The Must-Have in Robotic Heart Surgery: Haptic Feedback

The minimally invasive endoscopic surgery was introduced in the late 1980s in the abdominal surgery as revolutionary surgical technique (Voges et al., 1997). Surgeons no longer needed to physically place their hands within the body to perform an operation. In minimal invasive surgery, instruments and viewing equipments are inserted into the body through small incisions. Long manipulators are used to perform operations under manual guidance. This does not only minimize the collateral surgical trauma of an access incision but results also in quicker recovery. In heart surgery the introduction of endoscopic techniques were promising, but not satisfying like the application of robots in other surgical disciplines (Bholat et al., 1999; Gutt et al., 2004; Mitsuishi et al., 2000). Complex cardiac surgery had to be performed by long instruments without tremor filter or adequate freedom of movement, so satisfactory results were missing. In heart surgery pure endoscopic techniques have not established since the demanded high precision in this speciality did not reached with endoscopic instruments only. The promise of telemanipulated endoscopic assistance was to eliminate many of the beginning impediments, with the concurrent enhancements of motion scaling, tremor filtration, 3-dimensional vision and fulcrum effect. The surgeon could now operate with a surgical mechatronic assist system in a comfortable, dextrous and intuitive manner. The solution for the initial problems was the implementation of telemanipulators that offer with the endoscopic instruments as much degrees of freedom in movement as the hand of the surgeon in conventional open surgery performing 6 degrees of freedom instead of four in conventional endoscopic instruments. Furthermore the telemanipulator had to dispose of 3D-optic and a filter of tremor (Suematsu & Del Nido, 2004). The new system has been a telesystem controlled remotely by the surgeon. The implementation of totally endoscopic heart surgery was realised ten years later with the telemanipulator Da Vinci® (Intuitive Surgical, Inc., Sunnyvale, CA, USA) after introducing endoscopic surgery in abdominal surgery. Nevertheless technical limitations still exist that limit the application in special heart diseases and surgical indications in expert medical centres only. O pe n A cc es s D at ab as e w w w .ite ch on lin e. co m