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Robotic-Assisted General Surgery
continued from page 11

Da Vinci Xi system with robot, patient side cart
(video and power supply), and surgeon's console.
Surgical Specialists West Chester Surgeons (from left to right): Dr. Donelle
Rhoads, Dr. Steven Fukuchi, Dr. Ken Witterholt, and Dr. Pam Demnicki.

Robotic origins
The word "robot" can be traced to a 1920's play "Rossum's
Universal Robots" written by Czechoslovakian playwright and
novelist, Karel Capek (1880-1938). The play revolved around a
company mass-producing labors (rabota) who could do everything
a human could perform, but who lacked a "soul." The original
definition of robota in Czech-Slovonic language meant forced
labor, serf labor or drudgery. The modern definition is quite
different: a machine that looks like a human being and performs
various complex acts of a human being (sometimes emphasizing a
lack of capacity for human emotion).
In our society we don't think twice about the word robot: They
are in factories, amusement parks, and in our homes (we likely
have an object, e.g., vacuum, or toy that is a simplified robot).
Surgical robots have been in the operating room since 1985. The
first robotic-assisted surgery was performed for neurosurgical
biopsies. Robots for urologic procedures were first used in 1988

and a robot for orthopedic procedures (femoral head planing) was
available in 1992. The first surgical robot was approved in 2000
for general laparoscopic surgery. Robots can be used for operations
in otolaryngology, gynecology, urology, cardiothoracic, colorectal,
and general surgery.

Robotic-assisted surgery
Robotic-assisted surgery is an extension or derivative of
laparoscopic surgery: both use small incisions, carbon dioxide
insufflation, and a camera and instruments to pass through access
ports. The guiding principles of performing the operation do not
change. Resection of the gallbladder, partial stomach, small bowel,
or colon resection, hernia repair, or splenectomy have a step-wise
order to complete.
Common technical comparisons between robotic-assisted
surgery and laparoscopic surgery:

robotic-assisted surgery

laparoscopic surgery

ADVANTAGES

Improved visualization (3-D)
Improved dexterity
Seven degrees of freedom
Elimination of tremor
Elimination of fulcrum effect
Ergonomic position
Tele-surgery (remote access)
Scalable motion

Well established technology
Affordable
Widely available
Proven efficacy

DISADVANTAGES

Absence of touch sensation
Expensive
New technology
Unproven benefit

Loss of touch sensation
Loss of 3-D visualization
Compromised dexterity
Fulcrum effect (torqueing)
Amplified tremor

12 CHESTER COUNT Y Medicine | SPRING 2018


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