Vattikuti Urology Institute
History Timeline
It was 1921, when Karel Čapek invented the term “Robot” for a fictional humanoid in a play named R.U.R. ‘Rossum's Universal Robots’ (1920). Decades later, robots are used everywhere, from vacuuming floors and mowing lawns to assembling products from automobiles to computers. Robotic surgery, in medicine, is the use of machines guided by doctors to perform surgical procedures. The application of Robotic surgery started circa 40 years ago, with Arthrobot, the first robot to assist in surgery developed and used for the first time in Vancouver in 1983 and, has experienced a significant growth in the last two decades. Explore with us the milestones in the history and evolution of robotic surgery in the timeline below : an attempt to encapsulate the history of robotic surgery listing its developments so far.
EVENTS of
2000
2008-9
VUI surgeons in collaboration with the Cornell Institute of Robotic Surgery in New York, USA and the Institute of Urology at the University of Innsbruck in Austria report on the athermal trizonal nerve-sparing technique of robotic radical prostatectomy (RP). This technique is unique in several important ways. In particular it addresses concerns about the use of thermal energy and bulldog clamps during nerve-sparing, it incorporates steps to preserve and handle the trizonal neural structures and it presents a simplified manoeuvre to identify the bladder neck.
The athermal technique addresses concerns about the use of thermal energy and bulldog clamps during nerve-sparing, and emphasizes the importance of trizonal neural architecture.
The study analyzed 215 consecutive patients from January 2005. The operative duration was 120-240 min and the mean blood loss was 150mL. In patients potent before RP, the potency rate at 1 year after bilateral nerve-sparing was 87%. The overall surgical margin rate was 6.5% and positive margin rates for organ-confined cancer were 4.7%.
Tewari, A., Rao, S., Salamanaca-Martinez, J.I., Leung, R., Ramanathan, R., Mandhani, A., Darracott Vaughan, A., Menon, M., Horninger, W., Tu, Jiangling and Bartsch, G., Cancer control and the preservation of neurovascular tissue? How to meet competing goals during robotic radical prostatectomy. 2008 BJU International. 101, 1013-1018
2008-8
VUI surgeons participate in a multi institutional study to demonstrate the success of robotic partial nephrectomy for renal hilar tumors. Robotic assistance may facilitate tumor resection and renal reconstruction for challenging renal tumors, offering a minimally invasive and nephraon sparing surgical option for select patients who might otherwise require open surgery or total nephrectomy.
RPN was performed on 11 patients (mean age 56.4 years, range 30 to 76). Mean tumor size was 3.8 cm (range 2.3 to 6.4). Mean warm ischemia time was 28.9 min and mean opearating time was 202 minutes. Mean blood loss was 220 ml. Mean hospital stay was 2.6 days.
Rogers, C.G., Metwalli, A., Blatt, A.M., Bratslavsky, G., Menon, M., Linehan, M.W., Pinto, P.A. Robotic Paritial Nephrectomy for Renal Hilar Tumors: A Multi-Institutional Analysis. The Journal of Urology (2008) 180, 2353-2356.
2008-7
Surgeons at NIH report first successful robot assisted partial adrenalectomy with concurrent robot assisted extra-adrenal pheochromocytoma resection.
The potential advantages of robotic assistance for complex partial adrenalectomy cases include a magnified three-dimensional image and articulating robotic instruments, that may facilitate precise dissection, tumor excision and hemostasis.
Rogers, C.G., Blatt, A.M., Miles, G., Linehan, W.M., Pinto, P. Concurrent Robotic Partial Adrenalectomy and Extra-Adrenal pheochromocytoma Resection in a Pediatric patient with Von Hippel-Lindau Disease. Journal of Endourology, 2008 22 (7), 1501- 1503
2008-6
VUI surgeons report the first ever case of a robot assisted retro peritoneal cryoblation of a renal tumor
Total operative time was 381 min. Utilizing robotic assistance, the ureter, renal pelvis and the renal vein were successfully mobilized away from the tumor to enable beyond the margins of the renal tumor. Estimated blood loss is 100 cc.
Patel, M., Menon, M., Rogers, C.G., Robot Assisted retroperitoneal renal cryoblation. J Robotic Sur (2008) 2: 257-259
2008-5
VUI team reports the initial experience with a novel robotic-assisted dissection of the infrarenal aorta and iliac arteries. This novel technique may overcome the difficulty of aortic dissection in a purely laproscopic aortic surgery and serves as a bridging step toward totally robotic assisted aortic surgery.
From 02/2006 to 11/2006, 7 patients underwent robotic-assisted abdominal aortic procedures for AIOD and AAA. The use of a surgical robot for aortic surgery allowed for greater visualization and facilitated the aortic dissection over laprosopic-assisted procedures.
Lin, J.C., Reddy, D.J., Eun, D., Fumo, M., Menon, M., Robotic-Assisted Laparoscopic Dissection of the Infrarenal Aorta and Iliac Artery: A Technical description and early Results. Ann Vasc Surg 2008: 1-5
2008-4
VUI team reports case series of pure robotic ureteroneocystotomy for repair of complex UVF (ureterovaginal fistula) using the daVinci system. The daVinci provides a tremendous advantage for gross identification of viable structures within the dense scar tissue and the identification of healthy ureter for reimplantation.
In all patients, a standard 6 port approach was used. In all the cases reported, the robotic ureteroneocystotomy was completed without complication. Total console surgical time ranged from 62 to 118 min. The Foley cathetar was removed 24-48 hours after surgery. All patients were discharged completely dry with an indwelling stent in situ.
Laungani, R., Patil, N., Krane, L.S., Hemal, A., Raja, S., Bhandari, M. and Menon, M. Robotic-Assisted Ureterovaginal Fistula Repair. Report of Efficacy and Feasibility. 2008. Journal of Laparaendoscopy & Advanced Surgical Techniques. Vol 18(5), 731-734.
2008-3
VUI team reports a safe, quick and reproducible technique of robotically assisted right adrenalectomy (RRA), leveraging a high definition, magnified three-dimensional view of the operating field provided by da Vinci robot
All the adrenalectomies were done transperitonially through 5 ports, replicating predetermined surgical steps. There were no anesthesia or surgery related events and no patients had an uneventful recovery and were discharged in 0-3 days after RRA.
Robotic assistance facilitated micro dissection of fine anatomical planes around the right adrenal gland and provided direct access to the crucial ACJ (adreno-caval junction). This technique permits ligation of the adrenal vein as an initial step. with no need to handle the adrenal glands. In the initial experience with four patients this technique was reproducible, regardless of indication or anatomical variance.
Krane, S.L., Shrivastava, A., Eun, D., Narra, V., Bhandari, M., and Menon, M. A four-step technique of robotic right adrenalectomy: initial experiene. BJU International. 2008. 101, 1289- 192
2008-2
The VUI team describes a port placement technique for robtoic renal surgery that eliminates external collisions abd results in considerable flexibilty in the robotic arm movement. The technique involves the placement of the camera port laterally and robotic ports anteromedially allowed for enhanced reach of the robot into ureterovesial junction.
VUI team reports case series of pure robotic ureteroneocystotomy for repair of complex UVF (ureterovaginal fistula) using the daVinci system. The daVinci provides a tremendous advantage for gross identification of viable structures within the dense scar tissue and the identification of healthy ureter for reimplantation.
Laungani, R., Patil, N., Krane, L.S., Hemal, A., Raja, S., Bhandari, M. and Menon, M. Robotic-Assisted Ureterovaginal Fistula Repair. Report of Efficacy and Feasibility. 2008. Journal of Laparaendoscopy & Advanced Surgical Techniques. Vol 18(5), 731-734.
2008-1
the ROBODOC® Surgical System received 510(k) clearance from the United States Food and Drug Administration (FDA) for Total Hip Arthroplasty procedures. This milestone marks the only active robotic system cleared by the U.S. FDA for orthopaedic surgery.
2007
2600 robotic radical prostatectomy procedures are performed by the VUI.
The initial reports of studies from 1142 patients indicates that the intercourse rate ws 93% in men with no pre operative erectile dysfunction undergoing veil nerve-sparing surgery, although only 51% returned to baseline function.
Menon, M., Shrivastava, A., Kaul, S., Badani, KK., Fumo, M., Bhandari, M,m Peabody, J O., Vattikuti Institute Prostatectomy: Contemporary Technique and Analysis of Results. European Journal of Urology. 51 (2007) 648-658.
2006-2
2200 VIP’s are performed by the VUI. By now VIP is used not only by the robotic surgeons but also by laproscopic prostatectomists. Several centers in US, Europe and Asia have utilized the technique or modifications of the technique.
During these surgeries, the mean console times reduced from 274 min and mean intraoperative blood loss of 256ml in 2001, the operative time for the last 100 patients has been 115 min and mean console time 97 min
Kaul, S., Menon, M., Robotic radical prostatectomy: evolution from conventional to VIP. World J Urol (2006) 24, 152-160
2006-1
The robotic surgery team from the Vattikuti Urology Institute travelled to the Institute of Urology and Nephrology, Kuala Lumpur Hospital (KLH) in Malaysia to perform Robotic renal surgery and extend the use of robots to perform trans-peritoneal stone surgery. The results of these 45 surgeries clearly showed that robotic extended pyelolithotomy (REP) is a safe and effective minimaly in vasive treatment alternative to PCNL (percutaneous nephrolithotomy) for some patients with staghorn calculi.
Given the advantage of robotic system including excellent visualization tissues, magnification, three dimensional view and wristed movement of the arms. The tremendous reconstructive capability using the da Vinci system allowed for water tight closire of the collecting system after stone removal.
Badani, KK., Hemal,AK., Fumo, M., Kaul, S., Shrivastava, S., Rajendram, AK., Yusoff, NA., Sundram, M., Woo, S., Peabody, JO, Mohamed, SR. Menon, M., Ronotic extended pyelolithotomy for treatment of renal calculi: a feasibility study. World J Urol (2006) 24: 198-201.
2005
Surgeons at the Vattikuti Urology Institute pioneered a new technique of nerve-sparing robotic prostatectomy. The technique that preserves the prostatic fascia or the “Veil of Aphrodite” minimizes morbidity and maximizes functional outcomes. The technique is better than conventional nerve-sparing techniques in maintaing potency, and without compromising cancer control. The technique was possible due to the stereoscopic vision and magnification of the da Vinci robot, which permits accurate dissection of the fascial planes
Veil of Aphrodite referes to the prostatic fascia. The prostate is covered by anteriolaterally by prostatic fascia, also called lateral pelvic fascia or the pareital layer of endopelvic fascia. The prostatic fascia is rich in vessels, nerves and smooth muscle.
Study indicates that of the 154 men that underwent the Veil NSS (nerve sparing surgery), 96% of the men reported having had intercourse and 71% had recovered normal erectile function. No patient had a PSA recurrence in 12 months, 97% of the men were continent at 1 year and the median time for continence was 14 days The results of the follow up on the patients at 12 month showed that 34 of 35 (97%) undergoing fascia -preserving robotic radical prostatectomy had erections strong enough for vaginal penetation and 30 (86%) had normal erections.
Kaul.S., Savera, A., Badani, K., Fumo, M., Bhandari, A. and Menon, M., Funtional outcomes and oncological efficacy of Vattikuti Institute prostatectomy with Veil of Aphrodite nerve-sparing: an analysis of 154 consecutive patients. BJU int. 2005; 97, 467 - 472. Kaul, S., Bhandari, A., Hemal, A,m Savera, A., Shrivastava, A., Menon, M. Robotic radical prostatectomy with preservation of the prostatic fascia: A feasibilty study. J Urology 66 (6) 2005. Menon M., Kaul, S., Bhandari, A., Shrivastava, A., Tewari, A., Hemal, A., Potency following robotic radical prostatectomy: A questionnaire based analysis of outcomes after conventional nerver sparing and porstatic fascia sparing techniques. L urology, 174, 2291- 2296 2005.
2004-7
The team exceeds 1200 cases of robotic surgery various procedures have been performed, including anatomical radical prostatectomy for localized cancer of the prostat, retro pubic prostatectomy for benign hyperplasia of the prostate, radical cystectomy with urinary diversion for muscle-invasive cancer of the bladder in men and women, pylesplasty, adrenalectomy, nephrectomy, hysterectomy, myo mectomy, colpo suspension and vaso-vasal and vaso-epididymal anastomosis using the daVinci Robotic system
Hemal, AK., Eun, D., Tewari, A., Menon, M., Nuances in the optimum placement of ports in pelvic and upper urinary tract surgery using the da Vinci robot. Urol Clin N Am 31 (2004) 683-692.
2004-6
Menon et.al., develop an original technique for performing robotic radical cystectomy (standard and uterus-preserving) in women using the da Vinci system and for constructing an ileal and orthotopic neobladder.
The average operating time for the robotic radical cystectomy was 160 min and the mean operating times for ileal conduit and orthotopic neo bladder were 130 and 180 min. respectively. The mean blood loss was less than 100 mL. The surgical margins of the specimen were free of tumor in all patients.
Menon, M., Hemal AK., Tewari, A., Shrivastava, A., Shoma, AM., Abol-Ein., Hassan., Ghoneim, MA., Robot-Assisted Radical Cystectomy and Urinary Diversion in Female Patients: Technique with Preservation of the Uterus and Vagina. J Am Coll Surg 2004; 198: 386-393.
2004-5
The introduction of robotic-assisted laparoscopic urologic surgery emerges as a natural expansion of traditional laparoscopy, in which it offers the inherent advantages of minimally invasive surgery while improving the surgeons' ability to perform technically challenging operations in cases where traditional laparoscopy is difficult.
Menon et al use the Vattikuti Institute Prostatectomy as an enhancement to the robot-assisted radical prostatectomy for prostate cancer. The team has performed 750 radical prostatectomies using this approach. Menon et. Al., used assisted robotics surgery in complex and advanced uro-oncological surgery as demonstrated in the development of robot-assisted radical cystoprostatectomy for male patients with bladder cancer and both standard and uterus preserving techniques in female patients. Various groups report the feasibility of robotic assistance in nephrectomy which included robotic nephrectomies and robotic adrenalectomies and robot assisted laprascopic adrenalectomies. These teams reported it as a safe alternative to conventional laproscopic procedures. Robots are used in performing robot-assisted pyeloplasty. da Vinci assisted robotic system resulted in overall decreased operative time. Numerours other authors have also reported that the robotic articulating wrist allows precise dissection. laproscopic suturing and tobotic dismembered pyeloplasty in adults and in children. Robotic technology has been used for male reproductive microsurgery to perform vaso-vasal and vaso-epididymal anastomosis with accuracy and enhanced support.
Menon, M., Hemal, A.K., Tewari, A., Shrivastava, A., Shoma, A.M., El-Tabey, N.A., Shabban, A., Abol-Enein, H., and Ghoneim, M.A., Nerve Sparing robot-assisted radical cystoprostatectomy and urinary diversion. 2003 BJU International . 92, 232-236. Beecken, WD. Wolfram M., Engl T.et al. Robotic assisted laparoscopic radical cystectomy and intra abdominal formation of an orthotopic ideal neobladder. Eur Urol 2003. 44 (3), 337 -9. Gill IS, Sung GT, Hsu TH, Merany Am, Robotic remote laprascopic nephrectomy and adrenalectomy: the initial experience. J Urol 2000; 164: 2062-2085 Talamini MA, Chapman S., Horgan S., Melvin WS., A prospective analysis of 211 robotic assisted surgical procedures. Surg Endosc 2003: 17: 1521- 1524. Desai MM, Gill IS, Kaouk, JH et. al., Robotic-assisted laparoscopic adrenalectomy. Urology 2002: 60: 1104 - 1107. Gettman MT, Peschel R., Neururer R., Bartsch, G. A comparison of laparoscopic pyeloplasty performed wiht the daVinci robotic system versuss standard aparoscopic techniques: initial clinical results. Eur Urol 2002: 42: 453-457. Yohannes P., Surjonrappa SC., Rapid communication: laparoscopic Anderson-Hynes dismembered pyleoplasty using the daVinci robot: technical considerations J Endourol 2003: 17: 79-83 Bentas A, Wolfram M,m Brautigam R etal Da Vinci robot assited Anderson Hynes dismembered pyeloplasty: technique and 1 year follow up. World J Urol 2003: 21: 133-138 El-Ghoneimi A., Pediatri laparoscopic surger, Curr OPin Urol 2003: 12: 329 -335. Schoor Ra, Ross L;, Niederberger C. Robotic assisted microsurgical vessel reconstruction in model system. Worls J Urol 2003; 21: 48 -49.
2004-4
VUI surgeons led by Menon have performed over 1100 cases of robotic radical prostatectomy. The team reduces the time to perform key steps (vesicourethral anastomosis) by over 50% in more than 90% of the patients and reduces the blood loss requiring no transfusion.
The operating time ranged from 70 to 160 min. and the blood loss ranged from 50 to 250 mL The actual robotic dissection time is approx. 90 to 100 min. No patient required an intraoperative blood transfusion, no one donated autologous blood, and none received erythropoetin. Over 95% of patients are discharged within 24 hours, 3% stayed becuase of social reasons and 2% stayed because of ileus.
Laparoscopic technique provides 4 degrees of freedom of movement, compared with robotic surgery which provides 6 degress of freedom. In addition the current laparoscopic displays do not provide 3D orientation and lack tactile feedback.
Tewari, A., Srivastava, A., Menon, M. and members of the VIP team. A prospective comparison of radical retropubic and robot-assisted prostatetomy: experience in one institution. BJU Int 2003; 92 (3), 205- 210. Menon, M., Tewari, A., and Members of the Vattikuti Institute Prostatectomy team. Robotic radial prostatectomy and the Vattikuti Urology Institute Technique: An Interim Analysis of Results and Technical Points. Urology 2003; 61: 15-20 Menon, M., Hemal AK. Tewari, A. Shrivastave A, Bhandari A. Technique of apical dissection of prostate and urethrovesical anastomosis in robotic in radical prostatectomy. BJU Int 2004; 93: 715-9
2004-3
2 teams reported success in performing the difficult robotic procedures of RRCP, RRC and urinary diversions. (1, 2) Menon and team continue to apply the advantages of robotic assistance in advanced uro-oncological surgery, such as robot-assisted radical prostatectomy and robot-assisted radical cystoprostatectomy (RRCP) for patients who have muscle invasive bladder cancer.
RRCP was performed in 21 men and RRc was performed in three women. In men, the technique of nerve-sparing RRCP was used unless there were specific issues. In 2 women, a new technique was completed, that allowed preservation of urethra, uterus, vagina and both ovaries.
Beecken, WD. Wolfram M., Engl T.et al. Robotic assisted laparoscopic radical cystectomy and intra abdominal formation of an orthotopic ideal neobladder. Eur Urol 2003. 44 (3), 337 -9. Yohannes P., Puri V. Yi, B. Khan AK., Sudan R. Laparoscopy-assisted robotic radical cystoprostatectomy with ideal conduit urinary diversion for muscle invasive bladder cancer: initial 2 cases. J Endourol 2003: 17 (9). 729 - 32
2004-2
The challenging techniques of Vasovasostomy and vasoepididymostomy procedures are performed with robot assistance with great success. The ultrafine setting of the robotic gear allows the surgeon to make large gross movement that are reduced to fine movements at the end of the robot arms - reducing the normal physiological tremor on part of the surgeon.
The robot increases the technical precision of the anastomosis by eliminating the need the normal physiological tremor.
Fleming, Caleb. Robot-assisted vasovasostomy Urol Clin N Am 31 (2004) 769-772 Kuang, A, Shin PR, Matin S., Thomas AJ Jr. Initial evaluation of robotic technology for microsurgical vasovasostomy. J Urol 2004: 171 (1): 300-3
2004-1
FDA cleared the marketing of a robotic-like system to assist in coronary artery by-pass surgery enabling the surgeon to perform heart surgery while seated at a console with a computer and video monitor.
2003-7
July 2003 – Menon et al report first robot assisted radical cystectomy.
Ref: J Am Coll Surg. 2004 Mar;198(3):386-93
2003-5
Menon and the team develop a laparoscopic technique for nerve sparing RRCP (Robot assisted radical cystoprostatatectomy) using the daVinci system. The feasibility study of a three-step robot-assisted, nerve-sparing radical cystoprostatectomy shows that the procedure combines the oncological concepts of open surgery with the technical nuances of robotic surgery.
In the technique, the bowel segment can be exteriorized and the most complex form of the orthotopic bladder can be created through the incision used to deliver cystectomy specimen.
Menon, M., Hemal, A.K., Tewari, A., Shrivastava, A., Shoma, A.M., El-Tabey, N.A., Shabban, A., Abol-Enein, H., and Ghoneim, M.A., Nerve Sparing robot-assisted radical cystoprostatectomy and urinary diversion. 2003 BJU International . 92, 232-236.
2003-4
VUI team continues to prove VIP as a safe, effective and reproducible technique for removing the prostate. In most patients, it is done under 3 hours with minimal blood loss and a few complications. As the technique is refined, there has been a progressive decrease in operative time, blood loss, positive margins and complications.
With this approach, the advantages of creating a large intraperitonial working space are combined with those of extraperitoneal dissection. The issue of angled and 0-degree lens aids in easier identification of the anatomical lanmarks and results in less down timefor position re-orientation.
In the detailed study 100 patients undergoing RRP were compared with 200 patients undergoing VIP. While the variables before the surgery, the operative duration and pathological stages were comparable, there were significant differences in the measured outcomes. The blood loss was 910 and 150 mL for RRp and VIP, respectively and transfusion was greater after RRP (67% vs. none). There were four times as many complications after RRP (20% vs. 5%), the haemoglobin level at discharge was lover (100 vs. 130 g/L) and the hospital stay longer (3.5 vs. 1.2 days. 93% of the VIP and none of the RRP were dischsrged within 24 hrs; the duration of catheterization was twice as long after RRP (15.8 vs 7 days). Positive margin was more frequent after RRP (23% vs 9%). After VIP, patients achieved continence and return of erection more quickly than after RRP (160 vs 44 and 180 vs. 440 days) The median return to intercourse was 340 days after VIP but after RRP half the patients have as yet not resumed intercourse after 700 days.
2003-3
VUI team completes the anatomical study with the help of an anatomist to unravel the course of neurovascular bundles in the male pelvis area, with the goal to develop a clear map to assist in the performance of nerve sparing laparoscopic or robotic radical prostatectomy with good anatomical landmarks adapted for the new surgical approach.
Based on the dissection, the location of the pelvic plexus, course of the NVB and its relationship with the seminal vesicle, Lateral prostatic fascia and prostate were clearly identified.
In the United States, the first robot assisted radical prostatectomy may have been performed at Henrico Hospital in Virginia, although the details were never reported. Binder and Kramer performed minilaparotomy. They inserted the robotic ports under direct vision, closed the incision and proceeded with the prostatectomy.
Tewari, A., Peabody. James, O,Fischer, M., Sarle, R., Vallancien, G.,Delmas, A., Hassan, A., Bansal, A., Hemal, Ashok, K., Guillonneau, B., Menon, M. An Opearative and Anatomic Study to Help in Nerve Sparing during Laparoscopic and Robotic Radical Prostatectomy. European Urology., 43 (2003) 444-454.
2003-2
Mani Menon and his team continue to finesse the VIP technique and report success in over 350 cases.
The mean operative time is 160 min and mean blood loss is 156 mL. No patient required any blood transfusion. At 6 months, 82% of the men who were < 60 years of age and 75% of the men who were > 60 had the return of the sexual function. At 6 months, 96% of patients were continent
Menon, M., Tewari, A., and Members of the Vattikuti Institute Prostatectomy team. Robotic radial prostatectomy and the Vattikuti Urology Institute Technique: An Interim Analysis of Results and Technical Points. Urology 2003; 61: 15-20
2003-1
Computer Motion merged with Intuitive Surgical, Inc., in June of 2003
2002-2
Dr Mani Menon and his team developed a procedure - the Vattikuti Institute Prostatectomy (VIP) using the da Vinci Surgical System. The procedure resembles open radical prostatectomy more than its laparoscopic variant, overwritten by technical nuances that are derived from robotic technology. By Nov 2002, > 300 Robotic Prostatectomy and 270 VIP’s are performed. Patients undergoing robot-assisted prostatectomy had shorter operating room times, lower estimated blood loss (EBL), lower complication rates, earlier urethral catheter removals, and a shorter hospital length of stayaccording to published studies. Functional outcomes in terms of continence and potency were also improved. These benefits were attributed to the surgical robot's 3-dimensional vision, high quality and intuitive controls, and a high degree of freedom in instrument movements.
Although oncological outcomes and positive surgical margin (PSM) rates are equivalent between robot-assisted radical prostatectomy (RARP) and radical retropubic prostatectomy (RRP), RARP may have a benefit in a long-term cancer-recurrence free survival rate in D'Amico-classification high-risk prostate cancer patients. A systematic review by Ficarra et al. revealed that functional outcomes were favorable in RARP over RRP. Most of all, the enhanced visualization and dexterity of the surgical robot have helped to reduce postoperative complication rates, as demonstrated in a series of 3,317 patients by Agarwal et al. in 2011.
The robotic approach allows us to take very precise periurethral soft tissue biopsies, lowering the apical positive-margin from 24% to 5%.
Menon, M., Shrivastava, Alok, Sarle, Richard, Hemal, Ashok and Tiwari, Ashutosh : Vattikuti Institute Prostatectomy: A Single Team Experience of 100 Cases. Journal of Endourology Volume 17, Number 9, November 2003. Menon, M., Shrivastava S., Baize B., et al. Robot assisted anatomic sub-peritoneal prostactectomy: A stereoscopic video, J Urol 2002; 167(4S):180 Menon, M., Shrivastava A, Tewari A et. al Laproscopic and robot assisted radical prostatectomy : establishment of a strctured program and preliminary analysis of the outcomes. J Urol 2002; 16: 945-9 Menon, M, Tewari A, Peabody J. vattikuti Institute prostatectomy team: Vattikuti Institute prostatectomy: technique. J Urol 2003: 169: 2289-92.
Wooju Jeong, Ramesh Kumar, Mani Menon Past, present and future of urological robotic surgery. Investig Clin Urol. 2016 Mar; 57(2): 75–83.
Published online 2016 Mar 11. Doi: 10.4111/icu.2016.57.2.75
2002-1
The institute completed 115 open radical prostatectomies and 98 underwent either laparoscopic or robot-assisted prostatectomy in the duration of one year.
2001-7
ZEUS robotic system developed by Computer Motion was used in the trans-Atlantic operation. A doctor in New York removed the diseased gallbladder of a 68-year-old patient in Strasbourg, France.
2001-6
Prof. Marescaux used the Zeus robot to perform a cholecystectomy on a pig in Strasbourg, France while in New York.
2001-5
First daVinci, “Leonardo” installed at the Henry Ford Institute. The robotic system provides three-dimensional visualization, intuitive movement of instruments, and 360 manoeuvrability of the tips of the instruments through the laparoscopic ports. The systematic study of the robot-assisted surgical techniques at VUI studies establishes that robot-assisted anatomic prostatectomy is a safe, effective and reproducible procedure for the management of clinically localized prostate cancer.
The team developed the operation was based on the scientific foundation of anatomic radical prostatectomy as described by Walsh and the laparoscopic prostatectomy developed by Montsouris.
The robotic team (one console-side and another patient side surgeon) spent 1 month in L’Institut Mutualiste Montsouris learning the basic laproscopic skills. The team then trained on the da Vinci Surgical Systems.
Menon, M., Shrivastava, A., et al. Laproscopic and robot assisted radical prostatectomy. establishment of a structured program and the preliminay analysis. Menon, M., Shrivastava, A., Tewari, A., Sarle, Richard., Hemal, A., Peabody, James, O. and Vallencien, G. : Laparoscopic and Robot assisted radical prostatectomy: Establishment of Structured Program and Preliminary Analysis of Outcomes. J Urol 2002. 168(3). 945-949
2001-4
The CyberKnife® became the first image-guided robotic technology to receive FDA clearance for non-invasive cancer surgery to provide radio surgery for lesions anywhere in the body when radiation treatment is indicated.
2001-3
ZEUS® Robotic Surgical System from Computer Motion receives FDA regulatory clearance with the FDA decision for U.S. surgeons to assist in the control of blunt dissectors, retractors, graspers, and stabilizers a variety of instruments to perform a wide range of robotically assisted laparoscopic and thoracic procedures.
2001-2
FDA cleared the marketing of the CyberKnife with Dynamic Tracking Software (DTS) developed by Accuray Incorporated to provide radiosurgery for lesions, tumors, and conditions anywhere in the body when radiation treatment is indicated.
2001-1
SOCRATES™ Robotic Telecollaboration System was created by Computer Motion, Inc.. It includes integrated telecommunication equipment along with the robotic devices in order to provide remote surgical telecollaboration. This system was used for the first-ever transatlantic telesurgery performed.
November 2000-1
November 29, 2000 The da Vinci robot surgical system received Food and Drug Administration (FDA) approval for abdominal surgery. Vallancien and Menon perform the first robotic prostectomy on November 29, 2000 at the Vattikuti Urology Institute, Henry Ford Hospital in Detroit. The first patient, an autoworker from Detroit who was experienced in working with the first industrial robots and understood how precise they were. The first daVinci robot, “Leonardo” is leased and integrated in to the minimally invasive prostatectomy program at Detroit. At the same time, Abbou and collegues performed the first pure robot assisted radical prostatectomy. Small case series were then reported by Pasticier et.al and Rassweiler et. al.Vallancien and Menon perform the first robotic prostectomy on November 29, 2000 at the Vattikuti Urology Institute, Henry Ford Hospital in Detroit. The first patient, an autoworker from Detroit who was experienced in working with the first industrial robots and understood how precise they were.
November 2000
The da Vinci robot surgical system received Food and Drug Administration (FDA) approval for abdominal surgery.
July 11th 2000
Intuitive Surgical Inc. received clearance from the FDA to market the da Vinci Surgical System in the United States for use in laparoscopic surgical procedures.
March 13th 2000
Dr. Francois Laborde of L’Institut Mutualiste Montsouris Chiosy performed the first time pediatric cardiac procedures using Computer Motion’s Zeus robotic assistance to perform seven fully endoscopic closures of the patent ductus arteriosis (PDA).
March 7th 2000
Dr. Ralph Damiano, Jr., at the Milton S. Hershey Medical Center at Penn State College of Medicine in Hershey performed the first robotic assisted beating heart bypass in the United States using the Zeus Robotical Surgical System.
2000-3
daVinci robot gets FDA approval for abdominal surgery. Vallencien performs the first robot assisted prostectomy at VUI on Nov. 29th 2000.
daVinci robot is leased and integrated in to the minimally invasive prostatectomy program at Detroit. At the same time, Abbou and collegues performed the first pure robot assisted radical prostatectomy. Small case series were then reported by Pasticier et.al and Rassweiler et. al.
Pasticier G., Rietbergen, JB et al. Robotically assisted laparoscopic prostatectomy: feasiblity study in men, Eur Urol, 2001; 70-74 Binder J.,Kramer, W., Robotically assisted laparoscopic prostatectomy. BJU Int, 2001: 87(4) 408 - 410. Abbou CC, Hoznek A., et al. Remote laparoscopic radical prostatectomy carried out with a robot. Report of a case. Prog Urol. 2000: 10 (4): 520 - 523 Rassweiler, J., Frede T., et. al. Telesurgical laparoscopic radical prostatectomy. Initial experience. Eur Urol. 2001; 40 (1): 75-83Pasticier G., Rietbergen, JB et al. Robotically assisted laparoscopic prostatectomy: feasiblity study in men, Eur Urol, 2001; 70-74 Binder J.,Kramer, W., Robotically assisted laparoscopic prostatectomy. BJU Int, 2001: 87(4) 408 - 410. Abbou CC, Hoznek A., et al. Remote laparoscopic radical prostatectomy carried out with a robot. Report of a case. Prog Urol. 2000: 10 (4): 520 - 523 Rassweiler, J., Frede T., et. al. Telesurgical laparoscopic radical prostatectomy. Initial experience. Eur Urol. 2001; 40 (1): 75-83
2000-2
The advent of surgical robotics allows practitioners of open surgery to perform laproscopic radical prostatectomy. Further studies by groups causes resurgance in the interest in minimally invasive surgical treatment of prostate cancer.
Abbou and Colleagues, Rassweiler and associates, Binder and associates described and validated their techniques of laparoscopic prostatectomy that interest resurged in minimally invasive surgical treatment of prostate cancer.
Abbou CC, Salomon L. Hoznek A et al, Laparoscopic radical prostatectomy: the Montsouris technique. J Urol 2000; 55: 630-4
2000-1
Guy Vallancien performed the first robot assisted radical prostatectomy using the da Vinci Surgical System. This technique called as the Montsouris technique became the “gold standard” for laproscopic prostectomy. The landmark study by Guillonneau and Vallancien demonstrates that the laparoscopic radical prostectomy could be done safely and effaciously within a resonable operative time. This study triggered the world wide interest in minimal invasive surgery.
They reported excellent short term functional results, with 45% potency at 3 months and 72% continence within 6 months. In 1992,Schuessler had described the first laproscopic radical prostectomy. However, The procedure took too long and offered little advantage over conventional retropubic radical prostectomy. in our opinion, although it was a first described instance of the laproscopic radical prostectomy, the process was riddled with too many issues and did not pave the path for this type of surgery.
GUILLONNEAU, B.; VALLANCIEN, G.: “Laparoscopic radical prostatectomy: the Montsouris technique”. J Urol, 163: 1643, 2000 Schuessler, W.W., Schulman, P.G., Clayman, R.V. and Kavoussi, L.R.: Laparoscopic radical prostectomy: initial short-term experience. Urology, 50 : 854, 1997
2000-Vattikuti Institute Prostatectomy
The robotic approach in prostate surgery was introduced in originally in 2000 and at that time, only a few studies showed feasibility via a case report or series without clinical benefits. The robotic approach, known as The Vattikuti Institute Prostatectomy (VIP) has now been adopted exponentially since its introduction in 2000, when it was conceived at the Vattikuti Urology Institute (VUI) by Dr. Mani Menon.
Demonstrating a benefit in terms of perioperative outcomes reflected the initial experience with robotic prostatectomy at the VUI. Patients undergoing robot-assisted prostatectomy had shorter operating room times, lower estimated blood loss (EBL), lower complication rates, earlier urethral catheter removals, and a shorter hospital length of stay. Functional outcomes in terms of continence and potency were also improved. These benefits were attributed to the surgical robot's 3-dimensional vision, high quality and intuitive controls, and high degree of freedom in instrument movements. Although oncological outcomes and positive surgical margin (PSM) rates are equivalent between robot-assisted radical prostatectomy (RARP) and radical retropubic prostatectomy (RRP), RARP may have a benefit in a long-term cancer-recurrence free survival rate in D'Amico-classification high-risk prostate cancer patients. A systematic review by Ficarra et al. revealed that functional outcomes were favorable in RARP over RRP. Most of all, the enhanced visualization and dexterity of the surgical robot have helped to reduce postoperative complication rates, as demonstrated in a series of 3,317 patients by Agarwal et al. in 2011. From: Link
The surgical technique in robotic prostatectomy has evolved in many ways over the last 15 years. Initial surgical technique imitated a laparoscopic approach, which started posteriorly to dissect the seminal vesicles and vasa deferentia, followed by the bladder takedown to approach the bladder neck. It was not long before this posterior approach was supplanted by what we now think of as the VIP technique, wherein the prostate is approached anteriorly, starting with the bladder takedown, followed by the bladder neck, then dissection of the seminal vesicles and vasa deferentia. This change enabled the robotic approach to be applied on patient populations with higher body mass indices. Furthermore, progressive anatomic studies revealed that the neural tissue was not confined to a "neurovascular bundle," but rather spread over the wider surface of the prostatic fascia. We hypothesized that the preserved neural tissue of the anterolateral aspects of the periprostatic fascial layer, which we named the "Veil of Aphrodite," could potentially allow for greater nerve preservation. We found that a bilateral "Veil of Aphrodite" technique used in men with localized prostate cancer and normal baseline erectile function resulted in better recovery of postoperative erectile function and a higher percentage of erections firm enough for intercourse at 12 months postoperatively, compared to men undergoing a standard bilateral nerve sparing technique. From: Link
- http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4791673/
- http://www.ncbi.nlm.nih.gov/pubmed/16360454/
2000-Vattikuti Urology Institute
The first urologic robotic program in the world was built at the Vattikuti Urology Institute, Henry Ford Hospital Detroit, Michigan, in 2000 under the vision of surgical innovator, Dr. Mani Menon for the radical prostatectomy. The robot-assisted radical prostatectomy continues being modified with techniques to improve perioperative and surgical outcomes. The application of robotic surgical technique has since been expanded to the bladder and upper urinary tract surgery. The evolution of surgical technique and its expansion of application will continue to improve quality, outcome parameters and experience for the patients. From: Link
The Vattikuti Urology Institute (VUI) at Henry Ford Hospital in Detroit, Michigan, USA established the first urologic robotic surgery program in the world in 2000. It would not have happened without 3 crucial factors: an innovative idea, an experienced surgeon with tremendous foresight, and considerable philanthropic funding. In keeping with the legacy of Henry Ford and the spirit of innovation, we sought to develop and improve upon techniques of minimally invasive prostate surgery. Initially, Dr. Mani Menon and his colleagues adopted a laparoscopic approach for radical prostatectomy in collaboration with Dr. Guy Vallencien and Dr. Bertrand Guillaneau, skilled surgeons from France. However, it became apparent that due to the different body habitus of American men compared to Europeans, the laparoscopic approach was not as comparable to the retropubic approach as expected. The advent of a robotic surgical system approved for cardiac surgery offered a potential solution. Dr. Menon's experience informed his foresight in seeking to apply the surgical robot to urologic surgery. With the generous support from the Raj and Padma Vattikuti Foundation, a perfect storm gathered to initiate our journey into the robotic era. From: Link
EVENTS of
1990
December 9th 1999
Dr. Ralph Damiano, Jr., at the Milton S. Hershey Medical Center at Penn State College of Medicine in Hershey performed the first robotic assisted beating heart bypass in the United States using the Zeus Robotical Surgical System.
Nov 22nd 1999
The first closed-chest beating heart cardiac hybrid revascularization procedure is performed at the London Health Sciences Centre (London, Ontario). Dr. Douglas Boyd used a Zeus surgical robot to perform an endoscopic, single-vessel heart bypass surgery on a 55 year-old male patient’s left anterior descending artery
Sept 24th 1999
Dr. Boyd of London Health Sciences Centre’s (LHSC) University (Ontario, Canada) performed the world’s first robotically-assisted closed-chest beating heart cardiac bypass operation on 60-year-old dairy farmer John Penner using the Zeus system, in a clinical trial.
1999 Heart Bypass
On September 2nd 1999, Dr. Randall Wolf and Dr. Robert Michler performed the first robotically assisted heart bypass in the USA at the Ohio State University.
September 1999
German surgeons in the Department of Thoracic and Cardiovascular Surgery at the Johann-Wolfgang von Goethe University Hospital in Frankfurt, successfully completed the world’s first closed-chest Atrial-Septal Defect (ASD) closure, which was totally endoscopic through three ports of 1 cm using the Zeus system
July 1999
Professor Vigano, Dr. Rinaldi, and the surgical team, successfully perform a fully endoscopic, closed-chest cardiac surgical procedure using the da Vinci Surgical system at The San Matteo Hospital in Pavia cardiac surgical
1998 Robotic Fallopian Tube Reversal
Reported in Virtual Medical Worlds Monthly September 29, 1999:
The ZEUS robotic surgical system, developed by Computer Motion Inc., has assisted a team of surgeons at the Cleveland Clinic in performing a fully endoscopic fallopian tube reconnection procedure. The intervention was carried out in July, last year. As a result, the world's first child, born ever after this kind of reversal operation, has been successfully delivered ten days ago.
The fallopian tube reconnection procedure, referred to as tubal reanastomosis, was performed by Dr. Tommaso Falcone, who is head of the Reproductive Endocrinology and Infertility Section at the Cleveland Clinic, situated in the city of the same name. Dr. Falcone used Computer Motion's ZEUS robotic surgical system as part of a clinical trial, approved by the United States Food and Drug Administration (FDA).
Full article
1998-2
Dr Frank Diamiano performed the first procedure in the United States with a reanastomosis of a fallopian tube using the Zeus system, as part of the clinical trial.
May 1998-2
Dr. Friedrich-Wilhelm Mohr using the da Vinci surgical robot performed the first robotically assisted heart bypass at the Leipzig Heart Centre in Germany. A week later, Mohr performed the first coronary anastomosis and repaired five mitral valves (MVs) with the device [5] Mohr FW, Falk V, Diegeler A, Autschback R. Computer-enhanced coronary artery bypass surgery. J Thorac Cardiovasc Surg 1999;117:1212–1214
May 1998-1
French heart surgeon Dr. Alain F. Carpentier performed the first mitral valve repair using an early prototype of the da Vinci articulated intracardiac “wrist” robotic device.
1998-1
The AESOP 3000 (Automated Endoscopic System for Optimal Positioning) is introduced to the market.
The AESOP 3000 effectively acts as a third arm that works in synchrony with verbal commands, allowing the surgeon to have direct control of the endoscope, and provides a motionless image from which to operate, no matter how long the procedure. The robotic arm automatic the tedious and often tiresome task of holding the endoscope, freeing nurse resources to perform other important tasks.
1997-3
Jacques Himpens and Guy Cardiere in at the Centre Hospitalier Universitaire Saint-Pierre, Brussels, Belgium used the da Vinci by Intuitive Surgical Inc. system to perform the first telesurgery gall bladder operation.
World Journal of Surgery – Springer Journals Published: Nov 1, 2001 DOI: 10.1007/s00268-001-0132-2
Himpena J., Leman, G., Cardiere GB. Telesurgical laparascopic Chlocystectomy, Surg Endosc 12: 1091, 1998
1997-2
Integrated Surgical Systems Inc. purchased Innovative Medical Machines Int. (MMI), its Neuromate System and extended its field of robotic from orthopedics to neurosurgery.
NeuroMate, a neurosurgery system developed by MMI combined with Robodoc is used for surgical assistance for biopsy and tumor removal. In stereotatic neurosurgery, instead of pre-operative images, the NeuroMate system provided real-time 3D images to give surgeon precise location of a tumor.
1997-1998
French Laproscopic Surgeon Richard Gaston fom Bordeaux performed the first laproscopic removal of the prostate. He did not publish or present these results.
GUILLONNEAU, B.; VALLANCIEN, G heard about this procedure and visited Bordeaux to witnessed the surgery first hand as it was performed by Gaston Since 1997 many surgeons such as Rassweiler from Germany, Abbou in Paris and Bollens from Belgium started to work independently and publish their own modifications to the Guillonneau and Vallancien method for laproscopic prostectomy.
1997-1
The da Vinci Surgical System manufactured by Intuitive Surgical Inc., became the first assisting surgical robot to receive FDA approval to help surgeons perform laparoscopic surgery.
Jacques Himpens and Guy Cardiere in Brussels, Belgium used the da Vinci by Intuitive Surgical Inc. system to perform the first telesurgery gall bladder operation.
Himpena J., Leman, G., Cardiere GB. Telesurgical laparascopic Chlocystectomy, Surg Endosc 12: 1091, 1998
1996-2
Computer Motion introduces Zeus System into the market. Zeus only differed from the Da Vinci System only in the design of the surgeons workstation.
The Zeus system is composed of a surgeon control console and 3 table-mounted robotic arms . The right and left robotic arms replicate the arms of the surgeon, and the third arm is an AESOP voice-controlled robotic endoscope for visualization. In the Zeus system, the surgeon is seated comfortably upright with the video monitor and instrument handles positioned ergonomically to maximize dexterity and allow complete visualization of the OR environment. The system uses both straight shafted endoscopic instruments similar to conventional endoscopic instruments and jointed instruments with articulating end-effectors and 7 degrees of freedom.
1996-1
A group in Germany developed ARTEMIS - Advanced Robot and Telemanipulator System for Minimally Invasive Surgery (ARTEMIS). This was one of the first systems with arms enabled to move with six degrees of freedom and a three dimensional visualization system.
This system had remote telemanipulators like the SRI system, but the surgeon’s console had the hand input devices "over the shoulder" to provide extra manipulation abilities. This was a highly dexterous system, similar to the SRI system, but with significant differences, especially in the surgeon’s workstation. In Europe, a collaboration of Hermann Rinnsland, PhD of the Forschungszentrum Karlsruhe (Karlsruhe Nuclear Research Center, Karlsruhe, Germany) and Gerhard Buess, MD of the University of Tuebingen, in Tuebingen, Germany developed a telemanipulation robot for the handling of nuclear waste.
The system was very efficient, however after the first prototype was developed and demonstrated to be effective, funding for the Forschungszentrum project was not renewed and this promising system has yet to progress into the commercial phase.
Schurr MO, Brietwieser H, Melzer A, Kunert W, Schmitt M, Voges U, Buess G. Experimental Telemanipulation in Endoscopic Surgery. Surg Lap and Endosc, 6, pp 17-75, 1996 SCHURR, M. O.; BUESS, G.; NEISIUS, B. et al: “Robotics and telemanipulation technologies for endoscopic surgery. A review of the ARTEMIS project. Advanced Robotic Telemanipulator for Minimally Invasive Surgery”. Surg Endosc, 14: 375, 2000.
1995
Frederic Moll, M.D., Robert Younge and John Freund, M.D. formed Integrated Surgical Systems (now Intuitive Surgical) based on foundational robotic surgery technology developed at Stanford Research Institute. This system underwent extensive redesign and was reintroduced as the Da Vinci surgical system.
December 1993
The AesopTM 1000 (Automated Endoscopic System for Optimal Positioning) developed by Computer Motion is approved by the FDA. The Aesop is a robotic system used for holding an endoscopic camera in minimal invasive laparoscopic surgery.
Computer Motion, Inc. of Santa Barbara, CA, used seed money provided by the Army to develop the Automated Endoscopic System for Optimal Positioning (AESOP), a robotic arm controlled by the surgeon voice commands to manipulate an endoscopic camera in minimally heart surgery procedures.
AESOP consists of a single articulated arm with 4 degrees of freedom that holds the endoscope during laparoscopic procedures. In the first-generation model, the movements were controlled by the surgeon with a foot-pedal, but soon after a voice-control device was developed. Its advantage over a surgical assistant is that it does not fatigue and holds the camera with stability. It has proven to be very efficient by allowing the surgeon to operate without an assistant dedicated to holding the camera, and eventually alone without increasing the operative time. Besides urology, it is used in many other surgical fields such as gynaecology and gastrointestinal surgery.
GUILLONNEAU, B.; VALLANCIEN, G.: “Laparoscopic radical prostatectomy: the Montsouris technique”. J Urol, 163: 1643, 2000 KAVOUSSI, L. R.; MOORE, R. G.; ADAMS, J. B. et al: “Comparison of robotic versus human laparoscopic camera control”. J Urol, 154: 2134, 1995 METTLER, L.; IBRAHIM, M.; JONAT, W.: “One year of experience working with the aid of a robotic assistant (the voice-controlled optic holder AESOP) in gynaecological endoscopic surgery”. Hum Reprod, 13: 2748, 1998 GEIS, W. P.; KIM, H. C.; BRENNAN, E. J., JR. et al: “Robotic arm enhancement to accommodate improved efficiency and decreased resource utilization in complex minimally invasive surgical procedures”. Stud Health Technol Inform, 29: 471, 1996
1993
Neuromate - an image-guided, computer-controlled robotic system designed for stereotactic brain surgeries is launched in Switzerland. Preoperative imaging helped the surgeon plan the procedure, and a passive robotic arm was able to perform limited tasks in over 1000 procedures2,3. However, this technology still relied on preoperative images to position the robot, and was prone to errors when the brain shifted.
NeuroMate neurosurgical system, originally a Swiss development, but now a component of Integrated Surgical Systems (ISS) who developed RoboDoc. This was the first neurosurgical robotic device to get CE mark in Europe, and then the FDA approval in 1997 for stereotactic neurosurgical procedures. It also has an approval for neuro-endoscopic applications and for frameless stereotactic surgery in 1999.
The 5 DOF NeuroMate’s controller was re-designed, and used for surgical assistance for biopsy and tumor removal. In stereotactic neurosurgery, instead of pre-operative images, the NeuroMate system provided real-time 3D images to give the surgeon the precise location of a tumor.
LI, Q. H.; ZAMORANO, L.; PANDYA, A. et al: “The application accuracy of the NeuroMate robot--A quantitative comparison with frameless and frame-based surgical localization systems”. Comput Aided Surg, 7: 90, 2002
1992
With initial funding by DARPA, Yulan Wang developed the first voice activated robotic camera for larproscopic surgery that replaced a surgical assistant called AESOP ( Automated Endoscopic System for Optimal Positioning).
With initial funding by DARPA, Yulan Wang developed the first voice activated robotic camera for larproscopic surgery that replaced a surgical assistant called AESOP ( Automated Endoscopic System for Optimal Positioning). Subsequent modifications using the Hermes voice-activation system allowed control of movement by voice commands.
Approved by FDA in 1994 for use in humans for laproscopic surgery
Ballantyne GH, Robotic Surgery, Telerobotic surgery, telepresence and telementoring. Surgical Endoscopy, 2002, Oct;16 (10): 1389 - 1402
1992-1993
First surgical device called RoboDoc (based upon the IBM Puma arm) is introduced to the market focusing on Orthopedic surgeries. The first robot-assisted human hip replacements using Robodoc, on a 64-year-old man suffering from osteoarthritis. Ten more robot-assisted human hip replacements using ROBODOC were performed at Sutter General Hospital, Sacramento, Calif., under an investigational device exemption (IDE) approved by FDA Oct. 9,1992. This breakthrough opened the way to rapid development of 3-dimensional image directed, pre-operative planning, and computer guided robotic surgery.
ROBODOC was a modification of the basic principals of the Puma Arm which enabled pre-operative planning of the procedure (to include matching the prosthesis exactly with the femur that would accept the prosthesis).
Dr. Hap Paul, DVM and William Barger, MD (orthopedic surgeon) began collaborating with Russell Taylor, PhD of IBM’s T.J. Watson Research Center to develop a robotic system (based upon the IBM Puma arm) that would be able to be used for hip replacement surgery (many breeds of dogs, including German shepards and golden retrievers came to Hap Paul to have hip replacement for the fractured and dislocated hips). RoboDoc was able to precisely core out the femoral shaft with a 96% precision, while standard hand broach was able to provide an accuracy of only 75%. Dr. Barger then took the system to clinical trials in humans after Hap Paul proved its efficacy (clinically) in his veterinarian practice and RoboDoc is now a commercial product. Subsequently, other orthopedic surgeons such as Dr. Anthony DiGioia, MD, are developing other systems such as the HipNav for replacement of the knee and hip joints.
PAUL, H. A.; BARGAR, W. L.; MITTLESTADT, B. et al: “Development of a surgical robot for cementless total hip arthroplasty”. Clin Orthop Relat Res: 57, 1992 Paul, HA, Bargar WL, Mittlestadt B, Musits B, Taylor RH, Kazanzides P, Zuhars J, Williamson B, Hanson W, Development of a surgical robot for cementless total hip arthroplasty.Clin Orthop 1992 Dec;(285):57-66 DiGioia AM, Jaramaz B; Colgan BD. Computer assisted orthopaedic surgery. Image guided and robotic assistive technologies. Clin Orthop 1998 Sep;(354):8-16
Early 1990s
One of the early prototype systems developed at the Imperial College of London with a mechanically constrained system similar to the Puma and RoboDoc is introduced.
Introduced for assistance in trans-urethral resection of the prostate (TURP) and in precise coring. This system was a mechanically constrained system which used a robotic arm similar to the Puma and RoboDoc. However for patient safety, there was a large circular metal ring through which the resection instrument was passed and which prevented the robotic arm from moving out of the precise field of the prostate.
System developed by Sir John Wickham, MD and Brian Davies, PhD of Guy’s Hospital in London. After successfully proving the accuracy of the system on potatoes and then a few patients in the clinic trial, John Wickham was given permission to conduct studies on animals to show efficacy and safety.
1990
In 1990 in Atlanta, at the Society of American Gastrointestinal Surgeons (SAGES) Convention, Perissat, Berci, Cuschieri, Dubois, and Mouret were recognized by SAGES for performing early laparoscopic cholecystectomies, but Mühe was not.
However, in 1999 Mühe was recognized by SAGES for having performed the first laparoscopic cholecystectomy-SAGES invited Mühe to present the Storz Lecture. In Mühe’s presentation, titled “The First Laparoscopic Cholecystectomy,” which he gave in March 1999 in San Antonio, Texas, he described the first procedure.
EVENTS of
1980
1989-3
Inspired by Dubois, Jacques Perissat of Bordeaux, introduced endoscopic cholecystectomy in his clinic and presented this technique at a SAGES meeting in Louisville in April 1989.
Dubois and Perissat spoke enthusiastically about their work at the meetings and were largely responsible for establishing what is today called the French technique.
Dubois F, Berthelot G. Cholecystectomie par mini-laparotomie. Presse Med (Paris) 1982;11:1139–1141. Dubois F, Berthelot G., Levard H. Laparoscopic cholecystectomy: historie perspective and personal experience. Surg Laparosc Endose. 1991;1:52–57.
1989-2
In 1988-89, the parallel development of laparoscopic cholecystectomy emerged on the surgical front. Jacques Perrisat, MD of Bordeaux, France presented a video tape of a laparoscopic cholecystectomy to the Society of American Gastrointestinal Endoscopic Surgeons (SAGES) annual meeting in Atlanta, GA.
The profound effect of the introduction of laparoscopic surgery to the main stream surgical community (in addition to the pioneering procedures performed by Joe Eddy Reddick, MD, Douglas Owens, MD, Barry McKearnen, MD and George Berci, MD) caused an explosion in the use of laparoscopic cholecystectomy.
It soon became apparent that, although laparoscopic surgery was of great benefit to the patient, it created an enormous difficulty for the surgeon, since there was the degrading of the sense of touch, the loss of natural 3-D visualization(2) and impairment of dexterity principally due to the fulcrum effect of the instruments.
PERISSAT, J.; COLLET, D. R.; BELLIARD, R.: “Gallstones: laparoscopic treatment, intracorporeal lithotripsy followed by cholecystostomy or cholecystectomy--a personal technique”. Endoscopy, 21 Suppl 1: 373, 1989
1989-1
A high-tech medical device company Computer Motion was founded with a goal to revolutionize surgical practices and to improve patient lives.
Computer Motion was founded by Chief Technical Officer Yulun Wang, Ph.D., in 1989.
1988-2
Francois Dubois of Paris carried out his first laparoscopic cholecystectomy.
Although having no prior laparoscopic experience, Dubois acted immediately. He borrowed the instruments from gynecologists, performed his first animal experiments and, in April 1988, carried out the first laparoscopic cholecystectomy (LC) in Paris.
Mouret, Dubois, and Perissat: The Laparoscopic Breakthrough in Europe (1987-1988)
1988-1
The PROBOT was developed at Imperial College London by Dr. John Wickham, to perform prostatic surgery. The system is image guided, model based, with simulation and online video monitoring.
For an excellent video presentation on the history of this and other developments in robotic surgery, please view Dr. Prokar Dasgupta's VUI lecture Scientific Advances in Robotic Surgery: Here.
Dr Wickham's information begins at 05:10 into the video, but the whole presentation from Dr Dasgupta is well worth viewing.
It is designed to allow a surgeon to specify a volume within the prostate to be cut, and then automatically cut this without further intervention from the surgeon.
WICKHAM, J.: “Minimally invasive therapy”. Health Trends, 23: 6, 1991 PROBOT — A Computer Integrated Prostatectomy System
1987-2
One of the French private surgeons, Phillipe Mouret of Lyon, shared his surgery practice with a gynaecologist and thus had access to both laparoscopic equipment and to patients requiring laparoscopy. In March of 1987, Mouret carried out his first cholecystectomy by means of electronic laparoscopy. Phillipe Mouret has got the credit to perform the first laparoscopic cholecystectomy in Lyons, France using video technique. Cholecystectomy is the laparoscopic procedure that revolutionized general surgery.
Mouret P. Suspension of the abdominal wall: the birth of a concept - a personal experience. In Paolucci, Schaeff, editors., ed. Gasless Laparoscopy in General Surgery and Gynecology. Stuttgart: Georg Thieme Verlag; 1996:44–49.
1987-1
Mühe had conducted 97 endoscopic gallbladder removals.
He published information about his technique at the Congress of the German Surgical Society (April 1986) and at other surgical meetings in Germany. His concept, however, was ignored. In the middle of the 1980s, the surgical community was still not prepared for the era of “minimally invasive therapy.” Erich Mühe was a surgeon ahead of his time.
Semm K. Advances in pelviscopic surgery. In John M. Leventhal, ed. Current Problems in Obstetrics and Gynecology, Vol. V, Nr. 10. Chicago-London: Year Book Medical Publishers; 1982. The first publication on laparoscopic appendectomy appeared a year later: Semm K. Die endoskopische appendektomie. Gynäkol Prax. 1983;7:131–140
Late 1980-2
Important collaborations between the neurosurgical, radiology and robotics experts worked to create precise position probes, resection instruments, ablation devices and other surgical tools. These unique tools were designed principally for minimally invasive brain surgery. Significant advancements are the creation of the Stealth Station and the Open MRI System. These breakthroughs advanced the field of robotic surgery.
The StealthStation® TREON™ stereotactic image guidance system was developed for use in brain, spinal, and ear/nose/throat (ENT) surgeries. The system registers preoperative images of the patient (usually MRI and CT scans) with real-time images captured during the surgery by integrated light emitting diode (LED) cameras. A surgeon can choose a custom projection of the surgical area from a 3D image set, merge image data from multiple sources, and can control the location of the cameras in order to provide the best view of the surgical area. An open MRI system is used for real time updates of the brain image in the initial real time, image-guided neuro surgical systems. Currently, the system is in it's seventh generation.
The major contributors to this field include Frank Jolesz, MD of Brigham and Women’s Medical Center and William Lorensen, PhD of General Electric Research Center who pioneered the open MRI system. Neurosurgeon Richard Bucholz, MD of St. Louis University Medical Center developed the Stealth Station for use.
Jolesz FA, Image guided procedures and the Operating Room of the Future. Radiology 204:601-612, 1997 Bucholz RD, Greco DJ. Image-guided surgical techniques for infections and trauma of the central nervous system. Neurosurg Clin N Am 7:187-200, 1996 Karron DB and Bucholz RD. Evaluation of Tactical Audio Technology for Intraoperative Neurosurgical Instrument Navigation. Link
1985-2
The first documented laparoscopic cholecystectomy was performed by Erich Mühe in Germany in 1985. Prof Dr Med Erich Mühe of Böblingen, Germany, performed the first laparoscopic cholecystectomy on September 12, 1985, using a device of his own design (Galloscope) which maintain pneumoperitoneum and doubled as a laparoscope.
Erich Mühe, fascinated by Semm’s technique of laparoscopic appendectomy and spurred by successes of the Erlangen endoscopists, came up with the idea of laparoscopic removal of gallstones. In 1984, Mühe had already worked out the details of an operative laparoscope, the “Galloscope,” and on September 12, 1985, he carried out the first laparoscopic cholecystectomy on September 12, 1985.
Later, he modified his technique and operated through a trocar sleeve. Finally, he designed an “open laparoscope” with a circular light.
1985-1
The Puma 560 is a six degree of freedom robot manipulator. The end-effector of the robot arm can reach a point within its workspace from any direction. The Programamable Universal Machine for Assembly (PUMA) 560, a six degree of freedom robot manipulator a was used by Kwoh et al to perform neurosurgical biopsies with greater precision. This was the first robot-assisted surgical procedure reported in the literature.
The robotic system allowed for a successful procedure and the potential for greater precision when used in minimally invasive surgeries, such as laparoscopies which typically utilize flexible fibre-optic cameras. The 1985 procedure lead to the first laparoscopic procedure involving a robotic system, a cholescystecotomy, in 1987. Davies et al performed a transurethral resection using the Puma 560 machine in 1988
Kim VB, Chapman WH, Albrecht RJ, et al. Early experience with telemanipulative robot-assisted laparoscopic cholecystectomy using Da Vinci. Surg Laparosc Endosc Percutan Tech. 2002; 12: 34-40. Kwoh YS, Hou J, Jonckheere EA, et al. A robot with improved absolute positioning accuracy for CT guided stereotactic brain surgery. IEEE Trans Biomed Eng. 1988; 35: 153-161. Davies B. A review of robotics in surgery. Proc Inst Mech Eng. 2000; 214: 129-140.
Late 1980
In this era, researchers became interested in using technology developed by NASA (U. S. National Aeronautics and Space Administration) in the field of telepresence and virtual reality to enhance surgeon dexterity in microsurgeries. NASA's Ames Research Center and Stanford Research Institute roboticists and virtual reality experts in collaborated to develop a dexterous telemanipulator designed for hand surgery.
The concept of telesurgery became one of the main driving forces behind the development of surgical robots. As a result of the work done in the late 1980s, the terms Virtual Reality (VR) and Telepresence entered the everyday lexicon. One of the main VR design goals was to give surgeons the sense of operating directly on a patient, even if they were working on a console from across the room.
The concept of a DataGlove (a wired glove that uses fibre optics to determine the position of the hand and the fingers) and the object-oriented programming language to manipulate 3D visual data was invented. Researchers from NASA-Ames-Stanford Research Institute collaborated to design the telemanipulator for hand surgery. Richard Satava is credited with joining the team and recognizing that the DataGlove telepresence surgery prototype could be well suited for clinical use in the field of laparoscopic surgery.
HILL, J.W.; HOLST, P.A.; JENSEN, J.F. et al: “Telepresence interface with applications to microsurgery and surgical simulation”. Stud Health Technol Inform, 50:96, 1998 Reference for importance in surgery - NGUYEN, M. M.; DAS, S.: “The evolution of robotic urologic surgery”. Urol Clin North Am, 31: 653, 2004 Fisher SS, McGreevy MM, Humphries J, and Robinett W. Virtual Environment Display System. In: Crow F and Pizer S (Ed) Proceedings of the Workshop on Interactive 3-D Graphics 1:1-12, 1986. Satava RM. Surgical robotics: the early chronicles: a personal historical perspective. Surg Laparosc Endosc Percutan Tech. 2002; 12: 6-16.
EVENTS of
1960
1961
The first Unimate industrial robot was installed in a General Motors Inland Fisher Guide plant in New Jersey in 1961. It moved hot die castings to cooling baths before sending them to workers to finish processing the safely-cooled pieces. Because the Unimate was so successful, it was reportedly deployed to all factories by 1968.
1960
The inventor of the Unimate, Joseph Devol partnered with aircraft engineer Joseph Engelberger in the late 1950's. Together, they went on to form Unimation Incorporated and refine the invention for use. Devol and Unimation sold their first Unimate robot in 1960, though it was not delivered to GM until 1961. It has been reported that both men were inspired by Asimov’s stories to create robots to replace humans in the performance of dangerous tasks.
EVENTS of
1950
1954
Unimate was the first industrial robot, designed by George Devol in the 1950's. His original patent was filed in 1954, but it was not until 1961 when one was first installed for commercial use at a General Motors plant. The Unimate replaced humans who had previously performed the difficult and hazardous task of manipulating very hot die castings and welding.
EVENTS of
1940
1942
Isaac Asimov's short story Runaround was first published the year after he wrote it. It first appeared in Astounding Science Fiction, March 1942.
1941
Isaac Asimov coined the term “robotics” in 1941 in the short story Runaround for Super Science Stories Magazine. The science fiction writer popularized the term in his books: Runaround and I, Robot
In Runaround, Isaac Asimov also unveiled what was to become a popular theme in several of his novels. His Three Laws of Robotics were fictional laws governing robot behavior:
1. A robot may not injure a human being or, through inaction, allow a human being to come to harm.
2. A robot must obey the orders given it by human beings except where such orders would conflict with the First Law.
3. A robot must protect its own existence as long as such protection does not conflict with the First or Second Laws.
Asimov's laws have for years been a platform for discussion about how actual robots should be programmed. Runaround has been published in three collections of his stories: I, Robot (1950), The Complete Robot (1982) and Robot Visions (1990).
EVENTS of
1920
1921
The term “robot” was coined by the Czech playright Karel Capek in 1921 in his play Rossom’s Universal Robots. The word “robot” is from the Czech word robota, which means forced labor.
Karel Capek was inspired to write his play because of the unemployment generated by the introduction of mechanization during the Industrial Revolution.
Ewin, D.R.;Pigazi, A.;Wang, Y. et.al: Robots in the operating room - the history: Semin Lararosc surg, 11: 63, 2004