Semi-automatic surgery

Despite advances in technology and technique, there will always be one limiting factor in the operating room: the surgeon. Hours of exacting work can tire anybody, especially someone navigating the delicate intricacies of the human brain.

The Robot-Assisted Microsurgery (RAMS) prototype is a robotic surgical tool first developed for space use and later refined as a precision instrument for microsurgery that may replicate a surgeons precise moves without feeling fatigue.

‘The RAMS system works like an extension of the surgeon’s hands,’ said Peter D. LeRoux, MD, a neurosurgeon at the University of Pennsylvania Medical Centre.

The system consists of a set of robotic arms including a master arm, said to function like a joystick; and an operating arm, which performs the surgery.

The surgeon manipulates the master arm in the same way as he or she would hold a surgical instrument, and the operating arms mimic the surgeon’s movements on the patient. ‘Robotic surgery is not about replacing surgeons, but enhancing their abilities in the operating room,’ said LeRoux.

RAMS is said to serve as an intermediary between the surgeon’s hands and the surgical instruments as it allows the surgeon to filter out the slight tremors that are present in even the most skilled surgical hands.

The advantage of a robotic surgical system is that it could remove some of the random factors that affect surgery. ‘A surgeon’s performance can vary throughout a lifetime – or even during a procedure,’ explained LeRoux. ‘Automation can compensate for these variables and lead to better results for patients.’

According to LeRoux, RAMS also represents a change in the way surgical tools are created as it is typically surgeons who recognise the need of a particular tool, and then call upon the expertise of engineers to develop it.

Here, however, the engineers developed the surgical tool to solve a particular problem. At the behest of NASA, the Jet Propulsion Laboratory first developed the RAMS prototype as a means of conducting emergency surgery via remote control as they envisioned surgeons on earth performing robotic surgery on astronauts in space.

Long distance surgery is not the only application of the technology. With the help of MicroDexterity Systems, Inc., JPL has developed the system further to assist in microsurgery.

LeRoux and his colleagues have so far performed trials in 10 rats, repairing blood vessels that supply the brain, a common microsurgical procedure.

LeRoux notes that RAMS currently lacks sufficient tactile feedback and has a limited degree of freedom compared with that of a human hand but is optimistic that design flaws will be conquered with the help of surgeons.

‘In many ways, this technology is just a crude prologue to some of the amazing things that are ahead,’ concluded LeRoux.

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