The Robin Heart is Europe's first heart surgery robot and an original Polish design. Precise and optimally adapted to the surgeon's manual dexterity, it also helps him make the right decisions. Thanks to its ease of use and portability, the robot can be carried to a clinic in a suitcase.

Around 4 million minimally-invasive surgeries are performed in the world every year. The procedures are performed by means of special instruments inserted through small incisions in the patient's body. The aim is to limit the operative field and spare surrounding tissue, which would be damaged if a traditional surgical technique were used. The number of endoscopic procedures, less invasive than traditional surgery, performed through natural orifices in the patient's body, or through special openings called ports, is on the rise.

The success of the procedures largely depends on the instruments used. Unfortunately, typical endoscopic (laparoscopic) instruments reduce precision and make the surgery more difficult because they add to hand tremor and almost completely eliminate the natural sense of touch. Additionally, the surgeon does not have a direct view of the operative field-a camera inserted into the body through a third opening transmits the image to a display. So the surgeon's task is not easy. An ideal non-invasive surgery can be compared to renovating a house through a keyhole without disturbing the household members. Across the world, physicians and engineers are working to develop increasingly effective instruments to enable surgery with the use of the latest technology. But how can one enhance instrument precision and maneuverability, which are so important in the case of surgery on the beating heart, for instance? Surgical robots provide such capabilities.

In Poland, an interdisciplinary team led by Prof. Zbigniew Religa has been introducing modern devices to clinical practice to save the lives of heart patients. An artificial heart, prosthetic heart valves and recently a surgical robot are the results of projects carried out by the Biocybernetics Laboratory of the Heart Prosthesis Institute, a research center run by the Foundation for Cardiac Surgery Development in Zabrze. This is the only research center of its kind in Poland. Work on building a prototype of a remote-controlled robot for performing and assisting heart surgeries and other surgical procedures was initiated in 2000.

The robot, or actually a "tele-manipulator," is the first ever tool capable of assisting a surgeon by providing the capability to directly use surgery simulation and planning methods. Several models of the robot have been developed, differing in control and mounting systems. The Robin Heart 0 and Robin Heart 1 have an independent base and are controlled via an industrial computer and specialist software. The Robin Heart 2 is fixed to the operating table and has two arms, on which one can fix various surgical instruments. The control system uses its own software as well as signal and specialist microprocessors.

The latest model, known as the Robin Heart Vision, will become the surgeon's partner in the operating room next year. It will replace a human assistant who usually holds the "telescope" of the video channel to enable the observation of the operative field of laparoscopic instruments. As a result, the surgeon will be able to perform part of the surgery unaided by other people. The Robin Heart Vision is easy to use and install, and can be conveniently carried in a suitcase. In May, the Robin Heart received an award at the Intarg Scientific and Industrial Innovation Fair in Katowice.

The Polish heart surgery robot is an original design. Thanks to its modular structure, it can be adjusted for surgery of different types.

Work is under way to introduce a "tele-collaboration" system to be used during surgery. It will contain the real image from the camera, diagnostic data and surgery simulation data. The surgeon will be able to use the "tele-collaboration" program at any moment as it will be voice-activated and voice-controlled. New instruments and applications for the robot are also being developed. There are plans to use the robot for implanting artificial organs, prostheses and ventricular assist devices.

The ultimate goal of the project is to introduce heart surgery robots to clinical practice. A robot's mechanical arm and palm may, by eliminating hand tremor, imitate the surgeon's hand movements with high precision. The use of an assistant robot may be more effective and convenient than the assistance of medical staff as it shortens surgery time and enables the surgeon to plan the surgery in advance and train it on simulation stations. The lack of direct contact between the surgeon and the patient's body reduces the risk of health problems caused by infection. Robots also enable remote surgery in another city, on a battlefield or in outer space.

In classical surgery, surgeons are in physical contact with the patient through their hands or instruments they use. In the telesurgical system, the surgeon controls the movements of a surgical instrument from a distance, sitting in a place which is the surgical scene. An effective feedback system giving the surgeon tactile sensation, or the ability to perceive through touch, has not been developed yet. When tying a suture, the doctor performing a robotic surgery does not feel the thread. The designers of these systems have to improve safety, which means monitoring the applied force, and defining in advance the limits of incision, sterility and emergency procedures.

Surgical robots are now being tested in clinical applications, and their use is expanding. The Da Vinci range of robots, developed for heart surgery, are currently applied for prostate, kidney and other operations, proving their usefulness to both surgeons and patients. Robots are changing and maturing. Today they still require appropriately adjusted operating rooms and huge financial outlays. But in the future they will become more user-friendly and as indispensable as surgical gloves and blades.
Zbigniew Nawrat


The author (pictured) is a physicist with a PhD degree in medicine and a special interest in artificial hearts. He works at the Medical Academy of Silesia. He is also scientific director of the Heart Prosthesis Institute of the Foundation for Cardiac Surgery Development, and head of the institute's Biocybernetics Laboratory.