From Science Fiction to Reality: Robot-Assisted Surgery

Over fifty years ago, the Department of Defense (DOD) began to explore the concept of robot-assisted trauma surgery as a means of decreasing battlefield casualties. The initial idea was telesurgery, in which a signal would be bounced from a hospital or medical facility via satellite and transmitted to a mobile operating room unit in remote battlefields. After setbacks in signal transmission to these remote areas, the research shifted to robotic platforms that could perform minimally invasive surgical procedures.

In 1993, Anthony J. LaPorta, MD, FACS, Director of the Office of Military Affairs at RVUCOM, was brought on board to assist in testing the Green TelePresence Machine, a product of the Stanford Research Institute International and the US Army Research Command^[1]. He performed the first incision using the robotic surgical system, as well as the first gastric and vascular procedures during animal trials. The Green TelePresence Machine was a precursor to Intuitive Surgical, Inc.’s ^[2] da Vinci® Surgical System, the most prominently used robotic platform in the world today.

Early robot designs such as the Green TelePresence Machine also began to incorporate Degrees of Freedom (DOF) ^[3], the motion capabilities of the robotic arm (of which humans have seven). It was not until 1995 that Intuitive expanded upon surgical robots by adding the sixth and seventh DOFs to early versions of the da Vinci® (namedLenny and Mona). The da Vinci® also improved upon fragile instrument exchange coupling, inadequate visualization, and an unwieldy setup process^[4]. After several trials, including a mitral valve repair, the U.S. Food and Drug Administration cleared the da Vinci® for general Laparoendoscopic surgeries in 2000.

Today, the system has a jointed wrist-design that exceeds the natural range of motion of the human hand. With the da Vinci® model, Intuitive has added a stand-alone patient-side cart (a departure from earlier designs), a vision cart that provides communications across the system, a surgeons console with a custom-built endoscope with dual lenses, an improved stereoscopic viewer to reduce fatigue and nausea, and exchangeable instrumentation. As one of the most widely available robotic surgery systems in the world, the da Vinci® is now primarily used for minimally invasive surgeries such as hysterectomies and hiatal hernia repair.

RVUCOM’s Office of Simulation in Medicine and Surgery has held Virtual Reality da Vinci® Robotic Surgery Labs for students, allowing students to begin practicing complex surgical techniques. Surgery residents and practicing physicians have also been able to utilized this advanced technology at RVU. Decades of innovative designs turned what was once considered science fiction into reality. As for his early contributions to the development of these robotic surgical systems, Dr. LaPorta said, “The ability to change the world and save lives with no one knowing it was you is the ultimate gift to society.”

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[1] Known now as the United States Army Combat Capabilities Development Command.

[2] Intuitive Surgical, Inc. was founded in 1995 to create innovative, robotic-assisted systems that help empower doctors and hospitals to make surgery less invasive than an open approach. Working with doctors and hospitals, they continue to develop new, minimally invasive surgical platforms and future diagnostic tools to help solve complex healthcare challenges around the world. 

[3] A Degree of Freedom is a plane of movement: roll (rotational movement), yaw (a sideways movement in a horizontal plane), and pitch (an up and down movement in a vertical plane). In a human arm, excluding the hand, this translates to the following degrees: (1) Shoulder Pitch, (2) Arm Yaw, (3) Shoulder Roll, (4) Elbow Pitch, (5) Wrist Pitch, (6) Wrist Yaw, (7) Wrist Roll.

[4] George EL, Brand TC, LaPorta A, Marescaux J, Satava RM (2018). Origins of Robotic Surgery: From Skepticism to Standard of Care. Journal of the Society of Laparoendoscopic Surgeons, 22(4).