Comprising numerous technologies, from 3-D visualization to high-quality motors, the da Vinci surgical system is widely considered a breakthrough platform for performing complex, minimally invasive surgery.
Scott Hamilton, sales and applications engineer, Maxon Precision Motors, and Trisha McDonell, National Instruments -- Design News,September 27, 2010
Laparoscopy is a surgical approach in which long-shafted instruments are inserted through small incisions to access targeted anatomy. Compared with traditional open procedures, laparoscopy has revolutionized surgical treatment by shortening recovery time with less pain and fewer adhesions, resulting in better post-operative quality of life. However, manual laparoscopy has severallimitations, including lack of depth perception, poor camera control, limited degrees of freedom for the instrument tips, and inverted hand-instrument movements. These limitations lead to unnatural and painful surgical postures that result in surgeon fatigue.
Robotic-assisted laparoscopy, such as the da Vinci system, allows the surgeon to sit at a stereo console and remotely control endoscopicinstruments via a patient-side robot. The da Vinci system consists of three components: the surgeon console, a patient-side cart that holds the instruments, and the image processing equipment. The system's 3-D visualization provides depth perception, and the wrist-like articulations of the miniaturized instruments improve surgeons' dexterity and range-of-motion. The system also improves control byreducing hand tremor and providing motion scaling. The ergonomic instrument-hand-eye alignment and intuitive instrument movement can also reduce surgeon training time in comparison to using manual laparoscopy.
The da Vinci Si HD Surgical System is shown with two surgeon consoles, patient cart and vision cart. Source: Intuitive Surgical |
The da Vinci system is based on foundational roboticsurgery technology developed at SRI (formerly known as Stanford Research Institute). Intuitive Surgical later formed relationships with IBM, Massachusetts Institute of Technology, and Heartport Inc. to further develop the system. The FDA has cleared the da Vinci for a range of general, thoracic, urological, gynecological, head and neck, and cardiac procedures in both adults and children.
The da Vinci system requires up to five small (<1 cm) incisions for insertion of the two surgical manipulators and a camera. The da Vinci patient-side cart holds the instruments docked to the patient as surgical assistants stand over the patient. Meanwhile, the surgeon can operate the system while seated across the room at the console, where the look and feel of the open surgery isreplicated. The surgeon performs movements using masters (which help translate surgery motions). The surgeon's fingers grasp the master controls below the display with wrists naturally positioned relative to his or her eyes. The surgeon's movements are then translated into precise, real-time robotic movements inside the patient.
The robotic masters are controlled by the surgeon through wrist,hand and finger movements, just as with a typical open surgery. A full range of optional EndoWrist Instruments are also provided for the system. These instruments are designed with seven degrees of motion that exceed the dexterity of the human wrist. Each instrument has a specific surgical mission such as clamping, suturing and tissue manipulation.
The patient-side cart houses the two roboticarms and one endoscope arm, which duplicate the surgeon's movements. The laparoscopic arms pivot at the operating port, eliminating the use of the patient's body wall for leverage, thus minimizing tissue and nerve damage. Supporting surgical team members install the correct instruments, prepare the port in the patient, and supervise the laparoscopic arms and tools being used.
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