Abstract
The field of surgical robotics has been rapidly advancing, with a focus on improving minimally invasive surgery techniques. Minimally invasive surgery (MIS) is characterized by smaller incisions, reduced trauma to the patient, quicker recovery times, and less post-operative pain compared to traditional open surgery. Surgical robots have played a significant role in enhancing the capabilities of surgeons and expanding the potential for MIS. The next era of smart flexible surgical robots for MIS could encompass several exciting developments. Future surgical robots are likely to be more flexible and adaptable, allowing them to navigate complex anatomical structures with greater ease. In this chapter, the authors will present the current state-of-the-art surgical robotic applications for MIS, focusing on the limitations and challenges still open for their use in clinical applications. This chapter is significant as it not only offers insights into current technological advancements but also lays the groundwork for understanding future innovations that could revolutionize patient care in surgery.
TopIntroduction
Soft robotic devices possess favorable attributes for use in minimally invasive surgery (MIS) (Fiorini et al., 2022), yet numerous interdisciplinary challenges persist (Barua, Das, Datta, Roy-Chowdhury, et al., 2022). MIS involves the insertion of surgical instruments, whether rigid or flexible, into the body through small incisions or natural openings. This process contrasts with open surgery, which requires larger incisions for direct access to the target anatomy (Datta et al., 2023; Staub & Sadrameli, 2019). The primary objective of MIS is to complete surgical procedures with minimal harm to surrounding tissues while ensuring patient safety, rapid recovery, shorter hospital stays, reduced postoperative complications, and diminished pain. MIS presents unique challenges, including small, deformable, dynamically changing (Barua, Bhowmik, Dey, & Mondal, 2023), unstructured workspaces, limited visibility with few visual cues, and the use of long, slender instruments (Laut et al., 2016). The fulcrum effect, observed in some MIS procedures using long, rigid instruments, magnifies hand tremors because the insertion point acts as a pivot, making instrument manipulation more challenging (Barua & Datta, 2023; Garfjeld Roberts et al., 2020). Such adaptability is crucial for performing intricate procedures in confined spaces within the body.
Advanced imaging technologies, such as augmented reality (AR; Garcia, 2020) and virtual reality (VR; Miller et al., 2024), could be integrated into surgical robots to provide real-time, high-resolution, and 3D visualizations of the surgical site (Barua, Das, et al., 2023; Datta & Barua, 2024). The integration of these technologies has been proven effective in various health and medical areas (Almeida, 2024; Lobo et al., 2024; Martin & Alarcón-Urbistondo, 2024). This would improve the surgeon's precision and depth perception, enabling more accurate procedures. Continued advancements in micro- and nanotechnology could lead to the development of even smaller and more minimally invasive robotic tools. These tools could be used for highly precise procedures, such as delicate surgeries within the brain or other sensitive organs. As artificial intelligence (AI) based surgical robots become more sophisticated, ensuring their safety and reliability remains a critical concern. Advanced fail-safe mechanisms, redundancy, and rigorous testing will be essential to maintain patient safety (Figure 1).
Figure 1. The development of smart, flexible, and soft surgical robots for MIS involves engineering design, fabrication techniques, and technologies for human-robot interaction
Key Terms in this Chapter
Da Vinci Surgical System: A sophisticated robotic platform used in minimally invasive surgery, which operates on a master-slave principle and includes a surgeon's console and a patient-side cart with robotic arms.
Surgical Robot: A sophisticated medical device designed to assist surgeons in performing complex procedures with precision. Controlled by a surgeon from a console, these robots use advanced technology, such as robotic arms and cameras, to provide enhanced dexterity, visualization, and minimally invasive capabilities, improving surgical outcomes and patient recovery.
Smart Materials: Materials responsive to changes in their environment play a crucial role in the development of flexible surgical robots, contributing to their adaptability and effectiveness in MIS.
Minimally Invasive Surgery: A medical technique that uses small incisions and specialized tools to perform procedures within the body, reducing the need for large surgical openings. It offers advantages such as faster recovery, less scarring, and reduced risk of complications compared to traditional open surgery.
Laparoscope: A laparoscope is a minimally invasive surgical instrument equipped with a thin, flexible tube and a tiny camera that allows surgeons to visualize the inside of the abdominal or pelvic cavity. It is inserted through small incisions, enabling procedures like gallbladder removal, appendectomy, and exploratory surgery with reduced scarring and shorter recovery times compared to traditional open surgery. The camera transmits real-time images to a monitor, guiding surgeons during the procedure, and offering a detailed view of the organs and tissues.
Teleoperation: This refers to the remote operation of a machine or robot, a key feature in advanced surgical robotics, allowing surgeons to perform procedures from a distance.
Robotics: An interdisciplinary field of designing, building, and operating robots. These autonomous or remote-controlled machines perform tasks, often in manufacturing, healthcare, exploration, and more. Utilizing sensors, actuators, and AI, robotics aims to enhance efficiency and safety while advancing automation and technology across various industries.
Force Feedback: A feature in robotic systems that allows the operator to feel the forces exerted by the robot, enhancing the surgeon's tactile sensation and precision during procedures.
Soft Tissue: Soft tissue refers to a group of connective tissues in the body that includes muscles, tendons, ligaments, fat, and blood vessels. It provides support and flexibility, enabling bodily movements, and plays a crucial role in various bodily functions. Injuries to soft tissues can lead to pain and mobility issues.
Telemedicine: The use of telecommunications technology to provide remote medical care. It has become increasingly important in the context of surgical robotics, especially for procedures that can be controlled or assisted remotely.