| | JULY 20199CIOReviewinstruments that the surgeon can control with exceptional precision to make incisions, remove tissue, insert sutures and a lighted magnifying camera to visualize the surgical field. The device can extend up to nine and a half inches into the surgical field. The U.S. Food and Drug Administration (FDA) has approved the single-port robotic surgical system for urologic procedures and ENT procedures.Urologists are already developing new techniques with the technology including: · Extraperitoneal prostatectomy, inserting the cannula through an incision in the navel and into the pelvis to remove the prostate.· Intravesical prostatectomy to remove an enlarged prostate through an incision just above the pubic bone, inserting the cannula through the bladder to reach the prostate.· Perineal radical prostatectomy, removing the prostate through the perineum (band of skin between the scrotum and rectum), an area once considered too narrow to enter using conventional robotic instruments.· Repair of the ureter in young women with congenital blockages or narrowing of these tubes connecting the kidneys with the bladder, operating through a navel incision.Because of the ability to work in a narrow, deep space, colorectal surgeons have an interest in applying the technology to trans-anal minimally invasive surgery (TAMUS.)The patient leaves the operation with no external incisions. Similarly, head and neck surgeons insert the single-port system through a patient's mouth to remove a cancerous larynx, pharynx or esophagus more easily than they can with the four-armed unit. New Robotic Systems and ApplicationsMultiple manufacturers are entering the robotic surgery arena by designing innovative systems for certain types of procedures. There are now special robotic systems available for brain surgery, spine surgery, bronchoscopy guidance and joint replacement. Digital 3D imaging and other enhanced imaging technologies are further leveraged in computer assisted surgery to perform procedures more efficiently and safely. For example, surgeons can use a novel virtual reality system to overlay a patient's MRI or CT image on the organ to be operated on to localize blood vessels and critical structures, providing a roadmap and allowing the surgeon to literally see through the patient to complete the procedure as effectively and safely as possible. Near-infrared(NIR) fluorescence imagingenables the visualization of blood flow, abnormal lymph nodes and ureteral anatomy. Under investigation is the process of creating molecules that can be injected intraoperatively which allow the surgeon to "light up" nerves, or cancer cells in an organ allowing the surgeon to clearly seewhat to remove and what to leave in place. In essence, letting us "remove the bad while sparing the good."As surgeons consider the many more operations they may be able to perform using the latest robotic technologies and innovations, the possibilities are endless. Today, creative innovations are expanding the applications of robotic surgery to parts of the body once deemed inaccessible using traditional systems
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