The da Vinci Surgical System is a robotic surgical system made by the American company Intuitive Surgical. Approved by the Food and Drug Administration (FDA) in 2000, it was designed to facilitate complex operations using a minimally invasive approach, and controlled by a surgeon from the console. This system is commonly used for prostatectomy, and more and more for the restoration of heart valves and gynecological surgical procedures. According to the manufacturer, the da Vinci System is called "da Vinci" in part because Leonardo da Vinci's study of human anatomy ultimately leads to the first known robotic design in history. "
Da Vinci Surgical Systems operates in hospitals worldwide, with an estimated 200,000 operations performed in 2012, most often for hysterectomy and prostate removal. As of September 30, 2017, there are installed bases of 4,271 units worldwide - 2,770 in the United States, 719 in Europe, 561 in Asia, and 221 worldwide. The "Si" version of the average system cost is slightly below US $ 2 million, in addition to the several hundred thousand dollars annual maintenance fee. The da Vinci system has been criticized for its cost and for a number of problems with its surgical performance.
Video Da Vinci Surgical System
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The da Vinci system consists of a surgeon console that is usually in the same room as the patient, and a side bass patient with four console-controlled, interactive robotic arms. Three of the arms are for the tools that hold the object, and can also act as scalpels, scissors, bovies, or graspers. The surgeon uses a master console control to maneuver the three or four arms of the patient's robotic arm (depending on the model). The design of 'jointed-wrist' instruments exceeds the range of natural motion of the human hand; the scale of motion and the reduction of tremors further interprets and improves the hand movements of the surgeon. The da Vinci system always requires human operators, and incorporates some excess safety features designed to minimize opportunities for human error when compared to traditional approaches.
The da Vinci system has been designed to repair conventional laparoscopes, where surgeons operate on stands, using long-grasping handheld devices, which have no wrists. With conventional laparoscopy, the surgeon must search and move away from the instrument, to the nearest 2D video monitor to view the target anatomical image. The surgeon should also rely on a patient-side assistant to position the camera correctly. In contrast, the da Vinci System design allows the surgeon to operate from a sitting position on the console, with the eyes and hands positioned according to the instrument and using controls in the console to move instruments and cameras.
By providing surgeons with superior visualization, improved agility, greater precision and ergonomic comfort, the da Vinci Surgical System allows more surgeons to perform minimally invasive procedures involving complex dissection or reconstruction. For patients, the da Vinci procedure can offer all the potential benefits of minimally invasive procedures, including less pain, less blood loss and less need for blood transfusions. In addition, the da Vinci System can allow shorter hospital stay, faster and faster recovery back to normal day-to-day activities.
Maps Da Vinci Surgical System
FDA Permissions
The Food and Drug Administration (FDA) cleared the da Vinci Surgical System in 2000 for adults and children using a urological surgical procedure, general laparoscopic surgery procedure, gynecological laparoscopic surgery procedure, general non-cardiovascular thoracoscopic surgery procedure and assisted theracoscopic cardiotomy procedures. The FDA also cleans the da Vinci System for use with adjuvant mediastinotomy for performing coronary anastomosis during cardiac revascularization.
Medical use
The da Vinci system has been successfully used in the following procedures:
- Radical prostatectomy, pyeloplasty, cystectomy, nephrectomy and ureteric reimplantation;
- Hysterectomy, myomectomy, and sacrocolpopexy;
- Repair of hiatus hernia;
- Distal spleen-spare pancreatectomy, cholecystectomy, Nissen fundoplication, Heller myotomy, gastric shortcuts, donor nephrectomy, adrenalectomy, splenectomy, and bowel resection;
- Mobilization of internal mammalian arteries and ablation of cardiac tissue;
- Repair of the mitral valve and closing of the atrial endothelial septal defect;
- Mammary to anastomosis of the left anterior descending coronary artery for cardiac revascularization with adjuvant mediastinotomy;
- Transverse resection of upper aerodigestive tract tumors (tonsils, tongue base, larynx) and transactional thyroidectomy
- Resection of spindle cell tumors originating from the lung
Future apps
Although the general term "robotic surgery" is often used to refer to technology, this term may suggest that the da Vinci System performs operations autonomously. In contrast, the current da Vinci Surgical System can not - by any means - function on its own, as it is not designed as an autonomous system and has no decision-making software. Rather, it depends on the human operator for all inputs; However, all operations - including motor vision and function - are performed through long-range human-computer interaction, and thus with appropriate weak AI software, the system may in principle perform either partially or entirely autonomously. The difficulty with creating such an autonomous system is not trivial; the main obstacle is that the operation per se is not an engineering process - a requirement for weak AI. The current system is designed only to mimic the hand movements of the surgeon with the micro-end of the instrument, not to make decisions or move without the surgeon's immediate input.
The possibility of remote surgery is dependent on patients who have access to da Vinci System, but technically this system may allow doctors to conduct telesurgery in patients in other countries. In 2001, Dr. Marescaux and the team from IRCAD use a combination of high-speed optical fiber connections with an average delay of 155 ms with advanced asynchronous transfer mode (ATM) and Zeus telemanipulator to successfully perform the first transatlantic surgical procedure, covering the distance between New York and Strasbourg. The event is considered a global telesurgery milestone, and is dubbed "Operation Lindbergh".
Criticism
The criticism of robotic operations confirms that it is difficult for users to learn and that it has not been proven to be more effective than traditional laparoscopic surgery. The da Vinci system uses proprietary software, which doctors can not modify, thus limiting the freedom to modify the operating system. In addition, the $ 2 million cost puts it beyond the reach of many institutions.
The system manufacturer, Intuitive Surgery, has been criticized for cutting FDA approval by a process known as "premarket notification," which claims the product is similar to an approved product. Intuitive has also been accused of providing inadequate training, and encouraging healthcare providers to reduce the number of supervised procedures that are needed before doctors are allowed to use unattended systems. There is also a patient injury claim caused by an electric current which is released from the improper part of the surgical ends used by the system. The intuitive counterpoint that the same stray stream type can occur in non-robotic laparoscopic procedures. A study published in the Journal of the American Medical Association found that the side effects and blood loss in robotic hysterectomy were no better than those performed by traditional operations, although the cost of the system was much greater. In 2013, the FDA is investigating problems with da Vinci robots, including deaths during device-based operations; a number of related lawsuits are also underway.
From social analysis, the disadvantage is the potential of this technology to dissolve the creative freedom of the surgeon, so praised by the intellectual Timothy Lenoir as one of the most professional individual autonomous professions. Lenoir claims that in the "heroic age of medicine," the surgeon was praised as a hero for his intuitive knowledge of human anatomy and his excellent technique for improving vital body systems. Lenoir argues that the 3D console and da Vinci robot arm create a form of mediation action called medialization, where internal knowledge of images and routes within the body becomes external knowledge mapped into simple computer coding.
See also
- The ZEUS robot surgery system, the rival system was discontinued in 2003
References
External links
- "Robot da Vinci live radical prostatectomy during the EAU congress" on YouTube by the European Urological Association.
- "India's First Da Vinci Robotic Surgery Operation" on YouTube by Urologi Muljibhai Patel Hospital.
- "da Vinci Robotic Hysterectomies/Uterine Fibroids" on YouTube.
Source of the article : Wikipedia
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