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HISTORY OF ROBOTIC SURGERY
Gillian BasnettLead Nurse Uro-
oncology
UCLH
NATURAL SELECTIONAll the calculations that would ever be needed in this country could be done on the three digital computers which were then being built — one in Cambridge, one in Teddington, and one in Manchester. No one else, he said, would ever need machines of their own, or would be able to afford to buy them." -- Professor Douglas Hartree, Cambridge mathematician, 1951
PROGRESSION
MOBILE PHONES
COMPUTERS
ROBOTS
DAVINCI
TIMELINE OF ROBOTICS
1985 IBM Puma 560 performed neurosurgical 1985 IBM Puma 560 performed neurosurgical biopsiesbiopsies
1988 TURP performed with PROBOT1988 TURP performed with PROBOT
ROBODOC femur manipulation during hip ROBODOC femur manipulation during hip surgeriessurgeries
1990 NASA & Ames Research 1990 NASA & Ames Research teleprescenceteleprescence surgery (surgery (telesurgerytelesurgery), virtual reality, robots, and ), virtual reality, robots, and medicinemedicine
The U.S. Army The U.S. Army -- MASH (Mobile Advanced MASH (Mobile Advanced Surgical Hospital)Surgical Hospital)
1993 Computer Motion AESOP1993 Computer Motion AESOP®® voicevoice--activated activated robotic system for robotic system for endoscopicendoscopic surgerysurgery
1995 MONA 1995 MONA IntuativesIntuatives first robot performed 1first robot performed 1stst
Lap Lap ChoecystectomyChoecystectomy
1998 ZEUS1998 ZEUS®® HERMESHERMES®® centralized voice centralized voice command and recognition systemcommand and recognition system
Intuitive Surgery created Intuitive Surgery created daVincidaVinci Surgical Surgical SystemSystem®® a mastera master--slave systemslave system
2001, SOCRATES2001, SOCRATES™™ 11stst transatlantic transatlantic telesurgerytelesurgery performed( New York performed( New York –– StrasbourgStrasbourg
2002 first robotic 2002 first robotic prostastectomyprostastectomy
UK DISTRIBUTION
AddenbrookeAddenbrooke’’ss Hospital Hospital –– CambridgeCambridge
Barnet & Chase Farm NHS trust Barnet & Chase Farm NHS trust –– LondonLondon
Bradford Hospital Bradford Hospital -- YorkshireYorkshire
Broomfield Hospital Broomfield Hospital –– EssexEssex
Christies Hospital Christies Hospital –– ManchesterManchester
Frimley Park NHS Foundation Trust Frimley Park NHS Foundation Trust –– SurreySurrey
Guy's Hospital Guy's Hospital –– LondonLondon
Kent and CanterburyKent and Canterbury
Lister Hospital Lister Hospital –– HertfordshireHertfordshire
New Cross New Cross -- WolverhamptonWolverhampton
Oxford Radcliff Trust Oxford Radcliff Trust –– OxfordOxford
Royal Berkshire Royal Berkshire -- ReadingReading
Royal Royal MarsdenMarsden Hospital Hospital –– LondonLondon
Royal Liverpool Royal Liverpool -- LiverpoolLiverpool
Royal Surrey County NHS trust Royal Surrey County NHS trust -- GuildfordGuildford
St. George's Healthcare NHS Trust St. George's Healthcare NHS Trust -- LondonLondon
St. JamesSt. James’’s University Hospital s University Hospital –– LeedsLeeds
Saint MarySaint Mary’’s Hospital s Hospital –– School of Medicine School of Medicine –– LondonLondon
South Devon Healthcare NHS Foundation Trust South Devon Healthcare NHS Foundation Trust -- DevonDevon
SouthmeadSouthmead Hospital BristolHospital Bristol
The London Clinic The London Clinic –– London London
The Princess Grace Hospital The Princess Grace Hospital –– LondonLondon
University College Hospital (UCH)University College Hospital (UCH)-- LondonLondon
The Wellington Hospital (UK)The Wellington Hospital (UK)
WexhamWexham Park Hospital Park Hospital -- Berkshire Berkshire
Galway ClinicGalway Clinic
Mater Private Mater Private –– DublinDublin
Cork Maternity HospitalCork Maternity Hospital
WORLD WIDE DISTRIBUTION
325000 PROCEDURES PERFORMED LAST YEAR1,000,000 PROSTATES REMOVED TO DATE
2009 24%
2010 38%
2011 54%
2012 63%
MASTER SLAVE SYSTEM
DIRECT CONTROL
MIMICS MOVEMENT
NO MEMORY
WHY ROBOTICS?
SHORTER LENGTH OF STAY
SMALLER SCARS
LESS PAIN
BETTER DISEASE OUTCOME
LESS BLOOD LOSS
MORE ERGONOMIC
EASY TO LEARN
3D VISION
INTUATIVE
SURGEON
3D TECHNOLOGY
REMOVES HAND SHAKE
WRISTED INSTRUMENTATION
7 DEGREES OF MOVEMENT
INTUATIVE MOTION
EASY TO LEARN
WHY NOT?
MONEY
MENTORSHIP
MONEY
NUMBERS
MONEY
HAPTIC FEEDBACK
MONEY
WHO WHAT WHERE
WHERE IN THE BODY CAN YOU USE WHERE IN THE BODY CAN YOU USE ROBOTICS?ROBOTICS?
WHAT PROCEDURES CAN YOU WHAT PROCEDURES CAN YOU PERFORM?PERFORM?
WHAT CANWHAT CAN’’T IT DO?T IT DO?
UCLH
198 PROSTATECTOMY198 PROSTATECTOMY
3 PARTIAL CYSTECTOMY3 PARTIAL CYSTECTOMY
6 CYSTECTOMY WITH NEOBLADDER6 CYSTECTOMY WITH NEOBLADDER
4 CYTECTOMY WITH CONDUIT4 CYTECTOMY WITH CONDUIT
8 PELVIC LYMPH NODE CLEARANCE8 PELVIC LYMPH NODE CLEARANCE
4 NEPHRECTOMY4 NEPHRECTOMY
1 COMBINED URETHROPROSTATECTOMY AND 1 COMBINED URETHROPROSTATECTOMY AND MITROFFANOFFMITROFFANOFF
5 UNITS OF BLOOD5 UNITS OF BLOOD
NO CONVERSIONNO CONVERSION
67% 24HR STAY67% 24HR STAY
4 READMISSION4 READMISSION
ROBOTIC DEVELOPMENT AT UCLH
UROLOGYUROLOGY
GYNAECOLOGY GYNAECOLOGY
HEAD AND NECK/ ENT HEAD AND NECK/ ENT
COLORECTALCOLORECTAL
HEPATOBILARY HEPATOBILARY
BARRIATRICBARRIATRIC
SINGLE PORTSINGLE PORT
EDUCATION
Mentoring
Hands on experience
Technique refinement
Training modules
Console experience
Theatre teams
Master classes
FUTURE DEVELOPMENTS
TORS
FUTURE DEVELOPMENTS
Tele-presence
Remote mentoring
MRI overlay
Fluorescence imaging
Robotic assistants
Remote controlled
Micro bots
No incisions
FUTURE DEVELOPMENTS
SILS
NOTES
MICROBOTS
