[Essentials aspects of robotic systems]. / Aspectos esenciales de los sistemas robóticos urológicos.

OBJECTIVES: Most advances in Surgery can now be seen to have been preceded by the invention of new instruments. Conventional surgery progressed as new instruments became available. Transurethral resections became routine following the introduction 80 years ago of the resectoscope: a highly revolutionary instrument at that time. Ureterorenoscopes and nephros- copes opened new windows of opportunity for urologists. When the therapeutic potential of extracorporeal lithotripsy, was first mentioned in the literature most surgeons thought it was mere science-fiction fantasy. Very soon however, this new technique, the fruit of close collaboration between urologists and engineers, became a common-place reality. Laparoscopy met with similar disbelief and the early applications gave rise to controversy and even consternation, yet only a few years later most of our urological surgical procedures have adopted this technique. METHODS: At the beginning of the 20th century the astounding advances in engineering led many to forecast that before its end those systems might mimic human intelligence. However, many attempts to construct a rational thinking device revealed that even today this ambitious project was a still an unattainable dream. Consequently, attempts to design an autonomous urological surgical robot that might carry out unsupervised transurethral resections were unfruitful because the inherent and unpredictable complexity of surgical procedures obliges close and rigorous control by the surgeon. This important limitation led to the creation of 'master-slave' systems similar to those designed by our team in 1998 for transurethral resection. These are relatively simple tools and are infinitely safer than autonomous robots because they aim to effectively help the surgeon rather than replace him. RESULTS/CONCLUSIONS: The oft-repeated argument about whether or not a robot might ever replace the surgeon now has little sense because today it is merely a tool, an instrument for the surgeon's hands. The devices available today lack the all-important tactile feedback and to use them effectively, the surgeon is obliged to serve a new and arduous apprenticeship and the learning curve is unavoidably steep. Consequently, many prestigious authors understandably feel unable to recommend their use. Our accumulated experience with master-slave manipulators stimulates us to confidently predict that sooner than later, whether we like it or not, surgical robots will evolve to become indispensable tools that enhance the surgeon's skill, precision and speed in many surgical procedures.

Aspectos esenciales de los sistemas robóticos urológicos / Essentials aspects of robotic systems

Objetivo: Desde la antigüedad los adelantos en medicina se deben en gran parte a las herramientas utilizadas. Para la cirugía convencional se necesita un instrumental, igual ocurre con la resección transuretral que precisa de un resector, que fue un instrumento muy avanzado para la época en la que se creó. Lo mismo sucede con la ureterorrenoscopia o la nefroscopia. La litotricia extracorpórea surgió gracias a la estrecha colaboración entre ingenieros y urólogos, lo que supuso una auténtica revolución en la medicina. La laparoscopia ha dado lugar a una conmoción si cabe mayor, ya que gran parte de nuestra cirugía ha habido que adaptarla a esta nueva técnica. Métodos: Los grandes avances tecnológicos habidos a principios del siglo XX hicieron pensar que a finales de siglo estos sistemas serían capaces de imitar a la inteligencia humana, pero al intentar fabricar una mente racional se llegó a la conclusión de que conseguir que estos instrumentos tomaran decisiones suponía un desafío monumental inviable hoy en día. Por ello, ya dentro de la Urología, el intento de crear un robot autónomo para la resección transuretral fracasó, porque la complejidad de un procedimiento quirúrgico requiere un estricto y riguroso control por parte del cirujano. Ello dio lugar a los sistemas maestro-esclavo, como el diseñado por nosotros en 1998 para la resección transuretral, que son simples herramientas, infinitamente más seguras que el robot independiente, que facilitan el trabajo del cirujano pero que no lo sustituyen. Resultados/conclusiones: La reiterada polémica de que si los robots van a sustituir al cirujano no tiene sentido, porque de momento son tan sólo simples instrumentos. Los manipuladores existentes hoy en día, al carecer de sensibilidad táctil, tienen una larga curva de aprendizaje. Todo ello hace que por ahora no pocos autores de prestigio desaconsejen su uso. Sin embargo nosotros estamos convencidos de que, antes de que lo imaginemos, lo queramos o no, los robots en cirugía serán instrumentos obligados e imprescindibles y de que su uso se habrá generalizado (AU)

Objectives: Most advances in Surgery can now be seen to have been preceded by the invention of new instruments. Conventional surgery progressed as new instruments became available. Transurethral resections became routine following the introduction 80 years ago of the resectoscope: a highly revolutionary instrument at that time. Ureterorenoscopes and nephroscopes opened new windows of opportunity for urologists. When the therapeutic potential of extracorporeal lithotripsy, was first mentioned in the literature most surgeons thought it was mere science-fiction fantasy. Very soon however, this new technique, the fruit of close collaboration between urologists and engineers, became a common-place reality. Laparoscopy met with similar disbelief and the early applications gave rise to controversy and even consternation, yet only a few years later most of our urological surgical procedures have adopted this technique. Methods: At the beginning of the 20th century the astounding advances in engineering led many to forecast that before its end those systems might mimic human intelligence. However, many attempts to construct a rational thinking device revealed that even today this ambitious project was a still an unattainable dream. Consequently, attempts to design an autonomous urological surgical robot that might carry out unsupervised transurethral resections were unfruitful because the inherent and unpredictable complexity of surgical procedures obliges close and rigorous control by the surgeon. This important limitation led to the creation of ‘master-slave’ systems similar to those designed by our team in 1998 for transurethral resection. These are relatively simple tools and are infinitely safer than autonomous robots because they aim to effectively help the surgeon rather than replace him. Results/conclusions: The oft-repeated argument about whether or not a robot might ever replace the surgeon now has little sense because today it is merely a tool, an instrument for the surgeon’s hands. The devices available today lack the all-important tactile feedback and to use them effectively, the surgeon is obliged to serve a new and arduous apprenticeship and the learning curve is unavoidably steep. Consequently, many prestigious authors understandably feel unable to recommend their use. Our accumulated experience with master-slave manipulators stimulates us to confidently predict that sooner than later, whether we like it or not, surgical robots will evolve to become indispensable tools that enhance the surgeon’s skill, precision and speed in many surgical procedures (AU)

Nuevo brazo maestro para la resección transuretral mediante robot / New master arm for robotic assisted transurethral resection

OBJETIVO: En 1998 diseñamos un robot para la resección transuretral que constaba de un brazo maestro y un brazo esclavo que reproducía los movimientos del primero. En este artículo describimos el nuevo brazo maestro que hemos creado, que ha pasado de ser un mero "joystick" para convertirse en un auténtico elemento de trabajo. MÉTODOS: El brazo maestro se ha elaborado a partir de un elemento de trabajo convencional, integrado en una estructura articulada de metal y con sensores angulares en cada una de ellas. Cada sensor, a través del computador, ordena al brazo esclavo la posición y movimiento del resector. De esta manera podemos definir el espacio de trabajo del resector, que viene determinado por los cuatro movimientos básicos; desplazamiento horizontal, vertical, de penetración y rotación, más un quinto, el de corte del asa. Mediante programas informáticos, se ha dotado a este elemento de trabajo de un sistema capaz de eliminar los posibles errores del cirujano, e impedir movimientos fuera de campo de trabajo. RESULTADO: Se ha obtenido una herramienta de morfología y funcionamiento similar al resector conven cional, de manejo sencillo y que facilita el entrenamiento en la utilización del elemento de trabajo. Al tiempo que se beneficia de la tecnología punta, reduciendo el número de errores, ya sea por mala utilización como por cansancio o inexperiencia del cirujano. CONCLUSIONES: La nueva herramienta tiene un manejo idéntico al instrumento convencional, que permite que esta nueva tecnología no cambie los procedimientos habituales del cirujano durante la intervención. Además si se produce un uso inadecuado, el robot lo detecta e incluso se anticipa y actúa evitando que el error transcienda al paciente (AU)

[New master arm for transurethral resection with a robot]. / Nuevo brazo maestro para la resección transuretral mediante robot.

OBJECTIVE: In 1998, we designed a robot for transurethral resection that consisted of a master arm and a slave arm that reproduced the movements of the master. We describe the innovative master arm developed in two university departments that supersedes the mere "joystick" concept to become a true, operative surgical instrument. METHODS: The new master arm was developed from a conventional resectoscope working element integrated into a robotic manipulative device and fitted with angular displacement sensors. Each sensor, part of a computer-controlled feed back system commands the position and movements of the slave arm which, in turn, move the resectoscope. The surgeon freely chooses and manages precisely within a three-dimensional surgical field four basic resectoscope maneuvers; horizontal and vertical displacement, penetration-withdrawal, and rotation; he also controls the movements and operation of the resectoscope cutting loop. Additional computer-programs provide the surgeon with an error-free, fail-safe surgical instrument that denies any movements outside the planned surgical field. RESULTS: The fact that the new easily used instrument is similar in shape and works like conventional resectoscopes greatly helps familiarization and training. Advanced technology reduces the number of errors usually associated with fatigue or inexperience of the surgeon. CONCLUSIONS: The new surgical instrument handles just like conventional instruments so surgeons do not need to change their usual operating procedures. In addition, an early-warning program detects instantly and denies inappropriate maneuvers. This facility confers peace of mind to the surgeon and ensures patient satisfaction.