Grinding to a Start
While cardiac surgery at two of Manhattan’s leading medical centers may be the high-profile payoff of robotic surgery today, the technology’s roots are less glamorous. Incorporating robotics into surgical procedures began at academic institutions including MIT, the Carnegie-Mellon Institute and several campuses of the University of California. In 1986, the University of California at Davis and IBM’s Thomas J. Watson Research Center joined forces to begin development of computer-assisted hip replacement surgery; by 1992, a spinoff of that effort, Integrated Surgical Systems, introduced the Robodoc Surgical Assistant System.
The job of this robotic system is to grind away bone. At best, conventional surgical techniques leave gaps of 1 millimeter or more between bone and implant, but no more than 0.5 millimeters of bone will grow out from a cut bone. The insurmountable space eventually leads to implant failure. Milling bone with greater precision than an experienced surgeon could, Robodoc assures that a cementless prosthesis can achieve long-term fixation by allowing bone to grow into the porous coating of the implant. In fact, this March, Integrated Surgical reported that Robodoc had been used for the first total knee replacement performed using robotic surgery.
But grinding down hips and knees doesn’t fire the public imagination like mending an ailing heart. With the goal of aiding in complex procedures such as heart operations, companies developing robotics have come up with increasingly sophisticated systems. In 1994, Computer Motion produced the first FDA-cleared robot for assisting surgery in the operating room-the Automated Endoscopic System for Optimal Positioning, or AESOP. AESOP is essentially an electromechanical arm for positioning an endoscope. Two years later, voice control by the surgeon was added, allowing for exact, hands-free control during an operation. In 1998, Computer Motion introduced ZEUS, its robotic surgery system capable of operating on everything from an ailing heart to an inflamed gallbladder.
Rival technology underlying Intuitive Surgical’s da Vinci system grew up around the same time, financed by government funding for research in “tele-surgery”-computer-assisted medical procedures delivered at a distance. In the early 1990s, SRI International in Menlo Park, Calif., was one of several institutions receiving grants from the Department of Defense’s Advanced Research Projects Agency to develop tele-surgery. A prototype system was built and proved an inspiration to Frederic Moll, who co-founded Intuitive Surgical in 1995 and is now the company’s medical director. “What got me excited wasn’t the remote-surgery aspect,” Moll recalls, “but the way the system eliminated the need for a hand to be directly connected to a surgeon’s instruments. It offered new ways of solving the challenges in minimally invasive techniques.”