hystory

Medical Robotic History
Industrial robots evolved throughout the 20th century, and entered mainstream American life in 1961 when they were installed in the first automobile manufacturing line at a General Motors factory (ROVer Ranch, 2005). Medical robotic systems were slower to develop in a commercial capacity due to financial constraints Some of the first medical applications for robotic technology to be investigated were in the fields of neurosurgery and orthopedics (Falcone & Goldberg, 2003; Gerhardus, 2003; Nathoo, Pesek, & Barnett, 2003). Robotics entered the field of urology in the late 1980s with the application of a robotic arm, nick-named PUMA 560, for transurethral resection of the prostate (TURP) (Lanfranco et al., 2004). This early medical robot was approved for a limited clinical trial in humans (Satava, 2002; Taylor et al., 1996). It did not become a treatment of choice for TURP due to poor ultrasound imaging capabilities of the prostate (Allaf, Patriciu, Mazilu, Kavoussi, & Stoianovici, 2004). The next application for robotics in urology was in assisting the urologist with intra-operative percutaneous renal access. Many attempts to develop a highly precise, mechanical method of percutaneous renal access have led to a robotic surgical system that has been modified several times, but has now demonstrated an 87% accuracy rate in gaining renal access (Allaf et al., 2004; Kim & Schulam, 2004). An extended clinical trial of the robotic system demonstrated rates for the number of attempts, and time to renal access, which were comparable to the standard technique (Allaf et al., 2004). Further development and continued clinical trials are necessary to duplicate results demonstrating that this robotic surgical system can produce results comparable or better than the standard method of renal access (Allaf et al., 2004). Through the mid to late 1980s, scientists at the National Aeronautics and Space Administration (NASA)-Ames Research Center were working on development of virtual reality and telemedicine technology (Satava, 2003). Virtual reality is defined as "the simulation of a real or imagined environment that can be experienced visually in the three dimensions of width, height, and depth and that may additionally provide an interactive experience visually in full real-time motion with sound and possibly with tactile and other forms of feedback" (//Virtual Reality//, 2005). Telemedicine is the concept of a physician monitoring, diagnosing, and treating a patient without physically being in the patient's presence. Virtual reality technology connects the physician with the environment the patient is in, and allowing the physician the illusion of being present in this other environment, referred to as //telepresence.// Once telepresence has been achieved, medical robotics then allows the physician to manipulate the environment in which the patient exists without physically being present in that environment. Thus medical robotic technology is the key element in telemedicine that enables a physician to treat a patient without being physically present. The NASA group teamed up with mechanical engineers working on robotics from Stanford Research Institute (SRI) to create telemedicine technology that allowed manipulation of the patient (Satava, 2003). A general surgery endoscopist (Richard M. Satava, MD), who was working for the United States Army, was introduced to the NASA and SRI teams after meeting one of the SRI team members at a conference. Dr. Satava made the U.S. Army aware of the NASA-SRI project, and its potential benefits for telemedicine on the battlefield (Satava, 2003). Realizing the possible applications of medical robotics and telemedicine, the U.S. Army directed a large amount of funding for research and development of medical robotic technology (Satava, 2003). In 1989, Yulun Wang, PhD, a graduate engineer and acquaintance of Dr. Satava, founded his own medical robotics company with funding from the U.S. government and private industry. His company, Computer Motion, Inc.®, launched AESOP® (Automated Endoscopic System for Optimal Positioning), a robotic telescope manipulator, and the robotic surgical system ZEUS® (Marescaux & Rubino, 2003; Satava, 2003). AESOP was FDA approved for use in 1994, and is currently marketed in the United States (Marescaux & Rubino, 2003). Computer Motion, Inc. received FDA approval to market ZEUS in 2001 (Marescaux & Rubino, 2003). In 1995, another physician with a keen business sense saw the commercial value of the emerging robotic technology. Frederic H. Moll, MD, acquired the license to the telepresence robotic surgical system developed by the NASA-SRI teams, and started a company called Intuitive Surgical Inc.® (Intuitive Surgical Inc., 2005; Satava, 2003). Intuitive Surgical Inc. used the telepresence robotic technology pioneered by the NASA-SRI team to develop a master-slave telepresence robotic surgical system they named daVinci®. There are currently two robotic surgical systems approved for marketing in the United States for laparoscopic and thoracoscopic surgery: daVinci and ZEUS. Intuitive Surgical Inc. owns rights to both of them, after merging with Computer Motion, Inc. in June of 2003 (Intuitive Surgical Inc., 2005; Kim & Schulam, 2004). The merger also gave the rights to AESOP to Intuitive Surgical Inc. The daVinci robotic surgical system has been approved for use in adult and pediatric urologic surgical procedures, general laparoscopic surgical procedures, gynecologic laparoscopic surgical procedures, general non-cardiovascular thoracoscopic surgical procedures, and thoracoscopically assisted cardiotomy procedures (Intuitive Surgical Inc., 2005). The ZEUS surgical system is being supported by Intuitive Surgical Inc., but not actively