Laparoscopic and Robotic Surgery Training

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Global Status of Robotic Surgery
R. K. Mishra World Laparoscopy Hospital Gurgaon
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First robot was shown in a Movie Metropolis 1926
Robot word was coined by Czech writer Karel
Capek It stands for artificial humans
Courtesy of Harald Fischer, Institute for Medical
Technology and Biophysics, Frankfurt
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First da Vinci Prototype

• In 2001 after FDA approval first use on human

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Master Slave Manipulator
Robotic Surgery
World Laparoscopy Hospital
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Trans Atlantic MAS
September 7, 2001, First transatlantic surgery
took place from New York to Strasbourg.
Globalization of Surgery
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Advantages
Robotic Surgery Laparoscopic Surgery
3 D Vision 2 D Vision
Motion scaling Not possible
Wrist Articulation Limited Range of Motion
Fluid Movement Rigid Movement
Tremor Filter Tremor Magnified
Remote Sensing Technology Abdominal wall is Fulcrum
Ergonomically Intuitive Poor Ergonomics
25X Magnification 10X Magnification
MIES Not possible
Haptic Feedback Limited Tactile Feedback
Telesurgery with teleproctoring Not possible
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Seven Degree of Freedom
World Laparoscopy Hospital
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Three Dimension Vision
3D Vision
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Telementoring Remote Proctoring
TELEMENTORING - is remote guidance or
teaching TELEPROCTORING - supervision from a
distance using error log technology
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Cholecystectomy
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Robotic Appendectomy
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Robotic Hernia
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Hysterectomy and Myomectomy
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Clinical Limitations

• Not cost effective over standard laparoscopic
  approach for simple surgery.
• Increased operative time observed
• Not necessary where precise is dissection not
  required
• Large Operating room space required
• Good Patient Side assistant is required

World Laparoscopy Hospital
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2nd Generation Competitor Titan Medical Signs
MOU with Apollo Hospitals for Amadeus Robotic
Surgical System

• Some of the notable features of the Amadeus
  System are
• Multi-articulating arms,
• Sound communication system,
• Enhanced vision systems and
• Real-time feedback to surgeons to know the impact
  of their movements while performing surgery.

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Internal Locomotion Robot
Walking robot with legs
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Micro Robots Nano Robots
Designed at Sandia National Laboratories, New
Mexico

• Miniaturization to extremes
• Can roam within human body
• Equipped with DNA joints and carbon nano tubes
• Specific functions - Repairing/Destroying
  individual cells

• 1.63 cm3
• Mounted with cameras, temperature sensors,
  microphones, micro tools

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Protein DNA based Nano Robot
Powered autonomously by ATP Biomolecular Actuators
World Laparoscopy Hospital
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Conclusion

• Technology is always good - it is neither angel
  nor evil
• It is up to us to breathe the moral and ethical
  life into these technologies
• We should apply them with empathy and compassion
  for each and every patient
• Robotic surgery is one example of such technology
  that reduces operative morbidity, hospital stay,
  and recovery, while improving clinical outcomes,
  but at what point do the BENEFITS justify the
  increased EXPENSE?

World Laparoscopy Hospital
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Thanks!
World Laparoscopy Hospital