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to 540°, repeating several times the position of the hands curve to that of an organist. The assistant operational
in the handles of the surgeon’s console. The recovery function remains to be defined.
of the hand position could be avoided by magnifying
pronosupination in the way of a power steering system Endoscopic manual work
in cars. Assuming a magnification of 1/3, an operator Endoscopic microsurgery requires not only the
performing a pronosupination of 180°, could perform introduction of a camera into a natural or artificial
a pronosupination of 540° in 1 time. Considering the biological cavity, but also requires the introduction
prospects, the completion time of a vascular anastomosis of appropriate instruments to repair damaged tissue.
could be easily decreased by performing one unique Conventional microsurgical instruments are not suitable
movement with the needle going from one vessel wall for endoscopy. However, the instrumental arms of the
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to the other without having to repeat the movement, DaVinci robot, having a length of 50 cm, are equipped
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especially in deep surgical fields or hard to access as in at their termination with a miniature wrist or EndoWrist
the repair of the collateral ulnar artery during thumb that allows the introduction of instruments by a minimally
replantation. invasive approach and which goes straight to the surgical
target, as if a miniaturized operator’s wrist could directly
Magnification of the manual force feedback penetrate inside the body. The disadvantage remains
sensation of having performed four converging approaches.
The absence of force feedback or haptic sensation is often Considering the prospects, the “single port” with a
criticized in robotic surgery practiced with the DaVinci miniaturized 3D endoscope equipped with instruments
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robot. In reality, the force feedback does not exist in passing through the same flexible tube, seems to be an
conventional microsurgery. Some authors have shown that interesting research pathway.
the tightening sensation of a node with a 10/0 nylon is
perceived by a minority of individuals. In practice, the Augmented ergonomics
[3]
haptic sensation in conventional microsurgery is obtained Microsurgery is time‑consuming. Interventions are long
indirectly by visualization of the deformity of the soft and the fatigue of the surgeon is a deleterious factor. Any
tissues in which it has acquired experience in conventional factor that can improve the comfort of the surgeon can
procedures where the operator directly manipulates the improve the quality of the intervention. In conventional
instruments. Unlike the DaVinci robot, the Amadeus microsurgery, the gaze direction of the operator does
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robot is equipped with a device for haptic sensation, but not follow a direct line between the surgeon’s eye
its marketing is still confidential. The Mimic simulator and his target. The image undergoes deflections. The
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solely dedicated to training in robotic surgery is also consequence is that the hand‑eye‑head coordination
equipped with a device for haptic sensation. Considering is disrupted. The position of the head corresponds to
the prospects, if the force feedback is not currently used a target distant to the actual target. To maintain this
in conventional microsurgery and telemicrosurgery, it is position, the contraction of the muscles of the neck
not inconceivable that its magnification becomes a capital does not match that of the actual target and can cause
property, especially in supermicrosurgery in order to eyestrain and muscle fatigue. In telemicrosurgery, the
perform vascular, lymphatic, and nerve anastomoses that gaze direction of the operator follows a direct line to
are currently inaccessible because of their small size. his hands and the target. Paradoxically, although the
surgical console is not in contact with the patient,
Multi‑manual work the position of the operator’s head and hand is more
A surgeon uses both hands to work, but an organist also ergonomic than in conventional microsurgical where the
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uses his feet. If the DaVinci robot has 3 instrumental operator’s hands are in direct contact with the patient. In
arms, the same operator can only handle 2 simultaneously, conventional microsurgery, the operative field is cluttered
even in the latest versions of the robot. The third arm by the hands of the operator and his assistant. This can
is like the hand of an assistant, the operator places for increase fatigue as the surgeon may have to operate in
example to place a retractor. In microsurgery, certain uncomfortable positions. In contrast, the operating field
delicate gestures are performed. The advantage of in telemicrosurgery is cleared, thanks to the instrumental
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the DaVinci robot is that the third arm, unlike that of arm length, the fineness of the EndoWrist , and especially
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an assistant, does not tremble nor changes position. the absence of the operator’s hands.
Considering the prospects, the theoretical possibility to
use more than 2 instrumental arms simultaneously and Remote working
by the same operator is not to be immediately eliminated Conventional microsurgery requires direct contact between
on the pretext that surgeons have only used 2 of their the patient and the surgeon. This proximity seems logical,
hands till now. In fact, unconsciously, surgeons are already but it is not always possible, especially when a highly
using their feet to activate an electrocoagulation pedal, specialized technical gesture is required, and no specialist
an arthroscopic shaver or a fluoroscope. Admittedly the surgeon is available. It is clear that at present the use of
foot is only to activate an instrument used by hand, but a remote expert is not current practice, but considering
it is not impossible to imagine that the order of 1 or 2 the prospects, in the future in the middle of a procedure
instrumental arms could be confided independently to requiring a very specific gesture, it may be interesting to
one or two feet of a same operator. The acquisition of the call on a remote expert who could take control of the
independence of feet will require an equivalent learning robot and perform a very specific task.

Plast Aesthet Res || Vol 2 || Issue 4 || Jul 15, 2015 223