Robotics, Technology, and the Future of Surgery

and the creative use of the newly developed solid state, charge coupled device (CCD) cameras, laparoscopes, clip appliers, and energy sources enabled the laparoscopic revolution of the 1990s. And, without doubt, evolving technology will sustain the development of minimally invasive surgery. But the technology that fueled the laparoscopic revolution is aged and now hinders further advances in the field. In particular, several characteristics inherent to laparo-scopic surgery have slowed its more general diffusion into the surgical mainstream. These characteristics include: 1) The requirement of laparoscopic surgery for highly trained personnel to maintain instruments and to assist during an operative procedure; 2) Expensive instrumentation (particularly disposables); 3) Poor ergonomic design of laparoscopic instruments; 4) Two-dimensional video representation of the real-world, 3-dimensional operative field; 5) Work environment not conducive to operator comfort: a. poor monitor placement b. inefficient operating instruments sited remote from the operative site c. limited ability to steer rigid laparoscopic instruments 6) Lack of haptic (touch) sense; 7) Surgeon dependence upon a camera operator for visualization of the operative field. 277 These characteristics are hindrances to the diffusion of minimally invasive surgery, but they are not insurmount-able problems. Rather, they are challenges. Disposable instruments can be made in a reusable format with significant cost savings. Personnel can be cross-trained and used more efficiently. Three-dimensional laparoscopic cameras are available and can be further refined. These remedies, however, are only " quick fixes. " A more complete solution is needed for a comprehensive transition to minimally invasive surgery and, ultimately, for the evolution to noninvasive, image-guided therapies. Operating rooms (OR) designed for open surgery of the mid-20th century have not been easily adapted to a laparoscopic environment. Frequently floors of rooms used for laparoscopic surgery are cluttered with cables and wires connecting video monitors, light generators, and energy sources. Tubes linking suction devices to suction-aspirators and oxygen lines add to the confusion. Towers containing insufflation devices, video recorders, fiberoptic light sources, and monitors are cumbersome and difficult to move. More wires and tubes connect the patient to anesthetic delivery machines and monitoring devices. The technologies have been " added on " rather than " integrated into " the operating theater, and the " added on " look is very evident in a typical operating room. The human arm and hand, although a marvelous device for the performance of specific tasks, is another unit that has not adapted well to laparoscopic surgery. …