Surgical Robotics: Creating a New Program

Abstract

Objective:

To share our recent experience in developing and implementing a program for computer-assisted, robot-enhanced surgery.

Background:

Minimally invasive surgery has revolutionized our approach to the surgical patient during the last decade. While robotic surgery does promise the ability to operate at a distance, thus providing surgical skills in remote and hazardous areas, we have found several features that could enhance our abilities as surgeons in the same room with our patient. These include tremor filtration, motion scaling, movement indexing, provision of a wrist at the end of the intracorporeal instrument, movements of the instrument that are intuitive in that they follow the surgeon's hand, and a steadier image controlled by the surgeon. It is our view that robotic surgery is the next logical step in performing more complex procedures on smaller patients in a minimally invasive manner.

Methods and Procedures:

We defined a core group of individuals who shared our vision: pediatric surgeons, our institutional research director, a biomedical engineer and physicist, and our hospital chief executive officer. We then identified the individuals and corporations who are working with surgical robotics. After extensive comparisons and site visits we chose a single corporate partner. Our partnership was not just a plan to purchase instrumentation but also an agreement to continue research and development of equipment and surgical techniques. We developed short-term and long-term educational, research, and business plans. We shared information on surgical robotics and our business and research plans with our hospital administration and our hospital board of trustees to garner support. The staff of the hospital development office was also involved in generating financial support. We developed and implemented a robotic surgery training program and started to perform robotic surgery procedures in humans and to develop new procedures and technology in the laboratory.

Results:

Institutional and private donor support has allowed us to implement a robotic minimally invasive surgical suite in our operating room and in our research building. Within one year of embarking on our program we performed our first robot-assisted minimally in vasive surgery on a patient. Many of our pediatric subspecialty colleagues in cardiac, plastic, otolaryngology, orthopedic, ophthalmology, and neurosurgery have been utilizing our suites for procedure development in their areas of interest.

Conclusions:

The key elements in developing a new program are to define a core group of committed individuals, define your vision, create corporate partners, and garner financial support with a sound educational, research, and business plan.