Release date: 2016-04-29
I believe many people still remember a video that was very hot last year. The content is presented in a small glass bottle. A grape is undergoing surgery on a robot. The whole process of surgery is done by a surgical robot called Da Vinci. Because the whole operation process is fast and accurate, the grape skin "skin" is successfully stitched, which makes the Da Vinci robot clap the surprise, but for the medical profession, it is not a new thing.
As early as 2006, the first Da Vinci surgical robot was introduced to the People's Liberation Army 301 Hospital. After 10 years of development, more than 40 hospitals in China now have 57 Da Vinci surgical robots, which have completed nearly 30,000. A surgery.
The reason why the Leonardo da Vinci robot was named is because the R&D manufacturer thought that Da Vinci designed the humanoid machine in 1495, so it is considered to be the inventor of the world's first robot. But in fact, the Da Vinci robot is not what we have always thought of as human figure and artificial intelligence deep learning. Strictly speaking, Da Vinci robot is an advanced robot platform, which is controlled by surgeon, bedside robot system and imaging system. The composition of the three divisions.
From a medical point of view, the Da Vinci robot is an advanced laparoscopic system . It also requires a robotic arm to pass through the chest, abdominal wall, etc. during the surgical procedure. The design concept is to implement complex surgery by using a minimally invasive method.
Ms. Pan Zhongying, Dean of Beijing United Family Hospital, directly defined the Da Vinci robot as a surgical tool with robotic features.
As the first private medical institution in China to deploy Da Vinci robots, Beijing Hejia Hospital has already used the Da Vinci Robot System (hereafter referred to as “Da Vinci Robotâ€) to control 100 large and small operations, which is profound for robotic surgery. Understanding and practical experience.
Pan Zhongying said that the Da Vinci robot is mainly used to support the doctor's support, helping minimally invasive surgeons to perform surgical operations with higher precision and less error. For example, a surgeon has a very high level of medical skills, but when he encounters some difficult cases, the use of traditional medical devices is limited during the operation. At this time, the role of the Da Vinci robot is highlighted.
In addition to dealing with the "doctor's hand" in the process of surgery, because the Da Vinci robot's equipment is very fine, the size is calculated in centimeters, so the operation is very accurate, and the wound is small, bleeding is less, and the recovery time of the patient is greatly accelerated.
What are the advantages and disadvantages of surgical robots?
Zhu Gang, the chief physician of the Department of Urology, Beijing United Family Hospital, was one of the earliest Da Vinci robot controllers. The number of robotic operations by his hand has reached 11 units.
According to Zhu Gang, Da Vinci robots are now mainly used in urology, thyroid, gynecological oncology, gastrointestinal, child surgery and other related operations, because the symptoms in these places are not related to sensitive nerves, or they are deeply hidden and require high precision. operating.
Taking the prostate as an example, it is located at the interface of the urethra and the bladder. The traditional open surgery requires a large incision, but the robotic surgery only needs to open a few holes of about 1 cm, and the amount of bleeding is also less. In fact, more than 90% of prostate cancer radical resections in the United States are assisted by robots.
Director Zhu Gang sat in front of the Da Vinci robotic console.
As the first line of "robots" in robotic surgery, Zhu Gang believes that the medical profession has entered a new era of minimally invasive.
In traditional surgery, the doctor must hold the instrument himself, perform surgery on the patient's side, and be in a state of tension, which is easy to get tired. Now with the addition of the Da Vinci robot, the operating doctor can leave the operating table and simply control the robot arm on a console to complete the entire surgical procedure.
Da Vinci robots do not stop at the hands of liberating doctors. In some special conditions, Da Vinci robots can even go further than people. For example, the most difficult thing in traditional laparoscopic surgery is suturing and knotting. Da Vinci robots can It's better than people, even doctors who don't do laparoscopic surgery before.
Director Zhu Gang stood in front of the robot arm, and the instruments that directly contact the human body for surgery are very fine, and the size is calculated in centimeters.
Before the operation began, Director Zhu Gang and colleagues were adjusting the robotic arm.
However, Zhu Gang also admitted that compared with traditional surgery, Da Vinci robots have no tactile feedback during operation, which is a major drawback. Doctors are not used to getting started. However, with the increase in the number of operations and the accumulation of practical experience, tactile feedback is not the biggest obstacle. Behind this is the intelligent error correction function that reaches the Finch robot, which can control and correct the jitter caused by the surgeon's auxiliary action in real time and reduce the operation error.
Zhu Gang also confided that the pressure when sitting on the robot console is no less than a personal hand.
Strict requirements for patients and doctors
In addition to the doctor's proficiency in the Da Vinci robotic operating system, it is also important to select the right patient for robotic surgery. Although some patients are asked to use the significant effects of the Da Vinci robot, before each surgery begins, Heyijia Hospital will organize a team of experts to conduct consultations on the patient's condition to determine whether it meets the criteria for using robots for surgery.
Not only does the patient have a choice, the Da Vinci robot has strict requirements for the doctors, nurses and assistants who are being controlled, because the participants must be trained, tested and certified to be qualified to operate the robot, and these personnel must have previously Has a wealth of clinical experience. At present, the certificate involved in a robotic surgery includes the main knife certificate, assistant certificate, nurse certificate and so on.
“Doctors must be very knowledgeable about the hardware and software systems of robots. After online training, offline animal experiments, and certificates, they are eligible for clinical surgery,†said Zhu Gang.
However, such certificates are not standards set by the state, but are issued by robot manufacturers.
Talking about the price of Da Vinci robot-assisted surgery, Zhu Gang said that it is generally necessary to add 30,000 yuan to the traditional surgery, including the start-up fee and the actual cost of the consumables during the operation, which constitutes the basic price of Da Vinci surgery. system.
This is a market monopolized by foreign manufacturers.
In his conversation with Zhu Gang, he also revealed a very helpless reality. Although the practical application of the domestic robotic operating table is very mature, it is difficult to spread quickly.
On the one hand, Da Vinci surgical robots belong to Class A large-scale equipment. The introduction of this equipment by any hospital in China requires direct approval by the National Health and Family Planning Commission. What kind of hospitals can be configured and configured, there are clear standards, not hospitals. Money can be purchased.
On the other hand, the technology and market of Da Vinci robots are monopolized by foreign manufacturers, and the price is called huge profits. It is a disadvantage for domestic medical institutions to be led by their noses.
"In foreign countries, a Da Vinci robot costs only $1 million to $1.5 million, but the domestic price is as high as 20 million yuan, and it costs a lot of machine maintenance every year."
In addition, the robotic arm of the robot is a high-value consumable. It is temporarily installed on the robot. It can not be used after each arm is used for 10 times. The price of the arm is about 100,000 RMB per piece.
The price is still high, and the Leonardo da Vinci robot monopoly surgery robot market is not a one-time success. Before it was born, there were other surgical robots. However, when every new technology or product is attempted to be applied to an emerging field, the process and results are often full of variables, as are surgical robots.
As early as 1985, Americans tried to use the Puma 560 industrial robot to assist in brain biopsy, which was the initial prototype and exploration of surgical robots.
Later in the late 1980s and early 1990s, surgical machines dedicated to surgery were also born, more representative of the RoboDoc surgical robots.
Until 1994, Aesop's mirrored robot developed by Computer Motion of the United States achieved a more precise and consistent lens movement than humans. It took a crucial step in the development of robotic minimally invasive surgery systems, but it cannot be performed by itself. The instructions are for surgical operation, but just a "mirror" electronic manipulator. In 1996, Computer Motion again presented the Zeus robotic surgical system for minimally invasive surgery.
However, with the birth of the Da Vinci robot, the above robots have become cannon fodder. On January 9, 1999, Intuitive Surgical of the United States released the Da Vinci surgical robot system. In 2000, it was officially approved by the US Food and Drug Administration for use and certification, becoming the world's first robotic surgical system that can be used in abdominal surgery.
Since then, Da Vinci robots have been out of control and quickly applied to all parts of the world, almost monopolizing the global surgical robot market, and this situation continues to this day.
The birth of Da Vinci is also due to medical needs. The endoscopic technique is a typical representative. In the past, the instruments used by doctors were still traditional common thoracoscopy equipment, which made it difficult to master precise operation during operation and it was very uncomfortable to operate. The true intracardiac operation still requires the auxiliary incision of the chest wall to complete. Therefore, in order to overcome the defects of laparoscopic technology and the pursuit of better minimally invasive surgery, the minimally invasive robot system will be born.
In the event of a robot accident, how is the responsibility divided?
In fact, the popularity of Da Vinci robots, from the patient's point of view, most people still worry about safety issues, after all, the cold machine directly into the body to operate, in the event of an accident, who will bear responsibility?
Just a few days ago, Intuitive Surgical also announced a safety notice to customers, recommending that doctors use cardiac cryoprobes for robotic surgery.
Intuitive Surgical said they received five postoperative reports of a heart-shaped mitral valve repair using a Da Vinci robot, showing an increase in metal particles in the body. In five case reports, two patients developed transient neurological symptoms. Although it is not certain that the symptoms are directly related to robotic surgery, the company issued a safety notice.
In this regard, Pan Zhongying, dean of Beijing United Family Hospital, believes that robotic surgery is not foolproof, and high technology is not a panacea. In the event of an accident, how to trace the source and find out how the mistake is caused is quite critical.
"This is why the pre-operative patient screening is so important. As a manager, we must try to explore with the manufacturers, raise the safety issue to a high level, and systematically prevent it in advance, and minimize the probability of failure," she said.
In the face of sudden accidents, pessimists have doubts about surgical robots and even put an end to attitudes. However, for optimists, surgical robots are an inevitable trend. With the upgrade of robot systems and technologies, especially with artificial intelligence, robots Is it possible to do surgery on the patient? Even further replace the doctor?
Pan Zhongying's answer is that the surgical robot will lead to some changes in the doctor, but a surgeon and an anesthesiologist need a better tacit understanding. Robot surgery will not only replace the doctor, but the surgeon's teamwork ability will be more demanding. When you are taller, the role that doctors play will become more and more important.
She also cites, for example, that professional typists used typewriters to type words long ago. Now that computers are popular, full-time typists have disappeared. However, the requirements for typography and design are higher... It can be seen that the overall technical update and standards are gradually improved, which is an evolution process that human beings must experience when exploring new technologies and fields.
According to Pan Zhongying's vision, she hopes that the future surgical robot can truly realize remote control, enabling doctors to perform surgical operations even in different places, thus giving patients a global medical benefit. So, for ordinary patients, in the face of the introduction of surgical robots and high surgical costs, will they be willing to be the first to eat crabs?
Source: Titanium Media
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