ROBOTIC SURGERY

CHAPTER I

Preliminary
With the development of science and technology, the development of surgery, especially surgery undergone great changes, in which increasingly smaller surgical incision and the distance could not be located (tele-surgery), where the operator and the patient is not in one place. Unfortunately, the development of science and technology is still considered to be very expensive so it can not be applied in many health institutions, especially in countries that are poor, so there is not much that could have facilities and equipment including robotic surgery.

Robotic Surgery
      Robotic Surgery is a form of development of medical technology that uses a robotic system to assist the surgical procedure. Although robotics is equipped with computers, the system is not able to make their own decisions in surgery, so the doctor still plays a role in the actions of its operations.
      The surgeon uses a computer system to control the robot arm and end effectors, and can also use telemanipulators for input. One of the advantages of using a computerized method is that the surgeon does not have to be present in the operating room, surgeons could be anywhere diseluruhi world, and is it possible to perform remote operations.
      In the case of open surgery are now using the instrument of steel, to stretch the ribs can be more subtle if done by robots, controlled movement of the feedback can be made compared to using the human hand.
      The main purpose of these great instruments is to reduce or eliminate the tissue trauma that is usually found in this terbuka.Keterampilan operation can be obtained by surgeons with training possibilities were only a few minutes.


CHAPTER II

Can you imagine a surgeon with four arms and eyes that can look more closely, and the brain can process information continuously without a break? Do you think it's just science fiction? It may be true 20 years ago, but not anymore now.

BENEFITS
      Because the price of these machines are very expensive and, of course, the price is too expensive. Singapore in Southeast Asia that have this machine first. Hospital in Indonesia. Jakarta is the first mother.
The main advantages of robotic surgery are:

• 1. Operations that can be done by long distance
• 2. Some of the major advantages of robotic surgery is more precise
• 3. Smaller incisions
• 4. Reduce blood loss
• 5. Faster recovery time, shorten the length of post operative
• 6. Lower morbidity
• 7. satisfaction with the result of higher operating
      Other advantages compared with the usual manipulation of three-dimensional magnification and more ergonomic. The use of robotic surgery also minimize disruption caused by vibration of the doctor's hand while dissecting or stitch to close the wound.

APPLICATION
      Robotic Surgery in the world is very wide and made for the various branches of science such as Obstetrics, Oncology, Urology, Thorax Surgery, Orthopedic Surgery, but for the RS. Mother of Jakarta, for the initial steps of action to take is:
• myoma uteri
• Ovarian Cysts
• Hysterektomi (remove the uterus)
• Prostate Cancer
• Colorectal Cancer
Drazi Ara blew a breath of fresh air for the medical world after successfully developing advanced surgical techniques denganrobot, I-Snake. The use of this flexible robot will be a major revolution in medicine because it makes hard and complex operations into simple and impactful minimal.I-Snake is able to penetrate the body which could not be reached. The medical world can not be separated from technology of medical canggih.Dunia always demanding perfection in every step. Darzi acknowledged, special robot to the world of medicine is not cheap.
Medical operations that are expensive to be added the cost of robot. Two times more expensive. But the price of health care is expensive, and it is a guarantee: healthy. In the future more and more operations are expected to use the robot. Darzi is also a professor at the prestigious London Hospital, Imperial College, successfully make advanced robots ISnake a cost of about 2.1 million poundsterling. By I-Snake, the surgeons will be able to perform very complex operations, which previously carried out by a technique only can be more invasive.

I-Snake is a long tube-shaped flexible robot in which there are a number of sophisticated equipment such as motors, sensors, and imaging tools. "This tool will be function as hands and eyes of a doctor when it reaches the hard to reach inside body and its part," he said. It is capable of perform complex operations such as heart bypass. Looking ahead, ISnakedapat used for diagnosis of disease in the small intestine and colon. Ara Darzi has been successfully tested I-Snake laboratory.

With the presence of this tool in the risk of complex surgery would be suppressed. That is, akansemakin small incision, the healing period becomes shorter, and patients do not have lingered in the hospital. "The surgeon was certainly benefited by the presence of I-Snakekarena goresanpada they can minimize the skin," he explained to the BBC. He said the ability of imaging and sensing I-Snake tidaktertandingi. Coupled with the ease and sensitivity, this tool has diagnostic capabilities kompleksdibanding outstanding tools now. "I-Snake is the most advanced tools, cheapest, and is a non-invasive treatment. The recovery is more quickly and provide benefits that can improve the protection and quality of life of patients, "said Darzi.

One of the advantages of using robots is to reduce the level of trauma pascaoperasi.Operasi using the robot faster, so patients leave the hospital sooner. Another advantage, not a lot of robot operasimenggunakan painful, so patients feel more comfortable. What are the difficulties operasidengan robot? According to the Darzi who is also director of the Hamlyn Centre for Robotic Surgery, it is not easy to explain to patients how robots work.

Most people still think the surgeon the operation was carried out with full equipment such as scissors, knives, and various spotlights. "Patients should be told that the robot is not pure 100% computer, but there is also a specialist who runs the operation," paparnya.Kendati so, Darzi admitted, the doctor just looked and I-Snake moves through the screen it has a hand-monitor.Robot arms and legs that can lift and divide the parts that dikehendakisang doctor. "Operation cancer will be more smoothly," he said. I-Snake is a great work dalamdunia medicine. He also said that the surgeon does not have to worry anymore with inaccuracies dalamstandar and other procedures performed operasi.Gebrakan Darzi is implementing the use of robotic nurses and doctors at the hospital in London.

The hospital employs a robot, with the name "Sister Mary" and "DokterRobbie". The second robot that allows doctors to see and communicate with patients, both merekasedang was in the hospital or elsewhere. "This is a revolutionary concept which opens new avenues in telemedicine research and memadukanteknologi with health care," said Professor Ara Darzi. The man who has served as chief of surgery department, anesthesia and intensive care at Imperial College, said that the 1.5-meter-high robot which is controlled remotely by a doctor through a joystick. Darzi said, doctors can see patients with camera mounted on the top of the robot. The patient can see their doctors via the screen in robotic face. / Andika hendra Mustaqim / sindocpddokter.com - Continuing Physician Professional Development Indonesia

Robotic Surgery is the 'gold standard' New for Prostate Surgery
Welcome to the world of robotic surgery - and meet this wonderful doctor - Dr. Da Vinci. Da Vinci Surgical System combines 3-D capabilities of the endoscope and advanced robotic technology, which can virtually extend the hand and eye doctors, surgeons in the world. "Surgical robotics has many advantages. First, Da Vinci provides a minimally invasive alternative and a good magnification, so it gives a 3D view of the problem areas. In addition, robotic arms capable of mimicking human hand movements, so they can sew with a very precise," said Dr Tan Eng Choon of the EC Tan Urology at the Mount Elizabeth Medical Centre.
In addition to ease of surgery, the Da Vinci surgical system to give patients a more rapid recovery and minimal postoperative pain. Two hospitals in Singapore has invested heavily to robotic systems - Mount Elizabeth Hospital under the auspices of the Parkway Group and Singapore General Hospital. According to Dr Tan, Da Vinci system is very good, especially for prostate cancer, where surgery is often the treatment is common. Conditions affecting the organs of the urinary tract such as bladder and kidney cancer may also benefit from robotic surgery.
Under normal conditions, facing any kind of urologic surgery usually creates a major concern. Traditional open urologic surgery - in which a large incision is made to access the pelvic organs - has been the standard approach. But it has some drawbacks of open surgery. Weaknesses include postoperative pain, long recovery period and the potential impact of unpredictable long-term effect on sexual function and continence.
"The prostate is located in a deep cavity in the pelvis. This organ is small - about the size of a walnut - and difficult to access. The place is tucked away not only but also surrounded by nerves affecting urinary control and sexual function. That's why the conventional manner, we require a surgical open in cases of prostate cancer. Even so, surgery is quite hard to do, "he said.
The prostate is a male reproductive gland that produces fluid found in semen. Located below the bladder and in front of the rectum, the prostate surrounds the urethra - the tube that empties urine from the bladder. Prostate cancer affects the prostate gland and may spread to the surrounding structure. Although most patients do not show symptoms of prostate cancer, doctors can detect prostate cancer at a routine examination, using a combination of a blood test called a PSA test and digital rectal, or DRE. This disorder is common in men, especially the elderly. With better awareness, detection of prostate cancer is increasingly becoming a trend and decreased the death rate from prostate. Better treatments are also making more men get more active and productive lives after treatment.
For patients who had been diagnosed early, usually there are several treatment options include conservative approach, radiation therapy and prostatectomy - surgical removal of the prostate. Treatment of the latter is now a procedure "gold standard" for men under 70 years with organ confined cancer at an early stage. "The ultimate goal is to eliminate cancer prostatectomy. The second objective is to maintain urinary function and, if applicable, erectile function. Keeping the nerves necessary for erections can be a very important goal for patients. These nerves pass through the prostate and are often damaged when prostate is removed, "said Dr Tan.
Fortunately, the surgical option that is not how invasive are now available to many patients who face prostatectomy. The most common choice is laparoscopy, which uses a specialized surgical camera and rigid instruments to access and remove the prostate using several small incisions. But in spite of laparoscopy can be effective on many common procedures, limitations of this technology can not be used for more complex cases.
But with advances in robotic technology, surgeons can be complex even more efficiently and effectively. "The risk of prostate surgery is now much smaller. Now, we can zoom directly to the area where the nerves and tissues collected. With better clarity and critical anatomical details, the risks are common to traditional surgery can be avoided, such as incontinence and impotence, "said Dr Tan.
Robotic precision allows the preservation of urethral length and construction of a watertight anastomosis is better, thus reducing the likelihood of incontinence. With visuals that can be enlarged, dissection and preservation of the nerve can be done properly, so that male sexual function can be maintained. And unlike conventional surgery, which largely rely on expertise of the surgeon's work, computerized robotic surgery to minimize the "shaking hands" which means reducing the risk of error due to fatigue.
Da Vinci system was introduced here about three years ago. Since then, Dr Tan has been done between 70 and 80 cases of prostatectomy using robotic technology. Robotic surgery was first performed in Germany in 2000. Since then, tens of thousands of robotic prostatectomy surgery performed around the world, from the United States, Europe and now Asia. Until 2005, nearly 30 percent of all radical prostatectomy performed with robotic assistance.
Remarkable growth was fueled by the advantages of Da Vinci. But these technologies also brings a high priced - on average, the cost of a surgical robot 40 percent more expensive. But his lead to beat the extra cost.
"Da Vinci's operating costs by approximately $ 35,000, but this robot-assisted surgery provides better clinical outcomes, and the amount of blood lost is smaller, so if you count all the benefits, the cost is higher it still makes sense," he said. As another surgery, these benefits can not be guaranteed, as surgery is specific to each patient and procedure. Although prostatectomy with Da Vinci surgical system is considered safe and effective, but this procedure may not be suitable for everyone.
"Patients should always ask their doctor about treatment options available, before deciding which option is best suited to his case," said Dr Tan. In addition to the benefit of patients, this system also eliminates muscle tension in the doctor, because doctors simply sitting at a console and busied himself with the appearance of an enlarged prostate and pelvis.
Led to the mushrooming popularity of robotic surgery robotic centers around the world. "Robotic prostatectomy experienced unprecedented growth as a treatment option prostate cancer in the United States today. Asia seems to also follow this trend as seen in the increasing number of Da Vinci systems are implemented to accommodate the growing number of men diagnosed with early prostate cancer," Dr Tan protracted .
In addition to prostate cancer and other urological problems, the Da Vinci surgical system can also be used for several conditions ginealogi. But beyond that, for now its use is still limited. "Given the current design of robotic systems, only some types of surgery can be performed with this approach. But future advances in technology, we will surely witness the development and expansion of the scope of its use," concluded Dr. Tan.

 

REFERENCES
A. http://industri09wiyoga.blog.mercubuana.ac.id/2011/01/08/robot-canggih-bisa-operasi-jantung/
2. www.singaporemedicine.com/id/healthcaredest/story0004.asp
3. robotikasmanisda.com / search / surgical techniques-with-robot
4. kafeilmu.com / themes / surgery-surgery-with-robot-robotic-surgery.html
5. www.acehtraffic.com/2012/.../pertama-di-dunia-ahli-bedah-inggris.html