Top Inventions New

8/14/2019 Top Inventions New

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Robotic surgery

Surgical robotics is a new technology that holds significant promise. Robotic surgery is

often heralded as the new revolution, and it is one of the most talked about subjects in

surgery today. Up to this point in time, however, the drive to develop and obtain robotic

devices has been largely driven by the market. There is no doubt that they will become

an important tool in the surgical armamentarium, but the extent of their use is still

evolving.

In today's operating rooms, you'll find two or three surgeons, an anesthesiologist and

several nurses, all needed for even the simplest of surgeries. Most surgeries require

nearly a dozen people in the room. As with all automation, surgical robots will eventually


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eliminate the need for some personnel. Taking a glimpse into the future, surgery may

require only one surgeon, an anesthesiologist and one or two nurses. In this nearly

empty operating room, the doctor sits at a computer console, either in or outside the

operating room, using the surgical robot to accomplish what it once took a crowd of

people to perform.

Robotics technology is now being utilized in the field of medicine because it offers the

high precision and control that minimally invasive procedures require. Robotics are now

being used in gallbladder surgery, heartburn and endoscope positioning. In the future,

the applications of this technology will encompass closed-chest beating-heart surgery.

History of Robotic Surgery

In 1985 a robot, the PUMA 560, was used to place a needle for a brain biopsy using CT

guidance. In 1988, the PROBOT, developed at Imperial College London, was used to

perform prostatic surgery. The ROBODOC from Integrated Surgical Systems was

introduced in 1992 to mill out precise fittings in the femur for hip replacement. Further

development of robotic systems was carried out by Intuitive Surgical with the

introduction of the da Vinci Surgical System and Computer Motion with the AESOP and

the ZEUS robotic surgical system. (Intuitive Surgical bought Computer Motion in 2003;

ZEUS is no longer being actively marketed.[1])

The da Vinci Surgical System comprises three components: a surgeons console, a

patient-side robotic cart with 4 arms manipulated by the surgeon (one to control the

camera and three to manipulate instruments), and a high-definition 3D vision system.

Articulating surgical instruments are mounted on the robotic arms which are introduced

into the body through cannulas. The surgeons hand movements are scaled and filtered

to eliminate hand tremor then translated into micro-movements of the proprietary

instruments. The camera used in the system provides a true stereoscopic picture

transmitted to a surgeon's console. The da Vinci System is FDA cleared for a variety of


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surgical procedures including surgery for prostate cancer, hysterectomy and mitral valve

repair, and is used in more than 800 hospitals in the Americas and Europe. The da Vinci

System was used in 48,000 procedures in 2006 and sells for about $1.2 million.[citation

needed]

In 1997 a reconnection of the fallopian tubes operation was performed

successfully in Cleveland using ZEUS.[2]

In May 1998, Dr. Friedrich-Wilhelm Mohr using the Da Vinci surgical robot

performed the first robotically assisted heart bypass at the Leipzig Heart Centre

in Germany.

On 2 September 1999, Dr. Randall Wolf and Dr. Robert Michler performed the

first robotically assisted heart bypass in the USA at The Ohio State University.

In October 1999 the world's first surgical robotics beating heart coronary artery

bypass graft (CABG) was performed in Canada using the ZEUS surgical robot.[3]

In 2001, Prof. Marescaux used the "Zeus" robot to perform a cholecystectomy on

a pig in Strasbourg, France while in New York.[4]

In September 2001, Dr. Michel Gagner used the Zeus robotic system to performa cholecystectomy on a woman in Strasbourg, France while in New York.

The first unmanned robotic surgery took place in May 2006 in Italy.[5]

In January 2009, Dr. Todd Tillmanns reported results of the largest multi-

institutional study on the use of da-Vinci robotic surgical system in gynecologic

oncology and included learning curves for current and new users as a method to

assess acquisition of their skills using the device.


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Advantages of Robotic Surgery

Less Personnel Required

Because the surgical robots could take over the job of some of the people inside the

operating room, surgeries will require fewer personnel yet still be able to perform a moreeffective and safer surgery.

Surgery at a Distance

With improvements in telecommunications and speed of data transfer, robotic surgery

can even be done from a distance. This means that the surgeon could perform the

operation even though he is in another city or even another country far from the patient.

Reduced Trauma and Faster Patient Recovery


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Because robotic surgery would allow for operations needing only small incisions on the

patient's body, the rate of patients' recovery would be accelerated. This would translate

to less pain during and after the operation as well as less risks and complications for the

patient.

Robotic Surgical Systems

Da Vinci Surgical System

The Da Vinci Surgical System was approved for use in operating rooms last July 11,

2000 by the US Food and Drug Administration. This surgical system was developed by

Intuitive Surgical and enables the surgeon to see the surgical site in clearer detail than

the human eye allows. Surgeons can now work on a smaller than usual scale. The two

main components of the Da Vinci Surgical System are the View/Control console and the

surgical arm.

Used in a gallbladder surgery, a Da Vinci Surgical System uses 3 stainless steel rods

(two rods for surgical instruments and one for the camera) held in place by robotic arms.

These rods are then inserted into the patient via three small incisions in the abdomen.

The images from the camera are then displayed on the console giving the surgeon a

clear view of the surgical area. Using joystick-like controls to control the surgical

instruments at the tips of the two rods, the surgeon can remotely operate on the patient.

ZEUS System

The ZEUS System by Computer Motion is another surgical robot in the process of being

cleared by the FDA. The system is already being used in Europe and is showing

promising results. In fact, the ZEUS system has already been used to perform coronary

bypass surgery in Germany.

The ZEUS System at $750,000 is less expensive than the Da Vinci Surgical System,

which costs around $1 million.

AESOP


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The AESOP or the Automated Endoscopic System for Optimal Positioning by Computer

motion was the first surgical robot to be approved by the FDA. Its main feature is its

mechanical arm that can be utilized by the surgeon to accurately position the

endoscope. Through the use of foot pedals and voice activated software, a surgeon can

keep his hands free to perform surgery on the patient.

Types of surgery

Originally robots were used for surgery to remove gallbladders. Many surgeries to treat

other conditions have been added to the list since then. According to FDA, some of

them include:

Removal of the prostate

Heart bypass surgery

Mitral valve repair

Hysterectomy

Atrial septal defect

Gastric bypass surgery

Gastroesophageal reflux disease

Uterine fibroid removal "

Uterine and vaginal vault prolapse

Removal of the thymus gland


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Blood Transfusion

A blood transfusion is a safe, common procedure in which blood is given to you through

an intravenous (IV) line in one of your blood vessels. Blood transfusions are done to

replace blood lost during surgery or a serious injury. A transfusion also may be done if

your body can't make blood properly because of an illness.

During a blood transfusion, a small needle is used to insert an IV line into one of your

blood vessels. Through this line, you receive healthy blood. The procedure usually

takes 1 to 4 hours, depending on how much blood you need.

Blood transfusions are very common. Each year, almost 5 million Americans need a

blood transfusion. Most blood transfusions go well. Mild complications can occur. Very

rarely, serious problems develop.


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The heart pumps blood through a network of arteries and veins throughout the body.

Blood has many vital jobs. It carries oxygen and other nutrients to your body's organs

and tissues. Having a healthy supply of blood is important to your overall health.

Blood is made up of various parts, including red blood cells, white blood cells, platelets

(PLATE-lets), and plasma. Blood is transfused either as whole blood (with all its parts)

or, more often, as individual parts.

Blood Types

Every person has one of the following blood types: A, B, AB, or O. Also, every person's

blood is either Rh-positive or Rh-negative. So, if you have type A blood, it's either A

positive or A negative.

The blood used in a transfusion must work with your blood type. If it doesn't, antibodies

(proteins) in your blood attack the new blood and make you sick.


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Type O blood is safe for almost everyone. About 40 percent the population has type O

blood. People with this blood type are called universal donors. Type O blood is used for

emergencies when there's no time to test a person's blood type.

People with type AB blood are called universal recipients. This means they can get any

type of blood.

If you have Rh-positive blood, you can get Rh-positive or Rh-negative blood. But if you

have Rh-negative blood, you should get only Rh-negative blood. Rh-negative blood is

used for emergencies when there's no time to test a person's Rh type.

Blood Banks

Blood banks collect, test, and store blood. They carefully screen all donated blood for

possible infectious agents, such as viruses that could make you sick.

Blood bank staff also screen each blood donation to find out whether it's A, B, AB, or O

and whether it's Rh-positive or Rh-negative. Getting a blood type that doesn't work with

your own blood type will make you very sick. That's why blood banks are very careful

when they test the blood.

To prepare blood for a transfusion, some blood banks remove white blood cells. This

process is called white cell or leukocyte (LU-ko-site) reduction. Although rare, some

people are allergic to white blood cells in donated blood. Removing these cells makes

allergic reactions less likely.

Not all transfusions use blood donated from a stranger. If you're going to have surgery,

you may need a blood transfusion because of blood loss during the operation. If it's

surgery that you're able to schedule months in advance, your doctor may ask whether

you would like to use your own blood, rather than donated blood.

If you choose to use your own blood, you will need to have blood drawn a few times

prior to the surgery. A blood bank will store your blood for your use.


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Types of Blood Transfusions

Blood is transfused either as whole blood (with all its parts) or, more often, as individual

parts. The type of blood transfusion you need depends on your situation.

For example, if you have an illness that stops your body from properly making a part of

your blood, you may need only that part to treat the illness.

Red Blood Cell Transfusions

Red blood cells are the most commonly transfused part of the blood. These cells carry

oxygen from the lungs to your body's organs and tissues. They also help your body get

rid of carbon dioxide and other waste products. You may need a transfusion of redblood cells if you've lost blood due to an injury or surgery.

Platelets and Clotting Factor Transfusions

Platelets and clotting factors help stop bleeding, including internal bleeding that you

can't see. Some illnesses may cause your body to not make enough platelets or other

clotting factors. You may need regular transfusions of these parts of your blood to stay

healthy.

Plasma Transfusions

Plasma is the liquid part of your blood. It's mainly water, but also contains proteins,

clotting factors, hormones, vitamins, cholesterol, sugar, sodium, potassium, calcium,

and more.

If you have been badly burned or have liver failure or a severe infection, you may need

a plasma transfusion.


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Who Needs a Blood Transfusion?

Blood transfusions are very common. Each year, almost 5 million Americans need blood

transfusions. This procedure is used for people of all ages.

Many people who have surgery need blood transfusions because they lose blood during

the operation. For example, about one-third of all heart surgery patients have a

transfusion.

Some people who have serious injuriessuch as from car wrecks, war, or natural

disastersneed blood transfusions to replace blood lost during the injury.

Some people need blood or parts of the blood because of illnesses. You may need ablood transfusion if you have:

A severe infection or liver disease that stops your body from properly making

blood or some parts of blood.


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An illness that causes anemia, such as kidney disease or cancer. Medicines or

radiation used to treat a medical condition also can cause anemia. There are

many different types of anemia, including aplastic,Fanconi, hemolytic, iron-

deficiency, and sickle cell anemias and thalassemia (thal-a-SE-me-a).

A bleeding disorder, such as hemophilia or thrombocytopenia (THROM-bo-si-to-

PE-ne-a).

The Risks of a Blood Transfusion

Most blood transfusions go very smoothly. However, mild problems and, very rarely,

serious problems can occur.

Allergic Reaction

Some people have allergic reactions to the blood given during transfusions. This can

happen even when the blood given is the right blood type.

Allergic reactions can be mild or severe. Symptoms can include:

Anxiety

Chest and/or back pain

Trouble breathing

Fever, chills, flushing, and clammy skin

A high pulse or low blood pressure

Nausea (feeling sick to the stomach)

A transfusion is stopped at the first signs of an allergic reaction. The health care team

determines how mild or severe the reaction is, what treatments are needed, and if the

transfusion can safely be restarted.

Viruses and Infectious Diseases
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Some infectious agents, such as HIV, can survive in blood and infect the person

receiving the blood transfusion. To keep blood safe, blood banks carefully screen

donated blood.

There is a risk of catching a virus from a blood transfusion, but it's very low.

HIV. Your risk of getting HIV from a blood transfusion is lower than your risk of

getting killed by lightning. Only about 1 in 2 million donations may carry HIV and

transmit HIV if given to a patient.

Hepatitis B and C. The risk of having a donation that carries hepatitis B is about 1

in 205,000. The risk for hepatitis C is 1 in 2 million. If you receive blood during a

transfusion that contains hepatitis, you will likely develop the virus.

Variant Creutzfeldt-Jakob disease (vCJD). Variant CJD is the human version of

Mad Cow Disease. It's a very rare, yet fatal brain disorder. There is a possible

risk of getting vCJD from a blood transfusion, although the risk is very low.

Because of this, people who may have been exposed to vCJD aren't eligible

blood donors. Go to the AABB Web site for more information about vCJD.

Fever

You may get a sudden fever during or within a day of your blood transfusion. This is

usually your body's normal response to white blood cells in the donated blood. Over-

the-counter fever medicine will usually treat the fever.

Some blood banks remove white blood cells from whole blood or different parts of the

blood. This makes it less likely that you will have a reaction after the transfusion.

Iron Overload

Getting many blood transfusions can cause too much iron to build up in your blood (iron

overload). People with a blood disorder like thalassemia, which requires multiple

transfusions, are at risk of iron overload. Iron overload can damage your liver, heart,

and other parts of your body.
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If you have iron overload, you may need iron chelation therapy. For this therapy,

medicine is given through an injection or as a pill to remove the extra iron from your

body.

Lung Injury

Although it's unlikely, blood transfusions can damage your lungs, making it difficult to

breathe. This usually occurs within about 6 hours of the procedure. Most patients

recover. However, 5 to 25 percent of patients who develop lung injuries die from the

injury. These people usually were very ill before the transfusion.

Doctors aren't completely sure why blood transfusions damage the lungs. Antibodies

(proteins)which are more likely to be found in the plasma of women who have been

pregnantmay disrupt the normal way that lung cells work. Because of this risk,

hospitals are starting to use men and women's plasma differently.

Acute Immune Hemolytic Reaction

Acute immune hemolytic reaction is very serious, but also very rare. It occurs if the

blood type you get during a transfusion doesn't match or work with your blood type.

Your body attacks the new red blood cells, which then produce substances that harm

your kidneys.

The symptoms include chills, fever, nausea, pain in the chest or back, and dark urine.

The doctor will stop the transfusion at the first sign of this reaction.

Delayed Hemolytic Reaction

This is a much slower version of acute immune hemolytic reaction. Your body destroysred blood cells so slowly that the problem can go unnoticed until your red blood cell

level is very low.

Both the acute and delayed hemolytic reactions are most common in patients who have

had a previous transfusion.


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Graft-Versus-Host Disease

Graft-versus-host disease (GVHD) is when white blood cells in the new blood attack

your tissues. GVHD is usually fatal. People who have weakened immune systems are

the most likely to get GVHD.

Symptoms start within a month of the blood transfusion. They include fever, rash, and

diarrhea. To protect against GVHD, patients with weakened immune systems should

receive blood that has been treated so the white blood cells can't cause GVHD.


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Camera Pill

In collaboration with engineers from Given Imaging, the Israelite Hospital in Hamburg

and the Royal Imperial College in London, researchers from the Fraunhofer Institute for

Biomedical Engineering have developed the first-ever control system for the camera pill.

The patient swallows a capsule, about the size of a large vitamin. The pill, which

contains a camera, lights, batteries and a transmitter, takes two pictures every second

and transmits them to a small antenna array placed on the patients body which in turn is

attached to a walkman-sized receiver worn on a belt around the patients waist. The

doctor then downloads the data from the receiver to a workstation and essentially has

an entire movie of the digestive system at work.


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The main advantage to this procedure is comfort and convenience. Prior to the camera

pill, the normal method of detecting problems in the intestines was to insert a scope

through the mouth, all the way into the small intestine. This method was incomplete,

though, because the scope could not reach the all 20 feet of the small intestine.

The only drawback, which is the same as the traditional method above, is that the eight

hour battery life of the camera pill is not long enough to make it to the large intestine,

making colonoscopies and other such procedures still necessary. Also, you do have to

wear a bulky belt all day, and fast starting after your evening meal the previous day.

How It Works


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Down the Hatch

The patient gulps down the capsule, and the digestive process begins. Over the next

eight hours, the pill travels passively down the esophagus and through roughly 20 to 25

feet of intestines, where it will capture up to 870,000 images. The patient feels nothing.

Power Up

The Sayaka doesnt need a motor to move through your gut, but it does require 50

milliwatts to run its camera, lights and computer. Batteries would be too bulky, so the

cam draws its power through induction charging. A vest worn by the patient contains a

coil that continuously transmits power.

Start Snapping

When it reaches the intestines, the Sayaka cam begins capturing 30 two-megapixel

images per second (twice the resolution of other pill cams). Fluorescent and white LEDs

in the pill illuminate the tissue walls.

Spin For Close-Ups

Previous pill cameras place the camera at one end, facing forward, so the tissue walls

are visible only in the periphery of their photos. Sayaka is the first that gets a clearer

picture by mounting the camera facing the side and spinning 360 degrees so that it

shoots directly at the tissue walls. As the outer capsule travels through the gut, an

electromagnet inside the pill reverses its polarity. This causes a permanent magnet to

turn the inner capsule and the image sensor 60 degrees every two seconds. It

completes a full swing every 12 secondsplenty of time for repeated close-ups, since

the capsule takes about two minutes to travel one inch.

Offload Data

Instead of storing each two-megapixel image internally, Sayaka continually transmits

shots wirelessly to an antenna in the vest, where they are saved to a standard SD

memory card.


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Deliver Video

Doctors pop the SD card into a PC, and software compiles thousands of overlapping

images into a flat map of the intestines that can be as large as 1,175 megapixels.

Doctors can replay the ride as video and magnify a problem area up to 75-fold to study

details.

Leave the Body

At around $100, the cam is disposable, so patients can simply flush it away.

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