Medical Robotics and Computer-Integrated Surgery

The growth of medical robotics since the mid1980s has been striking. From a few initial efforts in stereotactic brain surgery, orthopaedics, endoscopic surgery, microsurgery, and other areas, the field has expanded to include commercially marketed, clinically deployed systems, and a robust and exponentially expanding research community. This chapter will discuss some major themes and illustrate them with examples from current and past research. Further reading providing a more comprehensive review of this rapidly expanding field is suggested in Sect. 52.4. Medical robots may be classified in many ways: by manipulator design (e.g., kinematics, actuation); by level of autonomy (e.g., preprogrammed versus teleoperation versus constrained cooperative control), by targeted anatomy or technique (e.g., cardiac, intravascular, percutaneous, laparoscopic, microsurgical); or intended operating environment (e.g., in-scanner, conventional operating room). In this chapter, we have chosen to focus on the role of medical robots within the context of larger computer-integrated systems including presurgical planning, intraoperative execution, and postoperative assessment and follow-up. First, we introduce basic concepts of computerintegrated surgery, discuss critical factors affecting the eventual deployment and acceptance of medical robots, and introduce the basic system paradigms of surgical computer-assisted planning, registration, execution, monitoring, and assessment (CAD/CAM) and surgical assistance. In subsequent sections, we provide an overview of the technology of medical robot systems and discuss examples of our basic system paradigms, with brief additional discussion topics of remote telesurgery and robotic surgical simulators. We conclude with some thoughts on future research directions and provide suggested further reading. 52.1 Core Concepts ....................................... 1200 52.1.1 Medical Robotics, Computer-Integrated Surgery, and Closed-Loop Interventions ...... 1200 52.1.2 Factors Affecting the Acceptance of Medical Robots......................... 1200 52.1.3 Medical Robotics System Paradigms: Surgical CAD/CAM and Surgical Assistance ................. 1202

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