Important Historic Robotic Companies and Systems
A high-tech medical device company Computer Motion played a very important role in developing early surgical robotic technology. The company was founded in 1989 with a goal to revolutionize surgical practices and to improve patient lives. They specialized in medical robotics and developed a baseline for integrated robotic surgery. The company designed and manufactured systems for the Intelligent Operating Room™ of the future and made a significant contribution to the fields of minimally invasive surgical robotics
Their first product was Aesop™, a robotic system used for holding an endoscopic camera in minimal invasive laparoscopic surgery. The system is like a third arm of the surgeon. It is operated by foot pedals which got rid of frequent problems due to hand tremors. In December 1993, the Aesop 1000 system was approved by the FDA. It became the first surgical visual aid robotic device certified by the FDA. The foot pedals, although easy to control for well trained surgeons, were a problem for new users as they had to look down on the pedals before they could adjust them.
Aesop 2000 released in 1996 used voice control, the Aesop 3000 released in 1998 added another degree of freedom in the arm, and the Aesop HR version was networked with other smart devices. In few years time thousands of surgical procedures were performed using AesopÕs robotic technology.
The ZeusTM Robotic Surgical System with three robotic arms attached on the side of the operation table was extension of AesopÕs arms to control surgical instruments. The first prototype was demonstrated in 1995, tested in animal in 1996, first tubal re-anastomosis and first CABG procedure carried out in 1998, Micro-wrist and Micro-Joint added after 2000. Micro joints in Zeus were designed to hold 28 different instruments including scalpels, hooks to tie knots, scissors and dissector. Computer Motion finally reached the market to compete with Intuitive Surgical (see below) when Zeusª got FDA approval in 2001. Surgeon carried out surgical procedure using small hand joystick which in turn controled the micro movement of the robotic arms. Computer MotionÕs one of the major contributions to the field of digital surgery was ZeusÕs capability to digitally filter out human hand tremor making the robotic procedure more steady and reliable. The system was designed for minimally invasive microsurgery procedures, such as beating heart, endoscopic coronary artery bypass grafting (E-CABGTM) and initiated more complex procedures like a mitral valve surgery IDE study.
Hermes is another important robotic system that does not use robotic arms but is used to connect all the intelligent tools in the operating room. It is a centralized networking platform designed to control many devices which allows surgeons to voice control them. Networking all the components in the room also gave the robotic system more control over the operating room environment like changing the positions of table, video cameras and surgical equipment and changing the lighting conditions etc. The network system was further extended outside the operating building using Socratesª to form a tele-surgery system enabling more experienced surgeon far away to take control of the operation.
In 1995 another strong competitor in the field of robotic surgery, Intuitive Surgical was formed based on foundational robotic surgery technology developed at Stanford Research Institute (SRI) International. In a short time the company collaborated with leading institutions and companies like IBM Corporation, Massachusetts Institute of Technology (MIT), Heartport Inc., Olympus Optical, Ethicon Endo-Surgery Ð a Johnson & Johnson Company, and Medtronic Inc. They came up with the da Vinci® System.
In 1997 da Vinci® Surgical system got FDA approval for assisting surgery and in July 2000 the da Vinci¨ Surgical system became the first laparoscopic surgical robotic system that got cleared by the FDA to perform surgery. The system was equipped with a 3D vision system in which a double endoscope generates two images resulting in the perception of a 3D image. With the release of this system Intuitive's major contributions to the history of robotic surgery is the EndoWrist¨, a miniaturized hand, and the control system, reproducing the range of motion and dexterity of the surgeonÕs hand, providing high precision, flexibility and the ability to rotate instruments 360 degrees through tiny surgical incisions. The aim was to make the robotic surgical procedure easy to control like in the open surgery.
Through the development and commercialization of the da Vinci® Surgical System, Intuitive Surgical caught up and surpassed Computer Motion in revenues within few years in 2000. The da Vinci® System is now widely used in clinical trials in the United States for a wide variety of surgeries. More than 240 da Vinci Systems are in use around the world. The FDA has cleared this system for use in performing many surgical procedures including general laparoscopic surgery, thoracoscopic (chest) surgery, laparoscopic radical prostatectomies, and thoracoscopically assisted cardiotomy procedures.
Between 1993 and 2000 Computer Motion protected itself with a wide variety of patents on various surgical procedures that are critical for the success of robotic surgery. Some of their main patents include:
- Three-dimensional vector co-processor
- Automated endoscope system for optimal positioning
- Shape memory alloy actuated rod for endoscopic instruments
- Method and apparatus for performing minimally invasive cardiac procedures
- Head cursor control interface for an automated endoscope system for optimal positioning
- Motion minimization and compensation system for use in surgical procedures
- Method and apparatus for performing minimally invasive cardiac procedures
- Medical robotic system
With all these patents in hand Computer Motion seemed to become the robotic surgery company of the future, but Intuitive Surgical has devised their own technology to compete in the robot market. In June 2000 the United States Patent and Trademark Office issued Computer Motion Inc. the ownership of hand tremor elimination with a robotic surgical system during minimally invasive surgery (No. 6,063,095). Law suit was filed against Intuitive Surgical for infringement of Computer Motion patents.
The ongoing patent disputes ended with the merge of Computer Motion Inc. and Intuitive Surgical Inc. In 2003 Intuitive Surgical Inc. announced the merge agreement in a stock swap valued at about $63 million, combining the companiesÕ products for operative surgical robots, telesurgery and operating room integration. After acquiring Computer Motion Inc., Intuitive Surgical Inc. became the leader in operative surgical robotics.
Integrated Surgical Systems Inc.
Integrated Surgical Systems Inc. another medical robotics company specialized in a different area, surgical robots for hip and knee implants. The Orthodoc and Robodoc¨ designed for orthopedic surgery was first developed in a collaborative project between University of California, Davis, and the IBM T. J. Watson Center. It uses pre-surgical images and software to first design the surgical procedure. Surgeon can precisely define the cavity in the hip bone, size and position the prosthesis before the real surgery. The Robodoc, the surgical assistant system runs the program and performs the surgery. Robodoc cuts the patient without direct human control of the cutting tool during the procedure. The computer aided design of the surgery results in cleanly cut cavity, accuracy, precise fit of the prosthesis and long lasting hips joints compared to the traditional methods.
In 1997 Integrated Surgical Systems Inc. purchased Innovative Medical Machines Int. (MMI) and extended its field of robotic to neurosurgery. NeuroMate, a neurosurgery system developed by MMI combined with Robodoc is used for surgical assistance for biopsy and tumor removal. In stereotatic neurosurgery, instead of pre-operative images, the NeuroMate system provided real-time 3D images to give surgeon precise location of a tumor.
Radiosurgery is also incorporating advanced robotic systems. In October 1st 2001 CyberKnife developed by Accuray Incorporated received FDA clearance for a compact, lightweight linear accelerator (linac) mounted on a robotic arm that provides lesions treatments anywhere in the body using radiation. Stereotactic Radiosurgery System (SRS) utilizes body's skeletal structure as a reference frame and its Dynamic Tracking Software (DTS) technology adjusts minor patient movements to achieve this high level of precision. Lesions are marked in relation to the bone structure using CT images, then during the procedure real time X-ray is used to accurately position the linac before delivering radiation beam.