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Robotic Surgery

Transcript: Marketing Robotic surgery is a dynamic developing technology. With its inception and continued use, we see economic issues, gender issues, and self image issues arise. These issues are highly complex, and many will not be answered for some time. Elson, 2000; Ancheta, 2000 Economic Aspects Most robotic surgery today is minimally invasive. It leaves very little markings on the body, and postoperative hospital time is often unnecessary. However, there are some forms of surgery that have lasting effects on the bodies and psyches of patients, regardless of visible scars. Currently, the da Vinci system can perform hysterectomies and myomectomies. Since robotic surgery technology advances so quickly, it would be safe to assume that robots may be performing cosmetic surgeries in the near future. However, some believe that the battle between the truth about robotic surgery and the novelty of it is lost because the marketing of the procedures is too strong. Conrad defines medicalization as "defining a problem in medical terms, usually as an illness or disorder, or using a medical intervention to treat it." I posit that a process such as surgery, which is a form of medicalization in and of itself, can be medicalized. Conrad talks at length about how biotechnology companies are "major players" of medicalization. Looking at the history of robotic surgery, one can see how the medicalization of surgery itself occurred. It all started with a need for more precision and better technique (the disease), and it was pushed along to what it is today by Army funding. Without this funding, we likely would not have the da Vinci or Zeus systems (the medical intervention that treats the problems of nonrobotic laparoscopic surgery). In the examples above, one can clearly see how the change in the body as a result of surgery has an impact on the mind of a person, or how the state of mind of a person will drive them away or towards having a surgical procedure. The interaction between body and mind in these cases cannot be denied. When robots perform these surgeries, they become the agents that create the link, rather than an actual surgeon. Questions to which there are no clear answers arise like "Should I trust this machine to give me a proper face lift?" or "Am I comfortable with a machine conducting a surgery on something that I use to gender identify?" Lanfranco et al, 2004 Continuing Development PROBOT- prostate surgery ROBDOC- hip replacement femur machining US Army funds research for battlefield application Companies and robotics develop out of Army funding AESOP- Automated Endoscopic System for Optimal Positioning - auditory commands to position camera Integrative Surgical- da Vinci Surgical System Computer Motion- Zeus system Robotic surgery is a relatively new and rapidly growing technology. Like most new technologies, there are still many factors about robotic surgery that are unknown. This presentation will show how history, economy, and organics interact to create complexity in a technology that is superficially simple. Robotic surgery is an expensive procedure, but it is "unclear whether the outcomes are better, worse, or the same." $1.39 million for the machine $140,000 per year for service contract $1,500 to $2,000 in disposable materials per patient, patient cost much higher Robotic surgery has an extremely steep learning curve, requiring a massive time investment "Robotic surgery has to be better to justify its learning curve, to justify its unknown cancer control, to justify its increased cost" Both doctors and patients fallaciously believe that newer is better, but there are some healthcare professionals trying to move away from that message. Gender Identity and Gynecological Surgery Conrad, 2005 (Kolata, 2010) Commodity-fetishism Robotic Surgery Because of its high costs, hospitals often market robotic surgery using questionable claims. Doctors and medical centers favor robotic surgery. Medicalization Lanfranco et al, 2004 Organic Aspects Beginning Robotic surgery has roots in minimally invasive laparoscopic surgery Laparosopic surgery has limitations Loss of haptic feedback, moving instruments while watching 2D video, restricted degrees of motion, and others. Robotic surgery developed to overcome these limitatoins Puma 560- robot developed in 1985 to increase precision in neurosurgical biopsies Current Systems da Vinci- movable cart with 2 instrument arms and a camera arm. 3D image is rendered over physican's arms giving the impression of being at the surgical site Zeus- table mounted 3 armed system that displays complete visualization of OR on a monitor (Kolata, 2010) Historical Aspects "Women's decisions to have cosmetic surgeries are socially situated and experienced." (Ancheta, 2000) Rebecca Ancheta delineates three key themes that come into play when women decide to have cosmetic surgery. The first is a response to the "mask of aging." The second is the importance of social networks. The third are beliefs

Robotic Surgery

Transcript: *Gregory D. Hager is a professor of computer science. Him and his team of scientists worked to break surgical procedures down to simple gestures that could be represented mathematically by computer software. *They viewed surgery as having a structure which could be taught, and they considered this structure to be the language of surgery. *To develop mathematical models for this language, they borrowed techniques from speech recognition technology and applied them to motion recognition and skills assessments. *Just as a speech recognition program can call attention to poor pronunciation or improper syntax, they can identify which movements in surgery will lead to operating room problems. *This system can identify which movements will be imprecise or too time-consuming. The Beginning The da Vinci surgical system can record and process all of the robot’s surgical movements digitally. Hager's team developed a way to use data from the da Vinci to mathematically model surgical tasks such as suturing. This data management involves making spreadsheets, data tables, and graphs, which are all math tools. This is needed to compare and organize the data received from the da Vinci system. *da Vinci system ROBOTIC SURGERY PROS AND CONS Less than 2 years later the same type of surgery was performed in the USA by Dr. Randall Wolf and Dr. Robert Michler -Can take longer to perform -Robot is very expensive (over $1,390,000) -Cannot be used for some complex procedures -More surgical training is needed -Risk of reaction to medication -Risk of trouble breathing -Risk of bleeding -Risk of infection The Math Involved CONS: In May 1998, Dr. Friedrich-Wilhelm Mohr using the da Vinci Surgical System performed the first robotically assisted heart bypass at the Leipzig Heart Centre in Germany. PROS: -Smaller and more precise movements -Less invasive procedure -Reduces surgeons movements -Reduces hand tremors: More accurate -Access to hard-to-reach areas -Surgeon can more easily see the area being operated on -Faster Recovery -Less pain and bleeding -Smaller scars -Less risk of infection -Shorter hospital stay Research

Robotic Surgery

Transcript: In 1988, The PROBOT, developed at Imperial College London, was used to perform prostatic surgery Pyloroplasty First Robotic Surgery And another step Future of Robotic surgery first laparoscopic procedure with robotic system in 1987 What is robotic surgery? The precise work Origin of Robotic Surgery What happens first? Future advancements Over the past decade, some 2,000 surgical robots have been sold in the U.S. manufactured all over the world marketed toward hospitals who are growing technologically Cost more than $1 million to purchase and $100,000 a year or more to maintain. Last year 2,585 units installed worldwide with 450,000 robotic surgeries Hysterectomy The ROBODOC from Integrated Surgical Systems was introduced in 1992 to mill out precise fittings in the femur for hip replacement. considered success story of service robotics wanted for safety and precision easier for people with busy lives; individual has fast recovery cost benefits The global medical robotic systems market was worth $5.48 billion in 2011 and is expected to reach $13.6 billion in 2018 What kind of surgeries? Another step Gall Bladder removal Product born in silicon valley Robotic surgery is a method to perform surgery using very small tools attached to a robotic arm. Future systems might include the ability for a surgeon to program the surgery and merely supervise as the robot performs most of the tasks. Kidney Removal one or two small surgical cuts in your belly. Gas may be pumped into your belly to expand it. laparoscope is inserted into your belly. Instruments to block off your tubes will be inserted through the laparoscope The tubes are either burned shut or clamped off with a small clip PUMA 560 robotic surgical arm used in neurosurgical biopsy in 1985. 3 years later same machine was used to perform a transurethral resection. Next Step The surgeon makes small cuts to insert the instruments into your body. Future advancements Impact Tubal Ligation surgery to widen the opening in the lower part of the stomach cuts through some of the thickened muscle so it becomes wider. The cut is closed in a way that keeps the pylorus open. This allows the stomach to empty. The surgery usually takes 1 - 2 hours. removal of a woman's womb Another step More on the daVinci system A thin tube with a camera attached to the end of it allows the surgeon to view enlarged 3-D images of your body as the surgery is taking place. 3 to 4 small surgical cuts in the belly and then using a laparoscope A surgical cut in the vagina, and using a laparoscope 3 to 4 small surgical cuts in the belly, in order to perform robotic surgery Robotic Surgery daVinci Surgery System 3 ways The robot matches the doctor's hand movements to perform the procedure using the tiny instruments. Some laboratories are currently working on systems to relay touch sensation from robotic instruments back to the surgeon. incision up to 12 inches long, just below the ribs or right over the last ribs. Muscle, fat, and tissue are cut and moved. The tube that carries urine from the kidney to the bladderand blood vessels are cut away. The kidney is then removed. The cut is then closed with stitches or staples. to close fallopian tubes three-four small cuts made in your belly. The laparoscope inserted through one of cuts. Other medical instruments inserted through other cuts. Gas pumped into your belly to expand working space. The gallbladder is then removed using the laparoscope. Risk factors Benefits injury to tissues and organs loss of blood loss of instrument inside body infection hernia spread of cancer cells inability to work nausea expense This is just a few! Robotic surgery today Next? The future of robotic surgery is promising. The human will invent better ways of accomplishing delicate medical procedures In 1990 the AESOP system became the first system approved by the Food and Drug Administration for its endoscopic surgical procedure. Based on Jim Harvey's speech structures First documented use in 1985 And after that? Shorter hospital stay less loss of blood less pain and discomfort fewer complications including risk of infection faster recovery greater precision small incisions with minimal scarring

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