ROBOTIC CARDIAC SURGERY

Since the birth of surgery, back in the Egypt of the pharaohs, the surgeons have worked on the human body utilizing tools: the surgical instruments.  These tools permit us to catch tissues, to cut them, to sew them, to repair them or to stop them bleeding. All these actions have been done traditionally with the direct vision of the surgeon, and manual direct control of all the surgical instruments.  The results of many interventions have depended since then of two fundamental factors: the capacity of judgment and decision of the surgeon, together with the manual ability of the same one to be able to utilize these instruments and to transfer decisions to precise movements.  The importance of this manual ability has given rise to traditions as that of "the hands of the surgeon".

Nevertheless, at the beginning of the 21st century we are attending various stimulating advances in the world of surgery, that already had occurred in other fields as the industry or the spatial technology: the application of robots for precision tasks like the surgery. 

Industrial applications of the robotics

The technological development of the end of the last century, and above all the apparition of computers, has permitted the construction of capable machines to manipulate other instruments.  These machines are employed in dangerous environments for the man, like the manipulation of explosives, radioactive materials or the space.

The facility of the machines to be able to reach places impossible for the human hand, together with the ability to carry out complicated tasks has permitted them to be employed in industries as the transport or the production of chips. 

Their success in the industry and further investigation have permitted to expand them on to other fields, among them the medicine.  The experience acquired in the management of scientific instruments has permitted that nowadays robots can be specifically designed for use inside the human body. 

Advantages of the surgery with Robots

The robots that are employed in surgery do not look alike to the robots of the books and movies of science-fiction. They are not capable by themselves to make decisions or to carry out tasks.  In reality they are what in technology are called telemanipulators. Their function is to reproduce with precise precision the movements that a surgeon orders him to do.  These robots therefore do not replace the surgeon, but they improve the capacity of the same one to carry out delicate movements.

       The advantages that contribute the use of robots are basically two: 
    1) In the first place, is not necessary to do large incisions to arrive to the heart, because instead of having to pass the hand of the surgeon only the arm of robot has to get through, which normally does not have more than 1 cm of diameter.  
    2) In second place, wins in precision.  A hand well trained is capable of carrying out movements of only a few millimetres. On the other hand a robot is capable of carrying out millimetre fractions movements with the same precision with which a surgeon would carry out larger movements.  

Applications in heart surgery

One of the fields where the robotics has reached its maximum application in medicine is the heart surgery.  In cardiac surgery more than in no other surgery it is extremely important the precision of the movements.  In order to work on the heart up to now it was necessary to do large incisions through bones and muscles and from time to time these injuries, and not the surgery on the heart, where the ones that caused the problems after the surgery. 

By means of the employment of robots it is possible to reach the heart through small orifices, without having to cut through any bones, this is at present one of the advantages of using the robots.  As well as the small size of the paths of entrance into the body, the robots are capable of repeating with precision the movements that the surgeon orders him, from sewing a small artery, to repairing a precise valve, carrying out cuts or sewing weavings, with threads of thicknesses of tenths of a millimetre.  

It is important to emphasize that these devices aid the capacity of the surgeon to carry out actions on the heart, but the intervention continues depending on the ability of the surgeon to handle the robot and to make the adequate decisions.  

Robotic interventions in cardiac surgery

One of the interventions that has been benefited the most out of the robotic surgery is the repair of the mitral valve.  In these interventions, instead of having to open the sternum, thanks to the robotic surgery it is possible to arrive to the valve through small orifices among the ribs. These orifices make it possible to introduce a small camera up to the valve, that offers the surgeon an enlarged three-dimensional vision  of the valve and the weavings that surround it, as well as  small scissors, pincers and sutures for the repairing of the valve, all handled by the robotic arm. In this manner an equal or superior repair is fulfilled  in contrast to which is obtained with traditional media, without the need to have to do large injuries in the thorax to arrive to the heart.

Secondly the interventions that are benefited most form the robotic surgery are the interventions of bypass aortocoronario and the surgery of the thoracic aorta, in which depending on the intervention type that has  to be carried out it is possible to substitute the conventional interventions by other which produce smaller injuries.  

The future of the surgery with robots

Up to now, the robots that are employed in surgery are only small arms that repeat in the distance the same movements that the surgeon carries out on a console.  They depend completely of the surgeon for each small action that they carry out.

In the future it is probable that the advances in technology will permit the robots to be capable of understanding and to interpret more complex orders, and that no longer it will be necessary that for surgeon to guide him in each basic movement.  In his place, through a trained robotic apprentice, the surgeon will be able to give generic orders as:  "Sews this glass on this point", and the robot will be capable of reproduce the order which he has previously learned with precision.

The time until we reach the point where a robot is capable to make the decisions and to act in an autonomous manner is still distant, so much in medicine as in the remainder fields of science, and will depend on the advances that are carried out in the Artificial Intelligence field.  Although the perspectives of future are exciting, the certain fact is that still they are very distant.  Nevertheless, fortunately we can affirm that in the beginning of the 21st century already a giant step has been made to benefits the patients, thanks to this, robots combine an arm the size of a ballpoint pen, with the precision of the most advanced technology.