Under the robotic knife - COVER STORY

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How technology is enabling the robotic surgeon. By David Boothroyd.

If you need an operation, the question everyone wants answered is: how good is the surgeon? But today – and even more so in the future – the question should be: how good is the surgeon’s robotic assistant? The potential benefits of robots in the operating theatre have been discussed for years, but it is only now that they are starting to have a major impact, at least for some types of operation. The US is leading the field, and here the best established medical robot, called Da Vinci, is rapidly becoming the preferred option for many types of operation. These include radical prostatectomy (the removal of the prostate gland, typically because of cancer), various kinds of cardiac and gastrointestinal surgery, and hundreds of others. The Da Vinci system is being used in more than 300 hospitals, mostly in North America and Europe. It has helped surgeons to perform thousands of operations – an estimated 16,000 in 2004. But it is expensive, costing more than $1million, which naturally limits its use. Now, thanks to falling costs of the required electronic and computing technologies, much more affordable robotic systems are appearing, which look set to make them used more widely over the next few years. Despite this new surge of interest and development in robotic surgery, the field is not new. For example, it was more than 20 years ago that a Puma 560 robot was used to place a needle for a brain biopsy under the guidance of a CT scanner. In 1988, a Probot system helped in a prostate operation, and in 1992, the Robodoc was used to mill out precise fittings in the femur for hip replacements. A recent study by Imperial College showed that robot assisted knee surgery, using a system called Acrobot, was significantly more accurate than the conventional approach.