Copyright of Future Drugs Ltd. Review 10.1586/17434440.3.5.575 © 2006 Future Drugs Ltd ISSN 1743-4440 575 www.future-drugs.com Robotic prostate surgery Michael Muntener, Daniel Ursu, Alexandru Patriciu, Doru Petrisor and Dan Stoianovici † † Author for correspondence The Johns Hopkins Medicine, URobotics Laboratory, Department of Urology, Mason F Lord West Tower, Room W115, 5200 Eastern Avenue, Baltimore, MD 21224, USA Tel.: +1 410 550 1980 Fax: +1 410 550 0773 dss@jhu.edu KEYWORDS: computer-assisted surgery, MRI compatible, prostate, robotics The increasing popularity of robot-assisted radical prostatectomy has put the field of robotics in the spotlight. However, the relationship between medical robotics and the field of urology is older than most urologists know and it will most likely have a bright future beyond any contemporary application. The objective of this review is to provide an insight into the fundamentals of medical robotics and to highlight the history, the present and the future of urological robotic systems with an emphasis on robotic prostate interventions. Expert Rev. Med. Devices 3(5), 575–584 (2006) Over the past few decades technological advances have revolutionized the way we practice medicine. Today, medicine relies heavily on technical equipment and technol- ogy is evolving ever more rapidly. The field of urology has a very rich tradition of embracing the use of advanced and pioneering technol- ogy to make existing procedures more toler- able and efficient as well as developing new treatment modalities. The advent of robotics in prostate surgery is a new horizon of this tradition. The robot-assisted laparoscopic radical prostatectomy (LRP) is certainly a robotic success story and the da Vinci ® Surgical System (Intuitive Surgical) is the most famous representative of medical robots currently in use. However, the use of robots for prostatic interventions has a longer, less well-known history and it will most likely have a bright future beyond any current application. Apart from a general overview of robotic surgical systems, this review will focus on the past, present and future of robotic prostate interventions. Fundamentals of surgical robotics The robot, a term first coined by the Czech playwright Karel Capek in 1921 in his play Rossums Universal Robots, comes directly from the Czech word ‘robot’ which means industrial worker. It is of no surprise then that the first robots, as we know them today, appeared in the fields of industrial manufacturing where automatization became increasingly important for economic efficiency during and after World War II. By definition, a robot is a mechanical device that is controlled using a computer system [1]. In particular, a medical robot is a controllable mechanical device that undertakes one of four healthcare-specific roles: a supportive role to patient and staff, laboratory assistance, for rehabilitation or surgery. Urological medical robots are robots that belong to the last category and are defined by three essential components: the manipulator, image acquisition device and a computer. The surgical manipulator is an electro- mechanical arm equipped with sensors and actuators responsible for holding and precisely moving instruments under computer control. The most commonly employed kinematic architecture for surgical manipulators is the remote center of motion (RCM) concept [2], developed in 1995 at IBM ® [3]. This architec- ture, specific to surgical robots, aims to repro- duce a surgeon’s natural motion during laparo- scopic surgery by allowing the manipulator to consistently enable and facilitate the pivoting of instruments about a fixed point in space during the surgical procedure; that is, the point where the laparoscopic instrument enters the body (FIGURE 1) [4]. The image acquisition device allows the robot and surgeon to visualize the surgical environment and define the operating tasks CONTENTS Fundamentals of surgical robotics History & past achievements Present robotic applications in prostate surgery Future robotic applications in prostate interventions Expert commentary & five-year view Key issues References Affiliations