In the early 1980s, general surgeons began experimenting with a modern form of procedure called minimally invasive surgery (MIS) in an effort to reduce the trauma of surgery for their patients. This performed well in some cases, and the exceptionally positive outcomes of MIS cholecystectomies attest to the effectiveness of such surgery. However, it quickly became clear that restricting the surgeon’s proximity to what he or she might see and reach across a few ports introduced a whole new range of issues.
With funds from the National Institutes of Health, researchers at Stanford Research Institute (SRI) created a prototype device in the late 1980s. This SRI device merged remote manipulation advancements with simple force feedback, stereoscopic mapping, multimodal sensory feedback, and ergonomic architecture. The Defense Advanced Research Projects Agency (DARPA) has supported funding for a device that would enable surgeons at a remote hospital to operate on troops wounded on the battlefield. At the moment, other locations interested in this kind of study included the Massachusetts Institute of Technology (MIT), IBM’s Watson Laboratory, NASA’s Jet Propulsion Laboratory (JPL), which was operating on an ophthalmic robot, and Computer Motion’s automated endoscopic method for optimum positioning (AESOP).
In the spring of 1997, a second concept system was performed on humans in general surgical procedures in Belgium. In the spring of 1998, the daVinci alpha prototypes (Fig 2) were used for cardiac operations in Paris and Leipzig, Germany.
In the summer of 1998, an FDA trial for laparoscopic indications was held in Mexico City. For two operations, laparoscopic cholecystectomy and Nissen fundoplication, four surgical teams conducted approximately 100 laproscopic daVinci cases and 100 control cases. The CE mark was obtained in 1999, and 12 systems were marketed that year. In the year 2000, 28 systems were marketed, and the FDA approved laproscopic use. The FDA approved thoracoscopic usage in March 2001, following clinical trials at the Ohio State Medical Center in the United States.
The engineers at Intuitive is tasked with creating a device that provides “an interactive operation experience for the surgeon by supplying both high-quality stereo vision and a man-machine interface that specifically links the surgeon’s hands to the action of the surgical tool tips within the patient’s body.”
The DaVinci machine, which consists of two main subsystems: the surgeon’s console and the patient side carriage, is designed to meet this task.
The projection system, the surgeon’s handles, the surgeon’s user interface, and the electronic controller are all housed in the surgeon’s console (Fig 3). The surgeon sits at the control panel, staring at an illustration that seems to be positioned over his or her hands. Each movement of the surgeon’s handles, or boss, is converted into movements of the instrument point, or slave, in real time. These motions can be multiplied from 1:1 to 1:3, and the control mechanism can filter out surgeon tremor, allowing the instrument tips to be more stable than the unassisted side. The combination of motion scaling and filtering, as well as image magnification, allows delicate movements simpler to execute than in traditional endoscopic techniques. The controller may often precisely interpret the surgeon’s motions, culminating in a rightward movement by the surgeon being mirrored by a rightward movement by the slave. At the same moment, the slave and master’s motions are being tested and compared in the x, y, and z axes at over 1300 times per second.
With more than 250 megaflops of computing speed, it is possible to precisely register the visual and robotic frames of reference—a critical component in providing the surgeon with a sense of immersion in the job. The machine controller also allows master and slave grasping (indexing), smooth control at workspace limits, and gravity compensation. The master input system has a wide workspace that allows the surgeon seated at the control console to perform the full range of motion necessary. Its low mass and friction, as well as its accurate monitoring of motion, enable precise commands to be sent to the robot. Force input allows the surgeon to sense significant touch connections and shows the boundaries of the robot’s workspace.
A specifically built endoscope with two completely different optical trains captures images from inside the patient. The camera atop the endoscope is made up of two separate three-chip charge-coupled system cameras that produce images with 800 lines of resolution and a signal-to-noise ratio greater than 62 dB. These photographs are seen on two medical-grade cathode ray tube displays, with each showing a subtly different picture to each eye, resulting in 3D vision with a very large stereo separation. Other 3D technologies, on the other hand, utilize a single optical train and off-axis imaging to provide 3D imagery with very narrow stereo separation.
This high-resolution 3D video imaging and projection device gives the surgeon a crystal-clear and vibrant vision of his or her work. The optical device reduces geometric distortion around the field of view, allowing stereo picture fusion even at the image’s edges. The machine also offers extremely precise color rendition to eliminate chromatic distortion. The machine uses mirrored overlay optics to project a picture of the surgical site over the surgeon’s shoulders, restoring hand–eye balance and supplying natural motion correspondence.
The tool handles used by the surgeon are serial connection manipulators known as masters. These masters serve as both high-resolution input instruments, interpreting the surgeon’s location, direction, and grip orders, and haptic screens, transmitting forces and torque to the surgeon in reaction to different measured and synthetic force cues.
The surgeon’s console’s user interface consists of foot switches and buttons that enable the surgeon to monitor the device during the surgical operation, as well as a number of other mode selection and initialization switches. The surgeon will use this interface to operate the endoscope from the surgeon’s console, reposition the masters in their office, aim the endoscope, and so on. The computer controller is the last main feature of the surgeon’s console. The electronic controller was designed with speed, durability, and fail-safe device activity in mind. This custom-designed control computer is capable of completely interconnected 48-degree-of-freedom control at upgrade speeds reaching 1000 cycles per second.
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