Development of Robotic Procedures
The first laparoscopic robotic procedure on human beings was performed in March 1997 by our team in Belgium (8). The system was the MONA (Intuitive Surgical, Mountain, Mountain View, CA, USA).First clinical prototype in 1997 : a three dimensional picture is obtained with specific glasses. The handles resemble usual surgical tools.
Following this experience we worked at improving the various components of the system : the surgical cart containing the robot arms, the computer and the working console. The most significant innovation was changing the shape of the clinical laparoscopic tools to handles resembling joy sticks.
In May 1998, our team performed the first two Nissen fundoplications procedures by robot technology in Broussais hospital in Paris (9).
The MONA robot in 1998 : binocular direct vision without glasses. An engineer must be present at all times.
In 1999 we performed in Mexico a randomized comparative trial comparing the robotic approach and the laparoscopic approach for cholecystectomy and Nissen fundoplication. Data were recorded for documentation for the Food and Drugs Administration (FDA) (10).
After these experiences the MONA™ system was improved. This resulted in the present " Da Vinci " system. During this evolution, we succeeded in progressively cutting down on the need for the continuous presence of an engineer. We benefited from a constant improvement in ergonomics and electronic performance at the console. The bulk of the “robot” was significantly reduced and the tools were improved according to the needs of each procedure.
The Da Vinci system was approved by the Food and Drugs Administration (FDA) for use in abdominal surgery in July 2000. It has since been adopted by several teams who are rapidly gaining experience with this novel surgery (11,12,13,14). Another manufacturer, Computer Motion, presently offers the Zeus system which has been approved by the Food and Drugs Administration for abdominal surgery as well (FDA) (15).
The Da Vinci system consists of two primary components : the surgeon’s viewing and control console and a moveable cart with three articulated robot arms. The surgeon is seated in front of the console, where he/she manipulates handles that are similar to “ joy-sticks ”. This is the master part of the robotic system. The imaging system which displays the operative field through binoculars offers a high-resolution, truly three dimensional image. Manipulation of the handles transmits the electronic signals to the computer which transfers the exact same motions to the robotic arms. The computer interface has the capacity to control and modify the movements of the instrument tips by downscaling deflections at the handles by a factor between (5:1 to 2:1). It can eliminate physiologic tremor, and can adjust grip strength applied to the tools. The computer generated electrical impulses are transmitted by a 10 meter long cable and command the three articulated “robot” arms. Disposable laparoscopic articulated instruments are attached to the distal part of two of these arms and introduced inside the abdomen through trocars mounted on the arms. The third arm carries an endoscope with dual optical channels, one for each of the surgeon’s eyes. In every procedure the optimal placement of the slave arm trolley must be determined in order to accommodate the operating table and especially to avoid crowding by the slave arms’ during the operation.
Da Vinci System: the computer is integrated in the console
