Cambridge Medical Robotics (CMR)
Updated may 2023
Mar 2019: CE Mark for Versius
2014. CMR Surgical founded.
Versius is the device from Cambridge Medical Robotics (CMR). As is follows the concept and the design of the da Vinci, lets remark differences and contributions.
- The surgeon´s console displays a 3D monitor instead of a visor. The open design allows anyone around to have a 3D view of the surgical field, but requires the use of polarized glasses (also for the surgeon).
- The patient-side component is split in individual modules for each arm. The philosophy is to “robotize laparoscopic procedures” which should add flexibility but might at the same time miss part of the potential of robotization. Check the set-up for different procedures.
- CMR claims to have created a Versius Digitally Native Ecosystem to make better informed decisions in patient care, and to be committed to research for an evidence based approach to surgical robotics.
Prior to commencing my venture into robotic surgery, I had established a firm grounding as an oncologic surgeon. My experience encompassed a wide range of resective and reconstructive procedures, as well as proficiency in minimally invasive surgical techniques and endoscopic surgery. These acquired skills and expertise serve as fundamental pillars for achieving success within the realm of robotic surgery.
The Versius Surgical System is a soft-tissue remote robotic surgical system based on a master-slave configuration. Cambridge Medical Robotics (CMR) was founded in January 2014 and entered into the fast developing field of robotic surgery, where different companies are competing with new devices. The first series of cadaveric trials with the new system were completed in June 2016 and it was officially introduced in September 2018. The first commercial introduction was at Galaxy Care Hospital in Pune, India, in October 2019, and in Europe, at Lothian and Milton Keynes University Hospital (HNS Foundation Trust), in the UK, in February 2020. In June 2022 there were over 5,000 clinical cases completed.
Although the basic concept is the same and there are very similar items (like the instruments), there are also some remarkable differences with the da Vinci Robotic Surgery System. There is no Vision Cart. Just the console and the effector modules. The console has and open design: the system works with a 3D image, but it is displayed in a monitor. Therefore the surgeon (or anyone around) needs to use polarized glasses. Additional 2D monitors might be connected to the system. There are no pedals in the surgeon´s console, so everything is controlled through the hand manipulators (we will discuss them in another chapter).
Endoscope and instrument arms are split into individual modules. There is an endoscope module and up to three instrument modules (also to be discussed later). The weight of the console is 180kg; each module 100kg. They do not use any motorized assistance to be transported. The system configuration is flexible, so it is possible to use just the endoscope (in the same way that other robotic endoscope holders), or one, two or three additional instrument arms. The company argues that this concept and design eases the coexistence with and a smooth transition from conventional endoscopic surgery to robotic remote surgery.
When the module is situated in the desired position by the surgical table, it needs to be locked.
This is manual manoeuvrer with a specific button.
A coat-tail will descent in the lower part of the module and it will be locked to the floor.
The button needs to be held until an acoustic signal is heard. For unlocking just press the button.
See other buttons at the module. “ZZZ” is of course for awakening and rest. The circular button with arrow-heads in the four directions is to align every module in the same working direction as the others. Plus (+) and minus (-) buttons modify the height of the platform. It can be raised up to 45 additional centimetres.
The connections panel at the back, down, is quite simple. Energies (monopolar and bipolar) to connect the instrument in the arm as required, and the connection to the console (“in”). There is another connection (“out”) as the modules can support a series connection.
The arm it-self has 3 joints that can be assimilated to shoulder, elbow and wrist (although there is another wrist at the tip of the instrument). The joints are free to move in every direction of the space. The neutral position of the first joint is vertical upwards, so the second joint has to be necessarily arched towards the surgical table. However, depending on the specific approach, the third joint can be arched in the same or in an inverse direction. The first option will be a “C” configuration, and the second a “Z” configuration, which are the only possible ones.
The motto of the company is think laparoscopic, operate robotically. So some of the components used in Versius robotic surgery might be used in conventional endoscopic surgery. This is particularly true for the endoscopes.
The Versius system incorporates a conventional rigid optic endoscope sourced from a third party, Richard Wolf (Knittlingen, Germany), renowned globally for its solutions in endoscopy. The Wolf panoview 3D HD endoscope is a dual 10mm rigid instrument measuring approximately 30cm in length, offering options for 0º and 30º views. This endoscope can be used for conventional endoscopic/laparoscopic surgery and Versius surgery. However, for the latter application, the system necessitates an external light source, including a light cable, in addition to the robotic components.
The camera head is specifically designed to be held by the camera/endoscope module. It receives signals from both the right and left endoscopes and processes them into digital signals for subsequent use. With the exception of the arm tip and connections, the camera module shares a similar appearance with the instrument modules. However, it is important to note that these modules are not interchangeable.
This solution prompts several considerations. The historical shift from analog to digital image acquisition is evident and logical. For instance, earlier iterations of the da Vinci system employed optic endoscopes but transitioned to videoendoscopes, which possess a camera chip located at the endoscope’s tip, enabling direct digital image acquisition. This transition offers multiple advantages, including lighter and more durable endoscopes, as well as expanded possibilities for image processing. Another important advantage is that the endoscope can be flexible. This is not used in the da Vinci multiport system, but it is critical for the design of the da Vinci Single Port (SP). While the optic endoscope may seem like a regression compared to current robotic surgery technology, it may find relevance during the transitional period from conventional laparoscopic surgery to remote robotic surgery. Undoubtedly, it remains a valid solution for the majority of contemporary endoscopic procedures. However, when considering transoral surgery, it is worth exploring the direction set by the Medrobotics Flex vision solution.
To be continued…
Notice. The Versius Surgical System has not the CE mark for Head and Neck Surgery