Nothing is new in surgical robotics - The Early history of soft tissue robotics and how modern systems are just better working copies
- Steve Bell
- Jan 25, 2024
- 5 min read
Updated: Jul 30
For a little bit of fun... Nothing is new in surgical robotics - trust me. No matter how clever we all think we are in the current robotics companies - most of the cool ideas were thought of in the past. I often hear people saying "but have you seen this cool thing? This great new idea?" For some of us that have been in this space for nearly 30 years - we've seen a lot before.
There are a few defining papers on the history of soft tissue surgical robotics but I like this one: Why? Because all the cool ideas we think of today have already been done in the past.
Let me just run a few thoughts past you and show you a few examples of what I mean:
Vicarious surgical showed this image a few years ago and everyone was raving about how cool the non tethered hand controllers were - and how amazing it was to have a 3D VR headset on instead of using screens. (By the way it's said VERB had non tethered controllers on their early concepts, and LUNA is launching with them now... Bad Idea?)
Well it's a very old idea - in fact it's from the 1960s The very first rendition below by Scott Fisher used... a VR header to view the scene and gloves that acted as controllers... untethered. Old idea. And a lot of\f the reasons this was abandoned in the 80's, the 90's and the recent 2010's have been well known.
Then we have the revolutionary idea of individual table mounted arms being the next frontier such as by Johnson & Johnson and Ottava (and VERB) - that promises to give a low robot footprint and the inherent table motion.
Well back in the late 80s and early 90s - that was also a thing with Computer Motion and Zeus. Which... oh look had table mounted individual arms - that allowed table motion. Plus the low OR footprint. For very good reasons that just came and went. In fact patient flow is an utter nightmare with it. Individual arms on carts have also been around for an age
DLR MIRO was yet another table mounted design that just didn't work. The issue is range of motion and multi quadrant limitatlions (plus horendous clash).
AESOP by Computer motion was a table mounted or cart mounted arm.
I want you also to notice (above) that the surgeon is sitting looking at an "open console" 3D screen with a cool "wing mirror" assistance LCD screen to control the functions of the robot. And guess what.. a ton of companies, including Medtronic with Hugo tout their revolutionary wing mirrors, open consoles, and input systems (4). Yes the design has advanced with modern screens - electronics and computing - but the idea is very old.
This is the early concept of the closed console - back to the 80's by SRI. Where the surgeon has hand controllers and 3D periscope view. This is what morphed into the daVinci console we all know today. And this concept also became the basis of the telemanpulation devices we see everywhere today from Revo-I to Medicaroid - to every chinese clone that is on the market.
And then we jump to MMI and the microsurgery robot - that is doing "open" surgery not lap. A revolution eh? Two arms that bring small gauge instruments for open surgery with tremor reduction and motion scaling...
Or maybe not - as back then in the early 80's SRI was already doing this - see the left image of their microsurgery system. And as a bonus you can see the early instruments were all with interchangeable end effectors - for those new companies touting their "reusable and cost effective" instruments. They've been around for 40 years my friends. Nothing new here - move on.
And then we have the modern miracle of distance surgery - using 5G. That must be a new idea right? Erm wrong. DARPA had that sewn up 40 years ago as well. They were using microwave signals bounced off aircraft to be able to do battlefield live surgery at large distances. Long distance tele-surgery was even completed transatlantic by Jacques Marescaux - in 2001. So people shouldn't shout too loud when they do a 5G procedure of 500Km. There are reasons beyond technology why it's impractical.
Sure... I hear you say... but what about new comers like Moon Surgical and their Maestro system. That must be a really new concept. I mean it's only just come out. We've never seen this before - A system that uses robot arms (SCARA) to allow solo surgery in laparoscopy...We all know and love laparosocpy, but it must come into the modern age for places like ASCs...
Well yet again this is a very old concept from the every early 2000's by a relatively unknown company known as Leonard Medical Inc - with their passive SCARA First assist.
The same concept with slightly less sensors - but a robotic arm that is moved by the table side surgeon. It holds the scope in one arm and the retraction instrument in the other. Looks pretty familiar right? And again a whole raft of reasons that this company is unknown and the product no longer exists. Maybe modern tech will revive this idea?
There are a ton of other examples (won't do it today) - modular socketed robots - single incision robots - endo snake robots - cardiac robots - and ortho navigation robots - as far back as Robodoc. But sometimes it is just that the world was not ready for such advanced ideas. Sometimes the technology was just not caught up to the idea. But for all of us that say "wow" to the next new shiny thing - we might want to remember that little is new in this space, and a little historical research can maybe help us see through some of the hype. This article is primarily for amusement - and just to remind us all to be humble and think of the shoulders we all stand on.
Dear Steve
Thanks for the informative post.
“controllers... untethered. Old idea. And a lot of\f the reasons this was abandoned in the 80's, the 90's and the recent 2010's have been well known.”
Can you perhaps elaborate on the reason you think untethered controllers were abandoned and if it is sonething surgeons want?
Stéphane T