Hospital staff, patients, investors, in fact, most people who learn anything about da Vinci Surgery usually ask: where did the name come from and where did the technology originate? The answer to the first question is simple. As for the second one, well, that’s been quite a journey.
Why "da Vinci"?
The name "da Vinci " stems for the 15th century inventor, painter, philosopher and Renaissance man: da Vinci is widely known for advancing the study of human anatomy. He participated in autopsies, produced many extremely detailed anatomical drawings and planned a comprehensive work of human and comparative anatomy.
His study of human anatomy eventually led to the design of the first known robot in history. This design, which has come to be known as "Leonardo's Robot," was probably made around the year 1495 but was rediscovered in the 1950s. da Vinci was intrigued by mechanics and automation. He developed a number of mannequins including a mechanical knight.
The Beginnings: Science Fiction
The story of telerobotic surgery involves the union of two very different technologies and the emergence of a completely new approach to minimally-invasive surgery. The first of these technologies emerged in the 1940s and was called "telemanipulation" or "telepresence" – the sensation that you are in one location, while being in another.
In Robert Heinlein’s 1942 science fiction short story, entitled Waldo, the lead character, Waldo Farthingwaite-Jones, was born frail, weak and unable to lift his own body weight. Heilnlein describes a glove and harness device that allowed Waldo to control a powerful mechanical arm by simply moving his hand and fingers.
About eight or nine years after Heinlein’s publication, these kinds of remote manipulators — popularly known as "Waldoes" — were developed in the real world. Using cable and linkages, they were used to move and manipulate hazardous materials and enter hazardous environments inhospitable to humans. The first telepresence robotic arm was developed in the 1950s for the same purpose.
Raymond Goertz, an early pioneer in the field of robotics, developed the first master/slave manipulator to handle radioactive material while working for the Atomic Energy Commission at Argonne National Laboratory.
1980s – Robotic Advancements
Over time, this master/slave technology has been used in other hazardous environments such as the bottom of the ocean or in outer space. Significant progress in telepresence and robotic activity was achieved in the 1980s because of major advancements in microelectronics and computing.
At the same time, we were seeing significant advancement in the medical arena. The first laparoscopy (minimally invasive surgery) was also being developed and conducted. Specifically, an endoscope-like device (long, thin tube with a camera at the end) was developed and the emergence of the Charge Coupled Device - known as a CCD - needed for digital imaging, video electronics and display technologies began to revolutionize the field of surgery and led to laparoscopic techniques for minimally invasive surgery. This culmination of technological advancements in surgery led to the first laparoscopic cholecystectomy (surgery to remove the gallbladder) in 1987 by French physician Dr. Philippe Mouret.
Soon after this landmark surgery, laparoscopic technology and techniques boomed in the late 1980s and continued to gain popularity into the 1990s for simple surgical procedures. However, the uses for laparoscopic surgery began to stall in the 1990s. The tools being used for manual laparoscopy only worked well for relatively simple surgical procedures that involved the removal of tissue and basic tissue closure. Sophisticated mechanisms, such as staplers and other tissue closure devices were developed but still did not allow laparoscopic techniques to gain traction in more complex surgical procedures.
Was it perfect timing?
Robotic telepresence was beginning to flourish at the same time laparoscopy was experiencing limitations. Many institutions recognized a potential opportunity to blend minimally invasive surgery (MIS) with robotics to overcome the limitations of laparoscopic surgery. The goal was to make MIS an option for even complex procedures with help from computers and mechanics.
Here are just a few of the groups and individuals who first married tele-robotic technology with minimally invasive surgical techniques – a pairing that would ultimately influence the development of the da Vinci Surgical System:• Dr. Russell Taylor and his group at the IBM Watson Research Center in Yorktown Heights, New York, in collaboration with Dr. Mark Talamini, a general surgeon from Johns Hopkins University, developed the Laparoscopic Assistant Robotic System (LARS) — a "third hand" that allowed surgeons to manipulate a laparoscopic endoscope under joystick control.
• Dr. Phil Green at the Stanford Research Institute, now SRI International in Menlo Park, California, in collaboration with surgeons at Stanford University, as well as army surgeon, Dr. John Bowersox, developed the "telepresence surgery system" in 1987. The device would later contribute key components to early da Vinci prototypes.
• Dr. Hari Das at the Jet Propulsion Laboratory in Pasadena, California began working with ophthalmic surgeon Steve Charles. Funded by NASA, their Robot Assisted Microsurgery (RAMS) workstation also began to make the connection between telerobotics and minimally invasive surgery. • Professor Brian Davies and his team at Imperial College in London, England began to develop robotic mechanisms for prostate and neurosurgical applications. Their I.C. PROBOT prostate surgery device was first trialed in early 1991.
• At the University of California at Santa Barbara, graduate student Yulan Wang developed a robotic system for NASA and discovered that it had the ability to manipulate an endoscope for laparoscopic surgery, in 1992. This became the seed for the Automated Endoscopic System for Optimal Positioning (AESOP) system and the company, Computer Motion Inc.
• At MIT, Professor Kenneth Salisbury and his students began developing innovative human-machine interfaces and haptics (the science of applying the sense of touch).
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All surgery presents risk, including da Vinci® Surgery and other minimally invasive procedures. Serious complications may occur in any surgery, up to and including death. Examples of serious or life-threatening complications which may require hospitalization include injury to tissues or organs, bleeding, infection or internal scarring that can cause long-lasting dysfunction or pain. Temporary pain or nerve injury has been linked to the inverted position often used during abdominal and pelvic surgery. Risks of surgery also include potential for equipment failure and human error. Risks specific to minimally invasive surgery may include: A long operation and time under anesthesia, conversion to another technique or the need for additional or larger incisions. If your surgeon needs to convert the procedure, it could mean a long operative time with additional time under anesthesia and increased complications. Temporary pain or discomfort may result from pneumoperitoneum, the presence of air or gas in the abdominal cavity used by surgeons in minimally invasive surgery. Research suggests that there could be an increased risk of incision-site hernia with single-incision surgery. Results, including cosmetic results, may vary. Patients who bleed easily, who have abnormal blood clotting, are pregnant or morbidly obese are typically not candidates for minimally invasive surgery, including da Vinci® Surgery. For more complete information on surgical risks, safety, and indications for use, please refer to http://www.davincisurgery.com/safety/. Patients should talk to their doctors about their surgical experience and to decide if da Vinci Surgery is right for them. Other options may be available. Intuitive Surgical reviews clinical literature from the highest level of evidence available to provide benefit and risk information about use of the da Vinci Surgical System in specific representative procedures. We encourage patients and physicians to review all available information on surgical options and treatment in order to make an informed decision. Clinical studies are available through the National Library of Medicine at www.ncbi.nlm.nih.gov/pubmed.
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