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Future ofRobotic Surgery
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247
5 Nanosurgery
The smallest and most interesting leap for minimally invasive surgery is nanotechnology, because it would harness many potent facets of biotechnology: robotics,
natural orice surgery, and genetic/protein level cellular rearrangements of an illness. Researchers at the Hospital of the University of Pennsylvania are working on
ways to use nanotechnology to treat acute respiratory distress syndrome with liposomes targeted to the pulmonary endothelium. They are approximately 100nm in
size and function as drug carriers coated with antibodies that bind to the inamed
pulmonary capillary endothelium [24].
6 Soft Robots
Equally impressive, but more on a macro scale, the origami robot is an ingested
robot that unfolds within the visceral lumen and is magnetically controlled
extracorporeally to image/diagnose or repair damaged organs [25]. Soft robotics
may offer the greatest integration with the quickest timeline of current technology
and surgical principles at hand by incorporating minimally invasive access and
human control. Through soft robotics, the near future of robotics seems most
attainable. Harvard University’s Octobot is the rst fully soft robot that is controlled
by a microuidic logic system rather than a rigid chip and fueled by hydrogen
peroxide cells. In addition, it potentially offers the potential of controlled or
autonomous intra-abdominal surgery and imaging [26].
7 Conclusion
With so many amazing new and overlapping technologies, surgeons are on the verge
of a robotic surgery explosion that will yield dozens of unique robotic fusions. How
can human surgeons remain competitive and at least semiautonomous? Basically,
the answer lies with the surgeon: surgeons must view the development of robotics
in surgery as a meaningful journey of discovery to gain more knowledge for the
benet of our patients. As robotic surgeons, we are committed to pursuing a safer
and less invasive platform that, combined with the dual interaction between surgeon
and robot, will enable us to achieve greater outcomes for patients while ensuring
that we have holistic identity in their care.
248
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R. S. de Araújo et al.
References
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2017;120:822–41.
2. Brodie A, Vasdev N.The future of robotic surgery. Ann R Coll Surg Engl. 2018;100(Suppl
7):4–13.
3. Samalavicius NE, Janusonis V, Siaulys R, et al. Robotic surgery using Senhance® robotic
platform: single center experience with rst 100 cases. J Robot Surg. 2020;14:371. https://doi.
org/10.1007/s11701- 019- 01000- 6.
4. Chan JY, Tsang RK, Holsinger FC, etal. Prospective clinical trial to evaluate safety and feasibility of using a single port exible robotic system for transoral head and neck surgery. Oral
Oncol. 2019;94:101–5; https://linkinghub.elsevier.com/retrieve/pii/S1368837519301654.
5. Ion lung biopsy system from Intuitive Surgical wins FDA approval. https://www.therobotre-
port.com/ion- lung- biopsy- intuitive- surgical- fda/.
6. J&J’s Auris touts Monarch robotic bronchoscopy feasibility study: MassDevice. https://www.
massdevice.com/jjs- auris- touts- monarchrobotic- bronchoscopy- feasibility- study/.
7. Misrai V, Rijo E, Zorn KC, et al. Waterjet ablation therapy for treating benign prostatic
obstruction in patients with small- to medium-size glands: 12-month results of the rst French
Aquablation clinical registry. Eur Urol. 2019;76:667. https://linkinghub.elsevier.com/retrieve/
pii/S0302283819305147.
8. Kang CM, Chong JU, Lim JH, et al. Robotic cholecystectomy using the newly developed
Korean robotic surgical system, Revo-I: a preclinical experiment in a porcine model. Yonsei
Med J. 2017;58:1075. https://doi.org/10.3349/ymj.2017.58.5.1075.
9. Seeliger B, Diana M, Ruurda JP, etal. Enabling single-site laparoscopy: the SPORT platform.
Surg Endosc. 2019;33:3696–703. https://doi.org/10.1007/s00464- 018- 06658- x.
10. Rassweiler JJ, Autorino R, Klein J, et al. Future of robotic surgery in urology. BJU Int.
2017;120:822–41. https://doi.org/10.1111/bju.13851.
11. Home-AVRA Medical Robotics. https://www.avramedicalrobotics.com/.
12. Kinross JM, Mason SE, Mylonas G, etal. Next-generation robotics in gastrointestinal surgery.
Nat Rev Gastroenterol Hepatol. 2020;17:430–40.
13. Kim W, Choi Y, Cho JY, etal. Robot single incision left lateral sectionectomy via da Vinci(R)
xi single site & vaginal extraction of the specimen. Surg Oncol. 2020;33:254–5.
14. Peters BS, Armijo PR, Krause C, etal. Review of emerging surgical robotic technology. Surg
Endosc. 2018;32:1636–55. https://doi.org/10.1007/s00464- 018- 6079- 2.
15. Chand M, Ramachandran N, Stoyanov D, Lovat L.Robotics, articial intelligence and distributed ledgers in surgery: data is key! Tech Coloproctol. 2018;22:645–8.
16. Rai S. Cognitive computing and articial intelligence systems market in healthcare. BCC
research report.
17. Kim SS, Dohler M, Dasgupta P.The Internet of Skills: use of fth-generation telecommunications, haptics and articial intelligence in robotic surgery. BJU Int. 2018;122:356–8. This
article highlights the futuristic technological advances such as low-latency fth generation
network (5G), Internet of Things (ultrasensitive miniaturized sensors needed for real.
18. How robots and AI are creating the 21st-century surgeon: robotics business review. https://www.roboticsbusinessreview.com/healthmedical/
how- robots- and- ai- are- creating- the- 21st- century- surgeon/.
19. Digital Surgery’s AI Platform guides surgical teams through complex procedures VentureBeat.
https://venturebeat.com/2018/07/16/digital- surgerys- ai- platform- guides- surgical- teamsthrough- complex- procedures/. This article highlights the current use of machine learning in
surgery.
20. Intuitive’s IRIS 1.0 Medical Image Processing Software. http://surgrob.blogspot.com/2019/04/
intuitives- iris- 10- medical- image.html.
21. EndoVisSub2019-SCARED: Home. https://endovissub2019- scared.grand- challenge.org/.
22. KiTS19: Home. https://kits19.grand- challenge.org/.
Future ofRobotic Surgery
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23. Google and the University of Chicago are sued over data sharing. The New York Times.
https://www.nytimes.com/2019/06/26/technology/googleuniversity- chicago- data- sharinglawsuit.html.
24. Brenner JS.Nanomedicine for the treatment of acute respiratory distress syndrome. Ann Am
Thorac Soc. 2017;14:561–4.
25. Walcutt L.Ingestible origami surgeon could be coming ‘soon’ to a pill near you. Forbes Mag.
May 24, 2017.
26. Burrows L.The rst autonomous, entirely soft robot. Harvard Gazette. August 24, 2016.
249
Index
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A
Abdominal cerclage in pregnant, 199
Abdominal sacrocolpopexy, 193
AccuStopTM haptic technology, 131
Acetabular reaming, 154, 155
Adnexal masses, 192
Advanced epithelial ovarian cancer
(AEOC), 197
Advanced Research Projects Agency
(ARPA), 3
Aesthetic plastic surgery
abdominal ap, 24
endoscopic abdominoplasty, 12–14, 16
evolution, 19–21
liposuction, 26–28
long term clinic follow-up, 9
mini dermolipectomy, 10
minimally incision abdominoplasty, 11, 9
minimal scar abdominoplasty, 9, 10
recti plication, 24, 25
robotic abdominoplasty, 17, 18
surgical technique, 21–24
ALF-X, 243
Aorta clamping, 32
Articial intelligence (AI), 68
Articial neural networks (ANN), 244
Atrial septal defect closure, 35
Augmented reality, 68
Auris robotic endoscopy system, 243
Automated Endoscopic System for Optimal
Positioning (AESOP), 3
Autonomous robots, 245, 246
Avatera system, 187, 188
Avicenna Roboex, 67
B
Benign gynecological diseases, RAS in, 188
adnexal masses, 192
endometriosis, 191
hysterectomy, 188, 189
myomectomy, 190
pelvic organ prolapse, 193
Big-data capture and data sharing, 246
Black Diamond microforceps, 211
Brain vascular anastomosis, 204
C
Cambridge Medical Robotics Surgical (CMR
Surgical), 5
Cardiac surgery
atrial septal defect closure, 35
bleeding control, 37, 38
clear surgical eld, 38, 39
concomitant surgery, 37
coronary artery bypass grafting, 36
cutting-edge technology, 40
da Vinci Surgical System, 31, 40
development, 31
knot tying, 37
mitral valve repair
operative method, 33, 34
patient selection and outcomes, 32, 33
stroke prevention, 39, 40
Cardiopulmonary bypass, 33
© The Editor(s) (if applicable) and 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
251
252
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Index
CASPER system, 128, 149
Cavitron Ultrasonic Surgical Aspirator
(CUSA), 244
Cervical cancer, 193, 194
Cervical lymph node, 105
Chimney factor, 199
Chopstick surgery, 234
Computed tomography (CT), 204
Confocal laser endomicroscopy, 220, 221
Cooperative robotic system, 168, 169
Corindus CorPath GRX (Siemens
Healthcare ), 229
CORI Surgical System, 133
Coronary artery bypass grafting, 36
Covidien Valleylab™FT10 electrosurgical
generator, 184
Cranial robotic guidance platforms, 228
Cul-de-sac obliteration, 191
Cup implantation, 154, 155
Cutting-edge 3D tracking technology, 228
CyberKnife, 206
D
da Vinci SP prototype (SP999), 234
da Vinci Surgical System, 4, 5, 31, 32, 36,
44–47, 73, 175, 177, 183, 195–197,
209, 211, 212, 226, 227, 230,
234, 243
advantages and disadvantages of, 178
anesthesia and ERAS, 178, 179
benets of, 177
da Vinci® Standard, 58
docking, 181, 184, 185
instruments, 182
patient positioning, 179, 180
port placement, 179–181
Si system, 59
SP system, 60, 61
S system, 58
Xi system, 59
X system, 60
See also Single-port (SP)
Deep-learning models (DLM), 244
Defense Advanced Research Projects Agency
(DARPA), 225
Digestive system, robotic surgery in, see Robotic
surgery in digestive system, 73
Digital surgery, 245
DLR MiroSurge robotic system, 230
E
Eagle syndrome, 105
Electrical sternum lifting system, 39
Endometriosis, 191
Endoscopy, 76, 77, 228, 229
Endovascular procedures, 229
EndoWrist instruments, 52, 182, 211
Energy devices, 49, 50
Enhanced Recovery After Surgery (ERAS),
178, 179
Enos robotic single access surgical system,
122, 188, 230
Ergonomics, 199
F
Facial paralysis, 105
Fertility-sparing surgery, 194
FIGO IA2 endometrioid endometrial
cancer, 196
Firey uorescence imaging, 214
Firey system, 59, 77
Flexible ber optic CO2 laser probe, 217, 218
Flex robotic system, 102, 122
Focal One® HIFU device, 66
G
Gasless method, 21, 24, 26
GelPOINT technique, 234–238
Gynecology, robotic devices in, 176, 199
Avatera system, 187
approval, 188
da Vinci Surgical System, 177
advantages and disadvantages of, 178
anesthesia and ERAS, 178, 179
benets of, 177
docking, 181, 184, 185
instruments, 182
patient positioning, 179, 180
port placement, 179–181
history and reality of, 175
Hugo™ robotic-assisted surgery (RAS)
system, 183, 185
malignant gynecological diseases,
robotic in
cervical cancer, 193, 194
ovarian cancer, 195, 197, 198
uterine cancer, 194–196
RAS, in benign gynecological
diseases, 188
adnexal masses, 192
endometriosis, 191
hysterectomy, 188, 189
myomectomy, 190
pelvic organ prolapse, 193
RAS, in special cases
abdominal cerclage in pregnant, 199
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253
in mastology, 199
uterine transposition, 198
Revo-I Surgical System, 186
Senhance Surgical System, 186
Versius surgical system, 186, 187
H
Handheld robots, 169, 170
Hand tremor, 168, 170
Head and neck surgery
Flex robotic system, 102
Hugo, 102
lateral cervical tumors, 108, 109
limitations, 110
multiportal linear system, 101
single port model, 101, 110
skull and nasopharynx base, 108
TORS, 102–105
Versius, 102
vestibular approach, 105–107
High-pressure water-jet dissection, 218, 219
Hinotori™, 176, 230
History, 1
AESOP, 3
Antiquity period, 1
cholecystectomy, 4
CMR Surgical, 5
Da Vinci® system, 4, 5
FDA, 5
eld of medicine, 2
Mona, 4
open surgery, 2
patient-related elements, 6
prototypes, 2
SRI system, 2
telepresence system, 3
transatlantic surgery, 3
ZEUS system, 3, 4
Hominis™ surgical system, 124
HPV-related oropharynx tumors, 102, 104
Hugo™ robotic-assisted surgery (RAS)
system, 63, 64, 183, 185, 230
Hypopharynx, 105
Hysterectomy, 188
cost of, 189
steps of, 189
I
Intensity-modulated radiation therapy
(IMRT), 104
Internal limiting membrane (ILM)
peeling, 164
Internal mammary artery harvesting, 36
Intraocular robotic interventional surgical
system (IRISS), 167, 168
Intravitreal drug delivery, 166
K
KangDuo, 211
Karl Storz imaging system, 184
Keyhole method, see Cardiac surgery
Knee orthopedic surgery, see Total knee
arthroplasty (TKA)
Knot-tying technique, 37
L
Landmarks registration, 130
Laparo-endoscopic single site surgery
(LESS), 60
Laparoscopic surgery, 229, 230
Laser tissue ablation, 228
Lateral cervical tumors, 108, 109
Latissimus dorsi tendon, 138–141
Leg length discrepancy, 154, 155
Linea alba, 27, 28
Lingual tonsils, 105
Liposuction, 26–28
Lung cancer
advantages, 43, 44
da Vinci Xi system, 44–47
robotic endoscopes, 48
robotic lobectomy
advanced instruments and clip
appliers, 50, 51
energy devices, 49, 50
fourth arm, 50, 51
instruments, 48
ports, 49
stapling devices, 52–54
M
Magnetic resonance imaging (MRI), 205
MAKO Integrated Cutting System (MICS),
131, 150, 151
Mako® Total Hip 4.0 Robotic System, 227
Malignant gynecological diseases
cervical cancer, 193, 194
ovarian cancer, 195
de-bulking, 197, 198
early staging of, 197
uterine cancer, 194–196
Master and Slave Transluminal Endoscopic
Robotic (MASTER), 123
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Index
Mastology, robotic in, 199
Mazor Core Technology robotic-assisted
surgery platform, 227
Mazor™ X robotic system, 227
Medicaroid, 243
Medtronic Robotic Surgery Program
(HUGO™), 123
Micro-Doppler sensing, 215, 216
Microsure Eindhoven-Holland (MUSA)
Surgical System, 140, 210, 211
Microsurgery, 209
See also Robotic microsurgery
Microsurgical testicular sperm extraction
procedures (micro-TESE), 219
Midas Rex™ MR8 high-speed electric drill
systems, 228
Miniature invivo robot (MIVR), 124
Minimally invasive abdominoplasty, 26
Minimally invasive surgery (MIS), 73,
177–179, 195, 199, 233
MiroSurge Telesurgery DLR System, 123, 230
Mitral valve repair (MVR)
operative method, 33, 34
patient selection and outcomes, 32, 33
Mona, 4
Monarch, 243
Multiphoton microscopy, 220
Multiportal linear system, 101
Myomectomy, 190
N
Nanosurgery, 247
Nanotechnology, 247
Natural orice transluminal endoscopic
surgery (NOTES), 123, 124
NAVIO System, 133
NeuroArm, 205
Neurobot, 205
Neuromate® robot, 228
Neurosurgery, 203
history of, 204, 205
robotic devices in, 204–207
Optics, 76, 77
Orthopedic surgery, 227, 228
Ottava surgical robotic system, 188, 230
Ovarian cancer, 195
de-bulking, 197, 198
early staging of, 197
P
Paraaortic lymphadenectomy, 180
Pectus excavatum (PE), 39
Pediatric surgery
advantages, 115
anesthesia considerations, 116
Da Vinci Robotic Platform
contraindication, 118, 119
generations, 117
indications, 118–121
perspectives, 120, 121
ENOS™ surgical system, 122
ex robotic system, 122
Hominis™ surgical system, 124
HUGO™, 123
laparoscopic procedures, 115
limitation, 116
MiroSurge, 123
MIVR, 124
NOTES, 123, 124
robotic pyeloplasty, 116, 117
Senhance surgical robotic system, 121
SurgiBot™, 123
training and simulation, 124, 125
Versius robotic system, 122
Pelvic organ prolapse, 193
Pelvic sentinel lymph node excision, 194
Port placement method, 45
Posterior compartment endometriosis, 183
Preceyes Surgical System, 164, 166
Probot robot, 225
Programmable Universal Machine for
Assembly/Programmable Universal
Manipulation Arm (PUMA), 2, 225
Pyeloplasty, 239
O
Ophthalmic surgery, 229
co-manipulated/cooperative robots,
168, 169
owchart, 163
handheld robots, 169, 170
membrane peeling, 164
retinal vein cannulation, 164, 165
subretinal injections, 165, 166
teleoperated robots, 166–168
Q
Quad-sparing midvastus approach, 135
R
Radical prostatectomy surgery, 237
Radical trachelectomy, 194
Radiosurgery, 206
Rectus plication, 9, 20–22, 26, 27
Retinal vein occlusion, 164, 165
Index
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255
Retrograde intra-renal surgery, 67
Retroperitoneal adrenalectomy, 233
Revo-I Surgical Robotic system (REVO
Surgical solution), 65, 176,
186, 230
ROBOCAST, 205
ROBODOC system, 128, 226
Robotic arterial anastomoses, 210
Robotic-assisted surgery (RAS), 195, 210
abdominal cerclage in pregnant, 199
adnexal masses, 192
endometriosis, 191
hysterectomy, 188, 189
in mastology, 199
myomectomy, 190
pelvic organ prolapse, 193
uterine transposition, 198
Robotic-assisted targeted microsurgical
denervation of the spermatic cord
(RTMDSC), 220
Robotic-assisted varicocelectomy, 217
Robotic-assisted vasectomy reversals
(RAVR), 219
Robotic-assisted vasoepididymostomy
(RAVE), 213, 219
Robotic-assisted vasovasostomy (RAVV),
213, 219
Robotic devices
in gynecology (see Gynecology, robotic
devices in)
in neurosurgery, 204–207
Robotic hysterectomy, 182
Robotic lympho-lymphatic anastomoses, 210
Robotic lymphovenous, 210
Robotic microsurgery
applications, 220
confocal laser endomicroscopy, 220
multiphoton microscopy, 220
prototype platforms, 221
assisting intraoperative devices, 214
rey uorescence imaging, 214
exible ber optic CO2 laser probe,
217, 218
high-pressure water-jet dissection, 218
instrumentation, 211, 212
micro-Doppler sensing and ultrasound, 215
optical magnication, 212, 213
tools for ligation/ablation in, 217
urological applications, 219, 220
VeinViewer, 216, 217
Robotic prostatectomy, 20
Robotic Retinal Dissection Device
(R2D2), 229
Robotic surgery, 209, 243, 244
autonomous robots, 245, 246
big-data capture and data sharing, 246
cranial robotic guidance platforms, 228
in digestive system
cables and trocars, 78–80
Da Vinci, 73
disposable materials, 97, 99, 100
grasping forceps, 80–83
kit, 94
needle holder, 90, 92
non-robot instruments required, 94
optics/endoscopes, 76, 77
power clamps, 83, 86
robotic clippers, 88
robotic staplers, 90
sterile materials, 95, 97
terms used, 75
for endoscopic procedures, 228, 229
for endovascular procedures, 229
general future of, 244, 245
nanosurgery, 247
laparoscopic surgery, 229, 230
ophthalmology, 229
in orthopedic surgery, 227, 228
soft robots, 247
ROSA Knee Robot®, 133
ROSA® Hip System, 152, 153
RPE65 gene, 165
S
Sacrocolpopexy, 193, 238
Senhance Surgical System, 65, 176, 186, 230
Sensei-Magellan system, 67
Shape-memory suture with spiral, 37
Single-port (SP), 101, 110, 233, 243
applications, 236–238
challenges and benets, 239
features, 234, 235
overview, 235
vs. Xi model, 235, 236
Single Port Orice Robotic Technology
(SPORT), 188, 221, 243
Single-Site Laparoscopic (LESS), 233
Skull and nasopharynx base, 108
“Sleeve gastrectomy” type, 86
Soft robots, 247
SP 1098-platform, 60
SpineAssist, 205
Steady Hand Eye Robot (SHER), 168, 169
Stealth Autoguide™ robotic cranial guidance
platform, 228
256
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Index
StealthStation™ S8 surgical navigation, 227
Stroke, 39, 40
Styloid process, 105
Subcutaneous fat gap, 24
Surgeons Operating Force-Feedback Interface
Eindhoven (Soe), 221
Supraglottic larynx lesions, 105
Supra-umbilical/periumbilical abbiness, 24
Sureform™ stapler, 52
SurgiBot™, 123
Symani Surgical System, 140, 210
T
Tactile feedback systems, 128
Teleautomaton, 204
Teleoperated robots, 166–168
Telepresence surgery system, 2
Tissue plasminogen activators (t-PA), 165
Tonsillar tonsillectomy, 105
Total hip arthroplasty (THA)
advantages
acetabular reaming, cup implantation
and leg length discrepancy, 154, 155
bone preservation, 155
cost-effectiveness, 155, 156
length of stay, 153
risk of dislocation, 154
complications, 148, 157
denition, 147
disadvantages
learning curve, 156
operative time, 157
history, 147–150
limitations, 157, 158
MAKO system, 150, 151
patient characteristics, 148
positioning, 148
ROSA system, 152, 153
Total knee arthroplasty (TKA)
bone cuts assistance, 131
CORI system, 133
history, 127
incidence, 127
indications and perspectives, 134, 135
intra-operatively adjustments, 130
learning curve and potential risks, 135
MAKO, 131, 132
preoperative planning, 129
robotic system evolution, 128, 129
ROSA, 133
soft tissue balancing, 130
tracker positioning and landmarks
registration, 130
VELYS, 132, 134
Total robotic endoscopic coronary artery
bypass (TECAB), 31
Toumai robot, 65, 66
Tracker positioning, 130
Transenterix, 243
Transoral robotic surgery (TORS), 102–105
Trismus, 105
Trocar Placement System reusable
VersaOne™., 184
U
Ultrasound, 215
Umbilicoplasty technique, 24
Upper limb and microsurgery
axillary nerve, 137, 138
cadaveric models, 137
contraindications, 143
future perspectives, 143, 144
history, 137
indications, 141–143
latissimus dorsi tendon, 138–140
limitations, 141
lymphatic vessel reconstruction, 141, 142
MUSA®, 140
quadrangular space release, 137, 138
supermicrosurgery, 140
Symani® features, 140
Urology, 219, 220
da Vinci® platform evolution
da Vinci® Standard, 58
Si system, 59
SP system, 60, 61
S system, 58
Xi system, 59
X system, 60
history, 57
Hugo robot, 63, 64
outcomes, 62
platforms, 62
prostate cancer focal treatment, 66
retrograde intra-renal surgery, 67
Revo-I robot, 65
robotic program, 61
robotic training methods, 69
Senhance robot, 65
technological improvements
articial intelligence, 68
augmented reality, 68
Index
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257
intraoperative ultrasound, 68
robotic scope imaging and
design, 67, 68
3D imaging reconstruction, 67
Toumai robot, 65, 66
Versius robot, 62, 63
Uterine cancer, 194–196
Uterine transposition, 198
V
Vattikuti Institute prostatectomy, 5
VeinViewer, 216, 217
VELYS Robotic-Assisted Solution, 132, 134
Ventricular septal defect (VSD), 37, 40
VersaOne™ Trocar Placement
System, 184
Versius surgical system, 62, 63, 122, 186,
187, 229
ViaCath System, 123
VITOM, 213
Vitreoretinal surgery, 163, 164
X
Xi Robot, 74
Z
ZEUS system, 3, 4, 226
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