**2. Robotics for the laparoscopic surgery**

In this field, the da Vinci surgical system (**Figure 1**) [3] of Intuitive Surgical, Inc. (US) has been a dominant robot since its FDA approval in 2000. As of August 1, 2018, 4666 units are installed in the world. Nearly 1 million procedures in the world are performed annually by using da Vinci [4]. Majority of da Vinci applications are urology and gynecology which are about one-third of the total procedures each [4]. Including the colorectal application in the other one-third, you can find that the da Vinci surgery is mostly used in the pelvic cavity. This is probably because pelvic cavity is narrow and deep, thus laparoscopic approach is challenging for those organs such as prostate, uterus, colon, and rectum.

Generally speaking, the robot for laparoscopic surgery provides threedimensional vision, dexterity, and intuitiveness. In fact, three-dimensional vision is not a robot specific feature. However, it is inevitable in order to exert the robotic dexterity. To understand the dexterity, let us explain the degrees of freedom. For example, in order to perform full dexterity by a grasping device, it requires seven degrees of freedom. First, the tip of the grasper has to be reached at desired position in three-dimensional space (X-Y-Z axis). Therefore, at least three degrees of freedom are required. Then, the tip of the grasper also has to change orientation at the desired position. The orientation is defined by rotations around X, Y, Z axis. Thus, it requires another three (rotational) degrees of freedom. Last, one degree of freedom is open/close motion of the grasper. Conventional laparoscopic forceps have only five degrees of freedom (three positional, one rotational around the shaft,

**95**

**Figure 2.**

*Intelligent Information-Guided Robotic Surgery DOI: http://dx.doi.org/10.5772/intechopen.82191*

**2.1 Senhance surgical platform**

**2.2 Versius surgical robotic system**

**2.3 Verb surgical**

and one grasping), resulting limited dexterity. da Vinci has wrist at the tip of the forceps, providing seven degrees of freedom. This is one of the key technologies of the laparoscopic surgical robot. Intuitiveness means that the operator's hand and device tip are synchronized in the three-dimensional vision. The computer of the robot calculates the device position, so that the direction of the device movement in the display is the same as surgeon's hand. Furthermore, the computer calculation is considering the line of sight in order to secure the hand-eye coordination. Those

There exist a lot of researches on surgical robots in academic institutes. However, sometimes they are very early stage, and it is unknown how long they take time until they reach at clinically usable phase. Here, we will introduce surgical robots which have already been in the market or are in the pipeline of the industrial companies.

Senhance surgical robotic system (**Figure 2**) [5–7] was originally developed in Europe under the name of "ALF-X", and then sold to US company TransEnterix, Inc. It received CE mark and cleared FDA for major laparoscopic surgery. The Senhance system has three independent robotic arms for instruments and camera. Each arm stands on the floor, has long beam as seen in **Figure 2**. Various types of the forceps are available and can be attached to the robotic arms. Unique features which are different from da Vinci are gaze control system of camera and force feedback. At the control cockpit, the eye motion of the operator is monitored and is used for the camera motion. If the operator moves head forward, the camera moves closer to the object. The company claims cost effectiveness as other emerging robot company than intuitive surgical do so [7].

Versius surgical robotics system (CMR Surgical Ltd., UK) also contains independent robotic arms for each instruments, but the size of the robotic arms are designed smaller (**Figure 3**). As the foot print of each robotic arm is 38 × 38 cm, it is portable, does not require large space, and setting up is easy. Comparing with 8 mm da Vinci instrument, CMR provides thinner, 5.8 mm instrument with wrist. It is

Johnson & Johnson (Ethicon) and Google (Verily Life Sciences) have jointly

established Verb Surgical Inc. (US). Their goal is not only robotics but also

under development, and not yet CE Marked nor 510(k) cleared.

*Senhance surgical robotic system (©2018 TransEnterix, Inc.).*

features are basically the same in the other emerging new robots.

**Figure 1.** *da Vinci surgical system ©2018 Intuitive Surgical, Inc.*

*Intelligent Information-Guided Robotic Surgery DOI: http://dx.doi.org/10.5772/intechopen.82191*

*Recent Advances in Laparoscopic Surgery*

devices are straight, do not have bending wrist. Those devices provide surgeon much less dexterity than the fingers and hands. In order to cope with those restrictions, long training time, experience, and practices are required for the laparoscopic surgeons. However, as those limitations are mainly technical issue, we believe the technologies can contribute to overcome those limitations. In this chapter, we introduce recent various technologies for laparoscopic surgery. First, we will overview the current worldwide surgical robotics. There is a dominant player in this field, da Vinci surgical system. However, several new robots by start-ups are in the pipeline. Then, we will introduce the robotics with the flexible endoscope as a new trend in the robotic surgery. They are also in the pipeline of the many companies, about to launch to the market. We think this field is promising as future minimally invasive surgery. After

In this field, the da Vinci surgical system (**Figure 1**) [3] of Intuitive Surgical, Inc.

(US) has been a dominant robot since its FDA approval in 2000. As of August 1, 2018, 4666 units are installed in the world. Nearly 1 million procedures in the world are performed annually by using da Vinci [4]. Majority of da Vinci applications are urology and gynecology which are about one-third of the total procedures each [4]. Including the colorectal application in the other one-third, you can find that the da Vinci surgery is mostly used in the pelvic cavity. This is probably because pelvic cavity is narrow and deep, thus laparoscopic approach is challenging for those

Generally speaking, the robot for laparoscopic surgery provides threedimensional vision, dexterity, and intuitiveness. In fact, three-dimensional vision is not a robot specific feature. However, it is inevitable in order to exert the robotic dexterity. To understand the dexterity, let us explain the degrees of freedom. For example, in order to perform full dexterity by a grasping device, it requires seven degrees of freedom. First, the tip of the grasper has to be reached at desired position in three-dimensional space (X-Y-Z axis). Therefore, at least three degrees of freedom are required. Then, the tip of the grasper also has to change orientation at the desired position. The orientation is defined by rotations around X, Y, Z axis. Thus, it requires another three (rotational) degrees of freedom. Last, one degree of freedom is open/close motion of the grasper. Conventional laparoscopic forceps have only five degrees of freedom (three positional, one rotational around the shaft,

that, the technologies in the navigation and training are described.

**2. Robotics for the laparoscopic surgery**

organs such as prostate, uterus, colon, and rectum.

**94**

**Figure 1.**

*da Vinci surgical system ©2018 Intuitive Surgical, Inc.*

and one grasping), resulting limited dexterity. da Vinci has wrist at the tip of the forceps, providing seven degrees of freedom. This is one of the key technologies of the laparoscopic surgical robot. Intuitiveness means that the operator's hand and device tip are synchronized in the three-dimensional vision. The computer of the robot calculates the device position, so that the direction of the device movement in the display is the same as surgeon's hand. Furthermore, the computer calculation is considering the line of sight in order to secure the hand-eye coordination. Those features are basically the same in the other emerging new robots.

There exist a lot of researches on surgical robots in academic institutes. However, sometimes they are very early stage, and it is unknown how long they take time until they reach at clinically usable phase. Here, we will introduce surgical robots which have already been in the market or are in the pipeline of the industrial companies.

### **2.1 Senhance surgical platform**

Senhance surgical robotic system (**Figure 2**) [5–7] was originally developed in Europe under the name of "ALF-X", and then sold to US company TransEnterix, Inc. It received CE mark and cleared FDA for major laparoscopic surgery. The Senhance system has three independent robotic arms for instruments and camera. Each arm stands on the floor, has long beam as seen in **Figure 2**. Various types of the forceps are available and can be attached to the robotic arms. Unique features which are different from da Vinci are gaze control system of camera and force feedback. At the control cockpit, the eye motion of the operator is monitored and is used for the camera motion. If the operator moves head forward, the camera moves closer to the object. The company claims cost effectiveness as other emerging robot company than intuitive surgical do so [7].

#### **2.2 Versius surgical robotic system**

Versius surgical robotics system (CMR Surgical Ltd., UK) also contains independent robotic arms for each instruments, but the size of the robotic arms are designed smaller (**Figure 3**). As the foot print of each robotic arm is 38 × 38 cm, it is portable, does not require large space, and setting up is easy. Comparing with 8 mm da Vinci instrument, CMR provides thinner, 5.8 mm instrument with wrist. It is under development, and not yet CE Marked nor 510(k) cleared.

#### **2.3 Verb surgical**

Johnson & Johnson (Ethicon) and Google (Verily Life Sciences) have jointly established Verb Surgical Inc. (US). Their goal is not only robotics but also

**Figure 2.** *Senhance surgical robotic system (©2018 TransEnterix, Inc.).*

**Figure 3.** *Versius surgical robotic system (©2018 CMR Surgical Ltd., UK).*

visualization, advanced instrumentation, data analytics, and connectivity. The details of the appearance of the robot, function, cost, etc. have not been published.
