History of Robotic Surgery

These robotic systems enhance dexterity in several ways. Instruments with increased degrees of freedom greatly enhance the surgeon's ability to manipulate instruments and thus the tissues. These systems are designed so that the surgeons' tremor can be compensated on the end-effector motion through appropriate hardware and software filters. In addition, these systems can scale movements so that large movements of the control grips can be transformed into micromotions inside the patient.

Historical Popularity

Robotic Technology has always been part of a complex interplay between industry, government, and creativity- practicality - scientists and entertainers. In the 1950's it occurred to cinematographer Morton Heilig that all the sensory splendor of life could be simulated with "reality machines." He proposed that an artist's expressive powers would be enhanced by a scientific understanding of the senses and perception. His premise was simple but striking for its time: if an artist controlled the multi-sensory stimulation of the audience, he could provide them with the illusion and sensation of first-person experience, of actually "being there." Only Morton Heilig seemed to have an inkling of things to come.

In 1962, the Hollywood-based cinematographer and part-time inventor, patented an arcade game called Sensorama.What was Sensorama? It was a mechanized marvel that used motion, sound, smells, and even artificial breezes, to convince users they were riding a motorcycle through the streets of Brooklyn or watching a belly dancer perform. Heilig's objective was to offer "reality for a nickel"-a multi-sensory experience that included tactile-feedback handlebars, 3-D stereoscopic views, and wafting aromas such as jasmine and hibiscus. Thus, individually and collectively, by thoroughly applying the methodology of art, the cinema of the future will become the first art form to reveal the new scientific world to man in the full sensual vividness and dynamic vitality of his consciousness."

Early Applications and Development

Early experiments with head-mounted displays centered on input from servo-controlled cameras which would move with the user's head, and thus move the user's field of view. In one early project at Bell Helicopter Company, the head-mounted display was coupled with an infrared camera that would give military helicopter pilots the ability to land at night in rough terrain. An infrared camera, which moved as the pilot's head moved, was mounted on the bottom of a helicopter. The pilot's field of view was that of the camera. The helicopter experiments demonstrated that a human could become totally immersed in a remote environment through the "eyes" of a camera.

With the viewer inside a building, a camera was mounted on the roof, with its field of view focused on two people playing catch. The viewer immediately responded to the motion of the ball, moving the camera to follow the game of catch by moving his head. Proof of the viewer's involvement in this remote environment came when the ball was thrown at the camera, and the viewer ducked! When the camera panned the horizon, the viewer reported a panoramic skyline. When the camera looked down to reveal that it was "standing" on a plank extended off the roof of the building, the viewer panicked! In 1966, as Associate Professor at Harvard, Ivan and his student, Bob Sproull, took the "Remote Reality" vision systems of the Bell Helicopter project, and turned it into "Virtual Reality" by replacing the camera with computer images. The first such computer environment was no more than a wire-frame room with the cardinal directions -- North, South, East, and West initialed on the walls. The viewer could "enter" the room by way of the West door, and turn to look out windows in the other three directions. What they called the "Head-Mounted Display," later became known as Virtual Reality.

Telepresence was spawned in the 1950’s by the atomic energy industry’s unique need for the remote handling of dangerous isotopes. These applications, termed "teleoperation", allowed hazardous materials to be handled safely at a distance while being monitored by television. Modern "telepresence" adds multisensory input that recreates the remote visual, auditory, and tactile environment. This allows the operator to feel physically present at the remote site, in terms of sensory input and the ability to manipulate objects. The perception of distance is erased, and the operator can act effectively in a locally recreated environment that is in fact an illusion.

Industrial Use

Robots gradually made their ways into factories for performance of dangerous, repetitive tasks requiring accuracy, for handling hazardous wastes in nuclear industries, and as delivery robots. The history of robotics in a surgical procedure owes to an industrial robot developed by IBM known as the PUMA line of robots. The Puma 560 was, an IBM robot used in 1985 by Kwoh et al to perform neurosurgical biopsies with greater precision. The earliest conceptions of surgical robots were developed by Scott Fisher at National Aeronautics and Space Administration (NASA) and Joseph Rosed, MD (Department of Plastic Surgery, Stanford University) in the mid to late 1980’s. These researches joined Michael McGreevy and Steve Ellis during the development of the first head-mounted display (HMD) for displaying the massive amounts of data being returned from NASA’s planetary exploration missions of voyager and others.

Virtual Reality

The term virtual reality was coined by Jaron Lanier During the late 1970s and early 1980s, Atari was a center for exciting developments in software and chip design for the home entertainment market. Several pioneering figures in the VR field got their start at Atari. For instance, Warren Robinett, who has directed the head-mounted display and nano-manipulator projects at the University of North Carolina in Chapel Hill, developed the popular video game Adventure at Atari in the late 1970s. Jaron Lanier (who coined the term virtual reality) got his start by creating the video game Moondust. when Atari registered $536 million in losses for 1983. The Atari Research Laboratory was a casualty of the economic crash in the video game industry (and computer industry more generally). Industry was clearly not prepared, after sustaining such a big economic blow, to continue the development of VR technology on its own. Indeed Lanier's failed efforts to market a consumer entertainment version of the DataGlove, called PowerGlove, for Nintendo, demonstrated that the 1980s was not the right time for a sustained industry push.

Government Support

Federal support was crucial to building the array of hardware and software necessary for industry to step in and move VR forward. Most of the people working in VR at Atari either migrated to work on VR projects in federal laboratories, or, like Jaron Lanier, landed government contracts. Lanier won a contract to build the DataGlove for NASA. He used the profits to launch VPL-Research in 1984, the first commercial VR company The NASA-AMES Team had expertise in virtual reality but not robotics. Joe Rosen and Scott Fisher joined Phil Green at the Standford Research Institute (SRI). The first project for development was an extremely dexterous telemanipulator to greatly enhance vascular and nerve anastomoses for hand surgery.

In keeping with the virtual reality and telepresence concept, the design focused upon an intuitive interface. Joe Rosen was beginning animal trials and working with the Green Telepresence Surgery System, Richard Satava began working with the NASA-Ames team and Phil Green worked on directing the telepresence effort toward macroscopic surgery and specifically to improving laparoscopic surgery.

DARPA

This project was eventually transferred to the Pentagon’s Advanced Research Projects Agency (ARPA – which was developing under the ARPA-net that later evolved into the internet). Under the surgeon general’s support ARPA (later to become DARPA in 1993) was requested to begin a program in advanced biomedical technologies to include telepresence surgery.