423 - Robotic Surgical Systems in Maxillofacial Facial

robotic surgical system was manufactured to overcome the limitations of laparoscopic surgery, including tremor, fatigue, 2D imaging and a limited range of freedom. Additionally, robotic surgery can also be described as an ability to enable surgical interventions via the application of telecommunications and robotic systems, where the patient and surgeon are separated. Since Puma 560, 6 the fi rst robotic surgical system was introduced in the mid-1980s to orient a needle for brain biopsy, three generations of systems have followed. Generation I: CMI ’ s Automated Endoscopic System for Optimal Positioning (AESOP). AESOP, a voice-controlled robot, was developed to serve as a stable camera platform and not multi-arm units. AESOP eliminates the need for an extra surgical assistant, and AESOP 1000 was approved by the FDA for use in surgery in 1995. Even though AESOP was widely applied in various surgical settings, including cardiology, urology and gynecology, until 1999, 7 there were several de fi ciencies. In addition, the robotic system required a few alterations to cooperate with surgeon ’ s style of operation. Generation II: Telerobot Zeus. Zeus was a kind of master-slave teleoperator between the surgeon and the patient-side manipulator. Zeus was introduced in 1995 to provide improved precision for the laparoscopic surgeon, and it was approved by the FDA in 2000. Zeus consists of an AESOP robotic scope and two additional manipulators to hold the operating instruments, and the three arms are mounted to an operating table. It had the advantages of remote control, three-dimensional visualization and tremor suppres- sion. In addition, this telemanipulator allowed a surgeon to perform surgical procedures from a remote region, such as hospital-to-hospital settings. However, it was no longer technically supported once the da Vinci surgical system began being used worldwide. Generation III: da Vinci surgical system. Comparatively, the da Vinci system aimed at recreating the feeling of open surgery and was preferred by the open surgeon, while the Zeus system was primarily adopted by the laparoscopic surgeon. The initial da Vinci robot was invented in 1999 by Intuitive Surgical, and it consists of three major parts: a surgeon ’ s console, a robotic cart on the patient ’ s side and a high- de fi nition 3-dimensional vision tower. 8 The surgeon ’ s console enables management of the corresponding instruments with master controls, and it was derived from part of the M7 system developed by Stanford Research Institute (SRI) — a surgical robot for open surgery. 5 The surgeon can operate from a comfortably seated position while having a high-de fi nition real-time view inside the patient. The patient-side surgical cart consists of three or four arms that were originally developed from the Black Falcon system: one arm handles the endoscopic camera (passes through a 12-mm trocar), while the other two or three arms hold the EndoWrist instruments (pass through 8- mm trocars), which provide enhanced degrees of freedom and excellent 3D imaging. This permits large-scale movement in surgery, such as the movements needed for dissecting and suturing. Moreover, the camera used in the system provides a true-to-life stereoscopic image of the patient ’ s anatomy, which is transmitted to both the surgeon ’ s console and the vision tower beside the surgical assistant. 8 The vision tower provides a broad perspective and visualization of the procedure to the surgical assistant at the patient ’ s side (Figure 1). Recently, several Figure 1 Robotic surgery operating room schematic. Review of robotic surgery in head and neck HH Liu et al 64 International Journal of Oral Science | The Surgical Technologist | MARCH 2019 110