Robotic surgery: from autonomous systems to intelligent tools

A brief history of robotic surgery is provided, which describes the transition from autonomous robots to hands-on systems that are under the direct control of the surgeon. An example of the latter is the Acrobot (for active-constraint robot) system used in orthopaedics, whilst soft-tissue surgery is illustrated by the daVinci telemanipulator system. Non-technological aspects of robotic surgery have often been a major impediment to their widespread clinical use. These are discussed in detail, together with the role of navigation systems, which are considered a major competitor to surgical robots. A detailed description is then given of a registration method for robots to achieve improved accuracy. Registration is a major source of error in robotic surgery, particularly in orthopaedics. The paper describes the design and clinical implementation of a novel method, coined the bounded registration method, applied to minimally invasive registration of the femur. Results of simulations which compare the performance of bounded registration with a standard implementation of the iterative closest point algorithm are also presented, alongside a description of their application in the Acrobot hands-on robot, used clinically for uni-condylar knee arthroplasty.