Hand X- The Hand-Held Robotic System
INTRODUCTION
Application of Robotics in minimal access surgery started in 2000 in areas which were otherwise difficult or inaccessible to laparoscopic equipment.
A Master Slave Robotic system like Da Vinci had been introduced to perform robotic surgery. The system occupies a considerable space in the operation theatre and is time consuming as it requires docking and undocking of the robotic arms to perform the surgery. It also requires trained technicians to operate the system.
Conversion to laparoscopy needs undocking and even changing the port size and position. Surgeons have the comfort to operate in a 3D monitor sitting beside the console but at an additional cost. So, there was research to evolve an alternative robotic system to address the financial as well as operational complexity and that’s how HandX was developed.
What is HandX?
Hand X is a hand-held Robotic system that was devised in 2018 by Human Xtension Ltd in Tel Aviv, Israel. Handheld robotic surgery is a cutting-edge technology that combines the precision and versatility of robotic systems with the dexterity and control of a surgeon’s hand. This simple yet powerful tool bridges the gap between Laparoscopic and Robotics surgery and makes difficult to reach anatomy easily and effortlessly accessible.
It is a light weight, 5 mm fully articulated software-driven handheld robotic system. The surgeons can perform minimal access surgery by using Hand X arm as and when necessary, without changing the trocar positions and the operative environment unlike in the bulky Master and Slave robotic system. This device is FDA cleared and CE approved.
It enables minimally invasive procedures, resulting in smaller incisions, minimized scarring, less pain and discomfort, reduced blood loss, lower risk of surgical site infection and post-operative complications, and faster recovery for patients
Advantages:
A) Surgeon driven solution: The surgeon holds the system and stands beside the patient throughout the surgery, just like using the conventional laparoscopic tool.
B) A modular system: HandX device has a modular design allowing the mounting of different instruments on the same hand piece.
C) Compatible with 5mm trocars: The instrument’s shaft is 5mm in diameter which can be introduced through the 5mm trocars justifying the M.I.S. (Minimally Invasive Surgeries) procedures.
D) Tactile feedback: HandX provides tactile feedback since the instrument is in the surgeon’s hand itself.
E) Natural ergonomics: It’s designed to make it more ergonomically handy.
F) Simplifying complex maneuvering in MIS: As the system is embedded with a software, it allows the surgeon to manoeuvre within the abdominal cavity of the patient with ease enabling the surgeon to perform the most complex procedures easily with maximum result.
G) Degrees of freedom: It offers 7 degrees of freedom – insertion, roll, grasp, internal yaw, external yaw, internal pitch, external pitch.
H) OT: Since the system is portable you do not need a dedicated robotic OT.
I) Quick set-up: Benefits of having a handheld system saves the set up or docking time.
J) Minimal need for unlearning and relearning: With HandX, there is a significant advantage as the port position and access will remain the same. This results in a very short learning curve, making the transition to HandX smoother and easier.
K) Dual modes for learning: HandX offers both intuitive and counterintuitive modes of operation, providing users with the flexibility to choose the method that suits them best. This enhances the ease of adaptation and ensures that users can comfortably utilize the system.
L) Minimal maintenance requirements: HandX is a low maintenance device and requires software upgradation for improvements and updates. This ensures that the healthcare facilities can focus on delivering quality care without worrying about frequent device maintenance.
M) Affordable solutions: The benefits of Robotic Assisted Surgery can be passed on to patients without imposing a significant financial burden.
A comparative study between Laparoscopy, HandX and Master Slave Robotic Surgery:
| LAPAROSCOPY | HANDX | MASTERSLAVE |
|---|---|---|
| Limited dexterity: The rigid instruments used in laparoscopy may restrict the surgeon's range of motion and tactile feedback. | Enhanced dexterity: Robotic arms provide a greater range of motion and flexibility, allowing for more precise manoeuvres, and provides tactile feedback. | Superior precision: Robotic arms eliminate hand tremors and enhance accuracy, particularly in delicate procedures. |
| Steep learning curve: Mastering laparoscopic techniques requires extensive training and practice. | Faster skill acquisition: As the port position and access remains the same, it results in a very short learning curve. | Learning curve: Surgeons require extensive training and proctoring to become proficient in robotic-assisted surgery. |
| Lack of depth perception: Two-dimensional visualization can make depth perception challenging for surgeons. | Improved visualization: High-definition cameras offer 3D visualization, enhancing depth perception and spatial awareness. | Enhanced visualization: High-definition, magnified 3D imaging provides a detailed view of the surgical site. |
| Surgeons may experience musculoskeletal discomfort or repetitive strain injuries over time. | Ergonomic design: Surgeons can operate comfortably from a console, reducing fatigue during lengthy procedures. | It offers improved ergonomics compared to laparoscopy |
| Affordable solutions: HandX aims to make Robotic Assisted Surgery accessible to a wider range of patients by offering economical prices. | Cost: The high initial cost and ongoing maintenance expenses may limit access to master-slave robotic systems in some healthcare settings | |
| 5 mm trocars are used | 10-12 mm and 8 mm trocars are used in Da Vinci or CMR robotic system | |
| Quick set-up: Benefits of having a handheld system saves the set up or docking time. | Setup time: The setup and calibration process for robotic systems may prolong operating room turnover times. | |
| Handheld robotic systems can be used across various surgical specialties | ||
| It is suitable for any hospital surgical environment and is designed to match surgical teams of any skill level. | It requires a dedicated Robotic Operation Theatre. | |
| Minimal maintenance requirements: HandX is designed to be a low- maintenance device, with only software upgrades needed for improvements and updates. | High Maintenance. |
As technology continues to evolve, handheld robotic systems will play a pivotal role in enhancing surgical outcomes and expanding the possibilities of minimally invasive procedures.