GROUP ASSIGNMENT

TECHNOLOGY PARK MALAYSIA

CT109-3-1-DGTIN-L-5

DIGITAL THINKING AND INNOVATION

APU1F2009CS(CYB)

HAND OUT DATE: WEEK 2

DUE DATE: WEEK 12

LECTURER: MS. HAIRUL AYSA BINTI ABDUL HALIM SITHIQ

PROPOSED SYSTEM: ROBOTIC SURGICAL SYSTEM

TEAM MEMBERS NAME & TP:

Wong Jian Wei TP061912

Then Dao Yang TP061959

Ong Hong Ray TP060490

Lim Jun Kai TP060384

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Table of Content

1. Abstract
2. Acknowledgement
3. Introduction
4. The issues of this system
4.1. The expense of surgery
4.2. Movement Latency
4.3. Potential mechanical failure
4.4. Public acceptance
4.5. Robot control
5. Types of similar system
5.1. DaVinci
5.2. ROBODOC and ORTHODOC
5.3. FreeHand
5.4. Stäubli TX60 Cleanroom robot
5.5. Magellan
6. The solution based on the issues
6.1. Cost issue
6.2. Movement Latency
6.3. Potential mechanical failure
6.4. 4
6.5. 5
7. Conclusion
8. References
9. Appendices
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1. Abstract
https://www.americanjournalofsurgery.com/article/S0002-9610(04)00375-7/fulltext

2. Acknowledgment

3. Introduction

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 4.0 The issues of this system

4.1. The cost of surgery

Surgery is an expensive project especially we use another technology such as robotic surgical system.
It will increase the cost of a surgical procedure. But why the robotic surgery system will increase the
cost? It is because surgical robots are costly to maintain and need a lot of training to operate them. In
addition, it is required to replace the throwaway components after a surgery. (
https://www.electronicspecifier.com/industries/medical/why-is-robotic-surgery-so-
expensive ) A surgery within a DaVinci surgery robot system will cost between $3,000 and
$6,000 more than a traditional laparoscopic surgery. 

https://www.robotshop.com/community/blog/show/weighing-the-advantages-and-disadvantages-of-
robotic-surgery

Although evidence questioning its clinical benefit, the use of robotic surgical system is
increasing every year in many countries especially United States. Intuitive Surgical Inc. now
is the most robotic technology supplier. In 2019, the company revenue in United States is
$3.1 billion and the procedure volume is around 883,000. So, we can estimate the minimum
cost to hospitals from this company. There are equating to $3,510 per procedure.
In conclusion, we need to consider the costs for these robotic systems when we need to have
operation.

(Childers CP, Maggard-Gibbons M (2018) Research Letter: Estimation of the Acquisition and Operating
Costs for Robotic Surgery. JAMA 320(8): 835-836. doi:10.1001/jama.2018.9219)/
https://healthmanagement.org/c/it/news/just-what-is-the-cost-of-robotic-surgery

https://isrg.intuitive.com/static-files/31b5c428-1d95-4c01-9c85-a7293bac5e05

4.2. Movement Latency

One of the most important problems with robotic surgery is the problem of delay -- the time it
takes the robot to execute the surgeon's orders. The computer takes a few moments to
communicate with the robotic arms.

(https://www.robotshop.com/community/blog/show/weighing-the-advantages-and-
disadvantages-of-robotic-surgery)

The Florida hospital experiment tested how does this affect latency as the distance to the
robot increases and how much of a delay the attending doctor would tolerate.

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According to the experiment, at 200 milliseconds, the surgeon cannot detect the delay.
Between 300 and 500 milliseconds, some surgeons can detect a delay, but they still can
compensate by pausing movement. But at 600 milliseconds, most surgeons begin to feel
insecure about their ability to perform the operation.

(https://www.computerworld.com/article/2927471/robot-performs-test-surgery-1200-miles-
away-from-doctor.html)

It takes a few moments for the computer to communicate with the robotic arms. While this is
not an issue for conventional surgeries, it makes it difficult for surgeons to react quickly to
problems that arise during the operation. This in turn increases the risk of surgery.

4.3 The potential mechanical failure of Robotic Surgery System

Mr Pettitt died due to complications of an operation to treat mitral valve disease. Complications mean
a secondary disease or condition aggravating an already existing one.

Usually, the robotic surgery would involve a few small incisions, performed by a surgeon seated at a
computer console in the operating room. The procedure would be carried out using robotic arms and
surgical instruments.

Before this accident, in a study titled “Adverse Events in Robotic Surgery: A Retrospective Study of
14 Years of FDA Data” researcher Homa Alemzadeh and colleagues looked at 14 years of reports to
the FDA at a time when 1.75 million robotic procedures were performed.

Between 2000 and 2013, a total of 144 deaths, 1,391 patient injuries and 8,061 device malfunctions
were reported with robotic surgery, according to the study published in PLOS One in 2016.

Burnt or broken pieces of instruments fell into the patient in 14.7 percent of the reported cases.
Another 10.5 percent of reports involved electrical arcing of instruments, and 8.6 percent involved
unintended operation of instruments. System errors and video/imaging problems were reported in 5
percent and 2.6 percent of the cases, respectively.

The most common problems were a malfunction of the robotic arms, joint setup, and camera,
followed by power error, instrument malfunction, and breakage of the handpiece.

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These include the loss of a large amount of blood, as well as possible inadvertent cuts, tears,
punctures, burns or other injuries to organs, tissues, major blood vessels or nerves.

Complications could also involve the loss of a piece of the instrument, such as a needle or other object
used during surgery, inside the patient’s body. Also, the patient could be injured because of the
position of his or her body during surgery

According to the FDA database, in five years ending on Aug. 31, 2017, the agency received 30 reports
of incidents in which the patient died in connection with surgery using the da Vinci system. The
system did not necessarily cause those deaths, but they occurred after or during surgery in which
surgeons used the system.

Example of adverse events reported to the FDA

Patient with nicked intestines dies

In March 2017, a patient’s intestines were reported to have been nicked during an inguinal hernia
repair using the da Vinci robotic system. This was not discovered until two days after the patient had
left the hospital. The patient returned suffering from abdominal pain and died that day.

Liver damaged blamed on surgeon

In November 2016, during gallbladder removal surgery, one of the robotic arms was moving on its
own, injuring the patient’s liver, causing it to bleed. The surgeon cauterized the injury using the same
instrument that had caused the injury. The manufacturer later attributed the incident to user error on
the part of the surgeon.

4.4 public acceptance

1983, is the year that the first surgical robot called The Arthrobot using by Canadian
physicians. [ CITATION And17 \l 2052 ] After that robotic surgical always be a Huge controversy
in society. Public is being Resistance from robotic surgery. However, robotic surgery has
continued to thrive throughout the years. Even the most famous ‘robotic surgery— “ da Vinci
Surgical System” have been severed in this world more than 10 year.

2009 have 70 deaths may relate to the surgical robots. [ CITATION Fin18 \l 2052 ]This
has cause public resisting from robotic surgery because of “unitability.” Besides that, Wu

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MengChao Considered as the "Father of Chinese Hepatobiliary Surgery is resistance from
Advanced medicine and robotic surgery as consider that the most important of the advances
in medical skills is doing by own hand.[ CITATION 澎湃新 16 \l 2052 ]

Through the years, technology has been improving a lot around society. No matter
what robotic surgery will become increasingly widespread. In fact, this will be an irrevocable
truth. surgical robot has been evolved to be even better. This will improve all aspects of
surgery. In the future, people will go along with the robotic surgery for all the advantages.
[ CITATION KHa01 \l 17417 ]

5. Types of similar system

5.1. DaVinci

The DaVinci surgical system have three components set, they are surgeon console, patient
cart, and vision cart. The main function of this system is to assist surgeon perform a
minimally invasive surgery. The term ‘robotic’ always mislead people. Robots do not
perform surgery.

The purpose of surgeon console: Your surgeon sits at the console, controlling the instruments
while viewing your anatomy in high-definition 3D.

The purpose of patient cart: Positioned alongside the bed, the patient cart holds the camera
and instruments that the surgeon controls from the console.

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The purpose of vision cart: The vision cart makes communication between components
possible and supports the 3D high-definition vision system.

The DaVinci system translates your surgeon’s hand movements at the console in real time,
rotating and bending the instruments while performing the procedure. The tiny wristed
instruments move like a human hand, but with a greater range of motion. The DaVinci vision
system also delivers highly magnified, 3D high-definition views of the surgical area. The
instrument size makes it possible for surgeons to operate through one or a few small
incisions.
(https://www.davincisurgery.com/da-vinci-systems/about-da-vinci-systems)

Advantages

 Better exactness: Your surgeon sits at the console and view your anatomy in high-
definition 3D via vision cart. They can also control the instruments with a greater
range of motion and prevent the mistakes that caused by surgeon hand trembling.

 Faster recovery: DaVinci surgical system is assist surgeon to perform a minimally

 Less blood loss: There is less blood loss during the operation because the system only
needs a smaller incision than other types of surgery.

 Less scarring: There is less scarring after the surgery because the system only requires
a smaller incision.

Disadvantages

 Device malfunction: This is the most serious but rare risk. It may cause the patient
death when device malfunction during the operation. If this case happens, the surgeon
must quickly perform another method of operation to fix the problem.

 Damage the surrounding organ: During surgery, if robotic hand is getting too close to
another organ, it may damage the organ. But this risk also rare, because DaVinci
surgical system is very precise.

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  Surgeon lack of experience: DaVinci surgical system need a very professional and an
experienced surgeon to operate it because the system is quite complicated. So, you
need to make sure your surgeon is ample experience in this system before surgery.

(https://blog.allaboutwomenmd.com/surgical-care/davinci-pros-and-cons.htm)

5.2 ROBODOC and ORTHODOC

knee cutter and hip cutter

The ORTHODOC Preoperative Planning Workstation provides surgeons with simple mouse-
click control and three-dimensional information. Presurgical planning begins with converting
a CT scan of a patient's joint into a three-dimensional virtual skeletal image that the surgeon
can manipulate to look at bone and joint features. In this way ORTHODOC enables the
surgeon can simulate operations and explore a variety of options without putting patients at
risk or wasting valuable operating time. The surgeon can then manipulate a a three-
dimensional model of the prosthesis based on the CT image of the bone for optimal
prosthesis selection and alignment. With ORTHODOC treatment, this virtual surgery
provides a precise preoperative plan for each patient.

Advantages

 Using controlled, gentle pressure, the ROBODOC can grind bone at a planned rate of
submillimetre accuracy.
 The motion of the robotic arm equipped with a high-speed rig has proved more
accurate than manual preparation techniques.
 ROBODOC’s specialized drill bits and other hardware have been developed to
precisely prepare the bones to make the best match for prosthetic implants

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  Based on extensive clinical studies ORTHODOC and the ROBODOC Surgical
Assistant work together seamlessly to ensure the ROBODOC Surgical System
provides better overall precision during total joint replacement.

(https://implant-drill.com/robodoc-surgery-cutters/knee-cutter-hip-cutter.html)

5.3 FreeHand
Free hand laparoscopic camera controller (FHLCC) is a new innovative robotic device that
has been recently implemented and adopted in laparoscopic surgery, providing the surgeon more
comfort in carrying out his surgical skills without the difficulties related to the mutual understanding
of the movements of the camera.

Free hand laparoscopic camera controller constitutes a simpler and smaller robotic machine of
last decade, allowing surgeons to perform laparoscopic surgery with a “hands free” technique. It
provides the ability of performing solo surgery without the need of camera assistant and tremor free
visual image. Laparoscopic solo surgery with the aid of FHLCC is also widely used in war conditions
as part of military surgery due to lack of necessary number of surgeons to perform a laparoscopic
surgery.

FHLCC can provide many advantages to the surgeon and its efficiency in performing
a surgery is much better than this with a camera assistant. Firstly, the surgeon has a direct
connection to the scope and an immediate and precise control of scope position. Camera
controller provides wide range of movements and a high-speed control of the laparoscope
with a high gradation of speed available to the surgeon. The visual image of the surgical field
is stable without the tremor of the camera assistant. Also, surgeon will have the ability to
perform a solo surgery without any difficulties related to mutual understanding of the
movements of the camera. The overall cost is lower compared to conventional laparoscopic
surgery as there is no need of camera assistant while the average surgery time is reduced.

Conclusion: Free hand laparoscopic camera controller provides the surgeon comfort in
carrying out his surgical skills without the difficulties related to the mutual understanding of the
movements of the camera. It combines the benefits of minimally invasive and robotic assisted
surgery, increases efficiencies, and improves patient recovery times.

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References:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6284172/

https://www.sagentia.com/case-study/prosurgics-freehand-breakthrough-surgical-robot/

https://www.researchgate.net/publication/227007521_Initial_experience_with_the_EndoAssi
st_camera-holding_robot_in_laparoscopic_urological_surgery

5.4 Stäubli TX60 Cleanroom robot

Stäubli TX60 Cleanroom robots were designed from the point of time to fit the rigorous
needs of cleanroom environments. They provide other blessings of superior output
capabilities and reliability, with field verified reliability in 24/7 industrial environments.
[ CITATION Mednd1 \l 2052 ]Stäubli TX60 Cleanroom robot often used in the
pharmaceutical industry, and everything is based on its stability and the benefits of
cleanroom. on general Stäubli TX60 Cleanroom robot with come with a cleanroom when
it uses for pharmaceutical industry. Normally used in manufacturing or scientific
research. A cleanroom is to help control an environment that has a low-level pollutant
such as airborne microbes, dust, or more. So that the cleanroom has a controlled level of
pollution.

Advantages

· Excellent dustproof technology. - with the cleanroom, Stäubli TX60 Cleanroom robot
allowed to work with those jobs this is needed to have a lower level of contamination.

· Occupancy space-The compact size between all types of Stäubli model robots, it has
reduced their footprint, therefore it can process enormous work envelopes, as it was
designed for a good sort of application.[ CITATION pland \l 2052 ].
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 · Six-axis robot more mobility - Stäubli TX60 Cleanroom robot is being served with six-
axis, it helps to able to move in the X, Y, Z planes, and is it more convenient while doing
Difficult task.[ CITATION Mar17 \l 2052 ]

Disadvantages

· Cost of Funds-A six-axis robot normally needs a budget of around 50k USD, and this is
a price not including a cleanroom. However, a Stäubli TX60 Cleanroom robot can
establish extremely valuable and bring a huge profit.

· Expertise-As with every other sort of technology, the initial setting up of industrial
robots requires a lot of preparation and experience, since they are adequate for performing
several tasks. Good automation firms provide their experience with a service package,
which is an incredibly important aspect. To reduce reliance on automation companies,
however, engineers can be trained to allow them to program robots, although assistance
from skilled automation companies is still needed.

5.5 Magellan

PROPOSED SOLUTION

EXISTING SYSTEMS REVIEW

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PROPOSED SOLUTION

EXISTING SYSTEMS REVIEW

6. The solution based on the issues

6.1 Cost issue

Judicious use of instruments: Not only robotic surgery but all the surgery, surgeon must
minimize the number of tools they use. This is the most important key to reduce the cost of
surgery. ‘The costs of instruments for robotic surgery have changed in range three times. The
highest-cost was three times greater than lowest-cost, but there was no difference in quality.’
Dr. Loftus said. In other words, the cost and the surgery quality are not related.

Surgeon experience: Experienced surgeon will reduce the number of complications. So that,
it will decrease the readmission rate and the cost of the hospital stay. ‘If surgeons do not have
the same level of skill across the board in robotic, it will affect the result in robotic surgery.’
Dr. Loftus said.

https://www.generalsurgerynews.com/In-the-News/Article/05-15/Doing-the-Math-Can-the-
Robot-Be-Cost-Effective-for-General-Surgery-/32395

6.2 Movement Latency

The movement latency problem has less to do with the speed of light at which electrons travel
over optical fibres and more to do with the processing time of Internet providers. A surgeon's
move of the robot's arm from a remote location requires two-way packet transmission: one
packet controls the robot's movement, and the other packet views the results in real time on a
video display.

In the research, the lag between the four campus hospitals in Orlando was five milliseconds.
From Orlando to Tampa, 10 to 150 milliseconds. This is no different from robotic surgery 10
feet away. The hospital tested the delay between the Florida celebrations. At a partner
hospital in Ft. Worth, Texas, the delays range from 30 milliseconds to 150 milliseconds and
are completely invisible to surgeons.

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These results indicate that modern, well-connected facilities possess the communication
bandwidth needed to safely perform telesurgery today. If there are no major problems with
the network, the network latency could be a negligible threat.

(https://www.robotshop.com/community/blog/show/weighing-the-advantages-and-
disadvantages-of-robotic-surgery)

6.3 Potential mechanical failure

There are several solutions that can be used to decrease the potential of mechanical failure in
a robotic surgical system. One of the solutions is make sure that all the robotic surgical
system had been approved by the Food and Drug Administration (FDA). The FDA is
responsible for ensuring the safety of foods, cosmetics, drugs, biological agents, medical
devices, and radiation products manufactured or imported into the United States. As the
United States has the most advanced and developed medical technology in the word, it makes
sense for other countries to follow the medical devices that had been approved by the FDA.
The use of FDA-approved medical devices in hospitals around the world could significantly
reduce the likelihood of robotic surgical systems causing surgery to fail.

Another solution to reduce the likelihood of mechanical failure in robotic surgery systems is
to make sure there are no problems with the machine before the surgery begins. If the robotic

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surgical system does not work properly during the operation, it could lead to the death of the
patient, so this is an action that must be taken to prevent the loss of more human lives.

Ensuring that the surgeon knows how to use the designated robotic surgical system can also
reduce the likelihood of mechanical failure of the robotic surgical system. Before using
robotic systems in surgery, surgeons must undergo standardized training and certified
practices. In addition, the surgeon must have sufficient experience in a particular operation.
This is because a doctor who has had multiple operations already knows what he is doing.

References:

https://psnet.ahrq.gov/web-mm/robotic-surgery-risks-vs-rewards

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5329842/

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