movements
from a certain degree of resistance encountered during the intraoperative [7, 8].
Although it was initially designed for use in open surgery, in 1989, Colonel
Richard Satava watched the presentation of a videotaped laparoscopic
cholecystectomy performed by Dr. Jacques Perrisat at the Society of American
Gastrointestinal and Endoscopic Surgeons (SAGES). This milestone made him
bring to the SRI team the idea of promoting the transition from the robotic
laparotomy system to a laparoscopic model. At the time, Colonel Satava argued that
the robotic telepresence system offered a solution to difculties with traditional
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