ROBOTICS A minimally invasive approach to traditional surgery https://www.davincisurgerycommunity.com/web/guest/home

Student Learning Objective Student will list and describe the three major components of the DaVinci Robotic System, including the principles of each component as they relate to patient applications and safety.

ROBOTIC SURGERY A surgical procedure or technology that adds a computer-assisted electromechanical device to the interaction between the surgeon and the patient (Association of Surgical Technologists: AST) console-manipulated devices remote-controlled endoscopes enhancing a surgeon’s “vision, tissue manipulation, and tissue- sensing” altering the traditional relationship between surgeon and surgical site. CORE CURRICULUM RATIONALE According to the Association of Surgical Technologists (AST) robotic surgery is defined as: a surgical procedure or technology that adds a computer-assisted electromechanical device to the interaction between the surgeon and the patient. Examples include console-manipulated devices and remote-controlled endoscopes enhancing a surgeon’s “vision, tissue manipulation, and tissue-sensing” and altering the traditional relationship between surgeon and surgical site.

EVOLUTION OF ROBOTICS Robotics > developmental stage > accepted and preferred method of practice Healthcare is purchasing surgical robots Robotics is constantly evolving, stay current through professional development CORE CURRICULUM RATIONALE Robotics has gone from a developmental stage to an accepted and even preferred method of practice for minimally invasive surgery. Many healthcare facilities despite location or size are purchasing surgical robots and training their staff on its use. Robotics is constantly evolving so it is imperative for surgical technologists to comply with national standards of practice and remain certified.

Standards of Practice, Perioperative Roles and Duties AST GUIDELINES Standards of Practice, Perioperative Roles and Duties http://www.ast.org/uploadedFiles/Main_Site/Content/About_Us/SOP_Rol e_Duties_ST_Robotic_Surgery(1).pdf AST follows specific Standards of Practice, Perioperative Roles and Duties for surgical technologists in the field of robotic surgery. Thus the surgical technologist must possess the knowledge to adequately assist the surgeon and still provide quality patient care and safety. http://www.ast.org/uploadedFiles/Main_Site/Content/About_Us/SOP_Role_Duties_ST_Robotic_Surgery(1).pdf

Robotic System: Clinical applications ADVANTAGES: robotic assistance > surgeons enhanced capabilities and precision > simulating open surgical environment > minimally invasive approach Technical Advantages: conventional rigid laparoscopic instruments<> robotic surgeons + 7 degrees of freedom with wristed laparoscopic instruments. CONTENT: Part I Robotic System A.) Clinical applications 1.) With robotic assistance, surgeons gain enhanced capabilities and precision simulating an open surgical environment but with a minimally invasive approach. 2.) Technical Advantages: Compared to conventional rigid laparoscopic instruments, robotic surgeons gain 7 degrees of freedom with wristed laparoscopic instruments.

a 3D HD view of the surgical field up to 10x magnification Technical Advantages: a 3D HD view of the surgical field up to 10x magnification motion scaling elimination of hand tremor and significantly improved ergonomics.     

Surgeon Benefits Surgeon Benefits: capabilities beyond the limits of the human hand improved visibility improved precision of dissection time‐saving intracorporeal suturing for water‐tight anastomoses access and maneuverability in tight pelvic spaces Surgeon Benefits: The technical edge of robotic assistance provides surgeons capabilities beyond the limits of the human hand. Surgeon adopt robotic assistance because of: improved visibility, improved precision of dissection, time‐saving intracorporeal suturing for water‐tight anastomoses access and maneuverability in tight pelvic spaces.

Surgeon Benefits -handling, examining and excising potentially cancerous tissue accessing difficult‐to‐reach lymph nodes avoidance of intra‐operative conversions and elimination of post‐ operative wound infections

DECONTAMINATION AND STERILIZATION COMPONENTS -robotic instruments are no different than traditional or laparoscopic instruments -thus should be handled accordingly -follow your clinical site’s (HCF) policy for all decontamination and sterilization instrumentation

Patient Console contains the camera and three instrument arms -camera and 3 instrument arms -motorized for simplified docking -each interactive robotic arm utilizes intuitive motion control -each arm equipped with clutch buttons for vital rapid instrument exchange -each arm moves around a fixed pivot point and uses simple click-lock cannulas -the CST is responsible for draping the patient console contains the camera and three instrument arms -is motorized for simplified docking -each interactive robotic arm utilizes intuitive motion control -each arm is equipped with clutch buttons for vital rapid instrument exchange -each arm moves around a fixed pivot point and uses simple click-lock cannulas -the CST is responsible for draping the patient console

Surgeon Console -surgeon operates> viewing magnified 3D image of the body’s interior -as controls are manipulated, da Vinci responds to surgeon’s input in real time -translates wrist & finger movements> precise movements of miniaturized instruments -surgeon may modify console settings to meet personal needs and save them at the da Vinci console, your surgeon operates while viewing a highly magnified 3D image of the body’s interior. -as the controls are manipulated, da Vinci responds to your surgeon’s input in real time, -translates wrist and finger movements into precise movements of miniaturized instruments at the patient-side cart. -the surgeon may modify console settings to meet personal needs and save them according to last name  

Vision Console -high-definition monitor allowing assistant or CST to view entire operation used to control settings like camera calibration capable of digital zooming and tiling screen to accommodate multiple feeds monitor is touchscreen and can be used as a proctoring tool monitor can be draped sterilely

Vision Console -contains a core which is its processing center -also contains built-in microphones for intraoperative communication -contains a core which is its processing center -contains a camera assembly for a variety of scopes -contains a integrated or adapted power unit for an array of energy instruments

Manipulators and Instrumentation -surgeon uses precisely controlled EndoWrist instruments into body through a series of endoscopic ports. -broad range of instrument types available > help surgeon perform specialized surgical tasks with precision and control. -each instrument has a specific surgical mission> clamping, suturing, and tissue manipulation. -quick-release levers speed instrument changes during surgery

Manipulators and Instrumentation Examples: vessel sealer electrocautery hook suction-irrigator graspers and scissors each instrument has lifespan of ten surgical procedures

Patient Safety -fewer days in the hospital, -less pain, -avoidance of a large abdominal incision, -decreased risk of blood transfusion, -quicker return to normal daily activities decreased intra‐operative minutes   decreased consumption of routine post‐op surgical care needs, such as IVs, narcotics, blood transfusions, wound care management & nursing care surveillance   avoidance of intra‐operative conversions avoidance of post‐operative wound infections

Patient Safety remains primary concern The same standards of practice are required by the surgical technologist for robotic surgery.  

Preparation, Positioning & Troubleshooting -every medical facility will orient the operating room according to procedure and patient positioning. -the CST must know how to orient the components of the robotic system within the OR as per the surgeon’s preference card. -docking and troubleshooting require hands-on experience in at a clinical site.

Geometric Systems Applied to Robotic Arms Cartesian coordinate geometry Cylindrical coordinate geometry Revolute geometry geometric systems related to a group of classes used to identify manipulators according to the combination of joints used in their construction AST standards

________________ helps the surgeon localize sound sources in noisy, complex auditory environments like the operating room. ______________ is a movable, rotating joint, as in the human wrist or a Davinci Endowrist instrument. ______________devices used to manipulate specific materials without direct contact. The robotic instruments are examples of tissue manipulators.   Binaural hearing: helps the surgeon localize sound sources in noisy, complex auditory environments like the operating room. Articulated: a movable, rotating joint, as in the human wrist or a Davinci Endowrist instrument. Manipulators: devices used to manipulate specific materials without direct contact. The robotic instruments are examples of tissue manipulators.

____________ ___the amount from which a figure is rotated either clockwise or counterclockwise from a fixed point. ____________ ___the number of independent parameters that define the configuration of a mechanical system. ____________ ___three critical parameters used in flight dynamics also known as angles of rotation. These parameters allow the surgeon to maintain control and orientation during surgical procedures. Degrees of rotation: the amount from which a figure is rotated either clockwise or counterclockwise from a fixed point. Degrees of freedom: the number of independent parameters that define the configuration of a mechanical system. Pitch, roll, & yaw: three critical parameters used in flight dynamics also known as angles of rotation. These parameters allow the surgeon to maintain control and orientation during surgical procedures.

___________: the detail an images holds or the capability of sensors to observe or measure the smallest objects clearly with distinct boundaries. ___________: a complex robot that is remotely controlled by a human operator or in this case, the patient console. ____________: a sophisticated form of robotic control in which a human operator has a sense of being on location so that the experience resembles virtual reality. Resolution: the detail an images holds or the capability of sensors to observe or measure the smallest objects clearly with distinct boundaries. Telechir: a complex robot that is remotely controlled by a human operator or in this case, the patient console. Telepresence: a sophisticated form of robotic control in which a human operator has a sense of being on location so that the experience resembles virtual reality.

CONTENT Understanding….any questions? How does robotic surgery compare to more traditional forms like laparoscopic and open surgery? How does the use of robotics relate to patient safety? What are some of the surgical applications of robotics? CONTENT Understanding….any questions? How does robotic surgery compare to more traditional forms like laparoscopic and open surgery? How does the use of robotics relate to patient safety? What are some of the surgical applications of robotics?

CONCEPT MAP Identify each of these components and describe three applications for each. ___________________________________________________________________________ __________________________________________________________________________ ___________________________________________________________________________

CONCEPT MAP Identify each of these components and describe three applications for each. ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ___________________________________________________________________________

DaVinci Online Community Create an account & join this online community Valuable resources Modules: review concepts ASSESSMENT: Distributive Practice (DP) DaVinci Online Community Please take the time to create an account and join this online community. There many valuable resources for students and professionals as well. The modules for example are an excellent way to review concepts and further familiarize yourselves with its applications.

How does the use of robotics relate to patient safety? Robotic surgery (telesurgery) is now an acceptable method of minimally invasive surgery and will only become more advanced. AST follows specific Standards of Practice, Perioperative Roles and Duties for surgical technologists in the field of robotic surgery. Patient safety however remains the surgical team’s primary concern!