A core idea of minimally invasive surgical robotics is that the technology enables surgeons to perform procedures with less damage to the body. Instead of a large incision, surgeons using Intuitive systems typically make five or fewer very small incisions, to insert cannulas—narrow metal tubes—into the body. Surgical instruments passed through these cannulas allow the surgeon and care team to perform the procedure. During the surgery, the cannulas move, which allows the surgeon to use the instruments as needed.
But as the cannulas move, they have the potential to stretch or damage the patient’s tissue. When Intuitive engineers were first developing the da Vinci robotic systems more than 20 years ago, they realized solving this issue would be crucial. The solution they came up with exemplifies the cooperation, precision and care that Intuitive puts into all its systems.
Early on, Intuitive engineers realized that the key was a principle known as the remote center of motion. This principle has been around since long before the development of robotic surgery. In essence, the remote center is a mechanism that allows an operator to rotate an object around a fixed point, from a distance. Over the years, engineers have developed a range of ways to do this, for a variety of uses. In robotic surgery, the remote center was first developed by researchers at IBM; in its early days, Intuitive saw the value of this approach and licensed their patent.
Intuitive engineers then worked to improve on that approach, making a series of adjustments. Eventually, they developed an elegant system that uses a network of metal belts and pulleys (see diagram). Their design allowed for the manipulation of the cannula from the base of the system; this system ensures that when the inserted cannula is moved inside the patient’s body, it angles around a fixed point in the patient’s body wall. When the cannula moves in this manner, it creates very little force on the patient’s body.
This mechanism is connected to the system’s software, enabling the surgeon to easily manipulate the system’s arms with the hand controls, while maintaining the remote center. Because the apparatus that moves the cannulas remains at a distance from the patient, the cannulas themselves can remain streamlined, which minimizes the size of the incisions in the patient.
“We designed the mechanism so that when the robot moves it's not going to take [the cannula] and try to force it side to side,” says Intuitive fellow Tom Cooper, a 26-year Intuitive veteran and one of the key engineers on the original da Vinci system. “It’s just going to tilt the cannula around the remote center, so there’s less pressure on the tissue.” This reduces friction, which helps keep the movement of the instruments steady and precise.
According to Cooper, various versions of this remote center solution have been used in most of Intuitive’s surgical robotic systems, including the da Vinci SP, Intuitive’s single-incision robotic system. The SP derives from “Single Port.”
For the past 16 years, Cooper, a thin, soft-spoken man in his 60s, has been working on this system, which has just one arm, from which a range of small, highly flexible instruments emerge inside the body. Over that time, he has also helped develop some of the system’s key features. One of these is a way to design the system so the surgeon can move the mechanical arm to point in any direction during a procedure without any help. This is a big leap forward, because it gives surgeons more freedom in a very limited space—the body cavity.
He had the inspiration for this while watching his son run at a high school cross country meet. To celebrate this transformative realization, he stopped for an ice cream cone on the way back to the office. “It’s just part of your job,” he says, smiling. “Figuring things out is what we do.”
Cooper has been working at Intuitive since the late 1990s, when it was a small startup. True to his low-key nature, Cooper says there was never a single moment when he knew the company would succeed. “I think it was more of a steady progression,” he says. “I guess we were concentrating so hard on solving problems, there wasn't that much time to think about whether it was all going to work or not.”
Cooper is now semi-retired, working half-time, developing improvements to some of SP’s instruments.
He says he loves working at Intuitive, although at times it can be stressful. “Sometimes to make progress, you really need something to work," he says. "But you also have no idea how to do that.”
When this happens, he usually relies on his colleagues. “The best way out of that kind of situation is brainstorming,” he says. “Trying to figure it out together.”
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