Unit IX robotic surgery

EXERCISE 1

Read and translate the text.

Robotic surgery, computer-assisted surgery, and robotically-assisted surgery are terms for technological developments that use robotic systems to aid in surgical procedures.

Robotically-assisted surgery was developed to overcome both the limitations of minimally invasive surgery or to enhance the capabilities of surgeons performing open surgery. In the case of robotically assisted minimally invasive surgery, instead of directly moving the instruments, the surgeon uses one of two methods to control the instruments; either a direct telemanipulator or by computer control. A telemanipulator is a remote manipulator that allows the surgeon to perform the normal movements associated with the surgery whilst the robotic arms carry out those movements using end-effectors and manipulators to perform the actual surgery on the patient. In computer-controlled systems the surgeon uses a computer to control the robotic arms and its end-effectors, though these systems can also still use telemanipulators for their input. One advantage of using the computerised method is that the surgeon does not have to be present, indeed the surgeon could be anywhere in the world, leading to the possibility for remote surgery. In the case of enhanced open surgery, autonomous instruments (in familiar configurations) replace traditional steel tools, performing certain actions (such as rib spreading) with much smoother, feedback-controlled motions than could ever be achieved by a human hand. The main object of such smart instruments is to reduce or eliminate the tissue trauma traditionally associated with open surgery without requiring more than a few minutes' training on the part of surgeons. This approach seeks to improve that lion's share of surgeries, particularly cardio-thoracic, that minimally invasive techniques have so failed to supplant.

In 1985 a robot, the PUMA 560, was used to place a needle for a brain biopsy using CT guidance. In 1988, the PROBOT, developed at Imperial College London, was used to perform prostatic surgery. The da Vinci Surgical System comprises three components: a surgeon’s console, a patient-side robotic cart with 4 arms manipulated by the surgeon (one to control the camera and three to manipulate instruments), and a high-definition 3D vision system. The da Vinci senses the surgeon’s hand movements and translates them electronically into scaled-down micro-movements to manipulate the tiny proprietary instruments. It also detects and filters out any tremors in the surgeon's hand movements, so that they are not duplicated robotically.

Major advances aided by surgical robots have been remote surgery, minimally invasive surgery and unmanned surgery. Some major advantages of robotic surgery are precision, miniaturization, smaller incisions, decreased blood loss, less pain, and quicker healing time. Further advantages are articulation beyond normal manipulation and three-dimensional magnification, resulting in improved ergonomics. Robotic techniques are also associated with reduced duration of hospital stays, blood loss, transfusions, and use of pain medication.

With the cost of the robot at $1,200,000 dollars and disposable supply costs of $1,500 per procedure, the cost of the procedure is higher. Additional surgical training is needed to operate the system. Numerous feasibility studies have been done to determine whether the purchase of such systems are worthwhile. As it stands, opinions differ dramatically. Surgeons report that, although the manufacturers of such systems provide training on this new technology, the learning phase is intensive and surgeons must operate on twelve to eighteen patients before they adapt. Moreover during the training phase, minimally invasive operations can take up to twice as long as traditional surgery, leading to operating room tie ups and surgical staffs keeping patients under anesthesia for longer periods. Patient surveys indicate they chose the procedure based on expectations of decreased morbidity, improved outcomes, reduced blood loss and less pain. Higher expectations may explain higher rates of dissatisfaction and regret.

Advantages of this technique are that the incisions are small and patient recovery is quick. In traditional open-heart surgery, the surgeon makes a ten to twelve-inch incision, then gains access to the heart by splitting the sternum (breast bone) and spreading open the rib cage. The patient is then placed on a heart-lung machine and the heart is stopped for a period of time during the operation. This approach can be associated with postoperative infection and pain, and prolonged time to complete recovery. Because patient recovery after robot-assisted heart surgery is quicker, the hospital stay is shorter. On average patients leave the hospital two to five days earlier than patients who have undergone traditional open-heart surgery and return to work and normal activity 50% more quickly. Reduced recovery times are not only better for the patient, they also reduce the number of staff needed during surgery, nursing care required after surgery, and, therefore, the overall cost of hospital stays.

Compared with other minimally invasive surgery approaches, robot-assisted surgery gives the surgeon better control over the surgical instruments and a better view of the surgical site. In addition, surgeons no longer have to stand throughout the surgery and do not tire as quickly. Naturally occurring hand tremors are filtered out by the robot’s computer software. Finally, the surgical robot can continuously be used by rotating surgery teams. While the use of robotic surgery has become an item in the advertisement of medical services, critics point out that studies that indicate that long-term results are superior to those after laparoscopic surgery are lacking. The robotic system does not come cheap and has a learning curve. Data is absent that proves the increased costs can be justified. In medical literature, very experienced surgeons tend to publish their results with robotic systems. However, these may not be representative of surgeons with lesser experience.

In early 2000 the field of general surgical interventions with the daVinci device was explored by surgeons at Ohio State University. Reports were published in esophageal and pancreatic surgery for the first time in the world and further data was subsequently published by Horgan and his group at the University of Illinois and then later at the same institution by others. In 2007, the University of Illinois at Chicago medical team, led by Prof. Pier CristoforoGiulianotti, reported a pancreatectomy and also the Midwests fully robotic Whipple surgery. In April 2008, the same team of surgeons performed the world's first fully minimally invasive liver resection for living donor transplantation, removing 60% of the patient's liver, yet allowing him to leave the hospital just a couple of days after the procedure, in very good condition. Furthermore the patient can also leave with less pain than a usual surgery due to the four puncture holes and not a scar by a surgeon.

EXERCISE 2

Say, to what degree the title can help understand the content of the text.

EXERCISE 3

Determine the part of speech according to the suffixes (prefixes), translate the following words.

machine - machining; supply - supplier; similar - similarly, direct - direction - directive - directly; differ - different - difference; set - setting; operate - operating - operation - operational - operative - operator; infinite - infinitely, rotate - rotation - rotational - rotative - rotary, advantage - advantageous; change - changer - changeable; remove - removal - removable; vary - various - variable - variety - variant - variation; base - basic - basically 

EXERCISE 4

Complete the following sentences using facts fromthe text.

1. It should be stressed that robotic surgery is.... 2. In fact, robotically-assisted surgery was developed .... 3. As a general rule the advantages of this technique are.... 4. As is known the disadvantages are.... 5. It is necessary to mention that a number of applications have been under made in ... . 

EXERCISE 5

Dividethetextintologicparts. Titlethem.

EXERCISE 6

Find in the text description of robotic surgery processes.

EXERCISE 7

Say what kind of information from the text is particularly important for you as an engineer.

EXERCISE 8

Express your attention to advantages and disadvantages of robotic surgery described in the text. Could you use any facts from the text in your course/diploma paper?

EXERCISE 9

Whatdoyouknowaboutrelationsofyouruniversitywithanyplantsproducingrobots?

EXERCISE 10

Write summary of the text for an engineering journal.

PART IV

PROCESSES IN AUTOMATION PRODUCTION

UNIT I

METHODS OF PROJECT EVALUATION

Text I

Evaluation Methods of Innovation Project Cost

EXERCISE 1

Read and translate the text.

What is the cost of an innovative project? Most often this question rises, when you want to assess whether the project is able to recoup its costs. In general, it means: reimbursement of expenses at the expense of operating incomes of the projects, gaining profit and recoupment of investments. In some cases, the costs of engineering setup have already been incurred, and the need to determine the cost of the project is attributed to the terms of acquisition or "transformation of the cost." Anyway, the cost of the project depends on the market, progress of the project implementation, and opportunities. There should be taken into account “a human factor”, when in the future managers may change their mind about the need to continue work on the project, if it appears economically unfavorable. If a chance to use a real option in our estimation is not taken, it may lead to underestimation of the project profitability. The most important feature of a real option is its ability to recognize rapidly changing economic environment in which the company operates, that is particularly important in the world economy nowadays.

As a rule, it is the method of cash flow discounting that is fundamental for any project cost estimation, despite the fact that this method has its specific features and cannot be suitable for analysis in conditions of indeterminacy.

The advantages of income approach are its versatility and theoretical validity. Income approach allows determining the value of asset according to the type and purpose of the transactions done by the evaluation, and also allows to forecast future earnings and economic incur using a mechanism of economic depreciation.

The main drawback of the income approach is to obtain original information necessary for the calculations. Besides, it is difficult to assess the amount of future earnings of the company implementing the project, because information on future revenues is uncertain.

Drawbacks of the cash flow discounting may have negligible effect on the evaluation results, but the use of this method is often a source of errors in assessing risky investments, where uncertainty and necessity to make a decision characterize the project and determine its value.

In practice, there exist various modifications of this method. In particular, in order to estimate the company risks are allowed in the cash flows, instead of allowance for project risk in the discount rate: expected cash flows are "weighted" according to the specific business risks. Thus, the specific risks of biotechnological companies are associated with passing the stages of development of biotechnology project when in the process of developing pharmaceutical products different phases of medical tests are specified). The discount rate allows risks of those projects only in which all the stages have been passed.

Income approach is the most reasonable, since the cost of the project lies in its ability to generate future cash flows. The risks associated with these cash flows are important. Method of real options can be viewed as an important specific opportunity to act as a legal or physical person, to realize an innovative project.

Option to terminate or sale the project is valuable because salvage value means the lower limit of the project cost. The project to be terminated costs more than the project which is not going to be terminated. Option cost in this case is the cost of the innovation project. The price of the exercise of option is the cost of the investment project. Underlying assets are goods, works, services, implementation of which will bring the estimated revenue from the investment project. Project cost is probably the most important stage for choosing the project (besides technical and marketing analysis), because at this stage financial parameters appear.

Anyway, the guidelines for choosing evaluation methods are true information and competent personnel to use this information for the most profitable investment.

EXERCISE 2

Learn the following words and expressions.

conditions of indeterminacy	условиянеопределенности
engineering setup	наладкапроизводства
income approach	доходныйподход
project termination	прекращение проекта
method of cash flow discounting	метод дисконтирования денежного потока
underlying assets	базисные активы
option cost	стоимость опциона
estimated revenue	предполагаемый доход
evaluation methods	способы оценки
transformation of the cost	трансформация стоимости
pharmaceutical products	фармакологические препараты
legal or physical person	юридическое или физическое лицо
economic obsolescence	экономическое устаревание
acquisition	приобретение

EXERCISE 3

Answer the following questions.

1. What methods are used for evaluating the project cost? 2. What does the project cost depend on? 3. What are advantages (disadvantages) of the income approach method? 4. How can you determine the real option method? 5. Why are availability of information and competent personnel important factors for the choice of evaluation methods?

EXERCISE 4

Determine the part of speech (according to the word-formative elements) and translate the words. 

achieve - achievement; apply - application - applicable; consider - consideration - considerable; burse - reimburse - reimbursement; define - definition - definite; flexible - flexibility; incur- incurred; convey - conveyance - conveyor; manufacture - manufacturing - manufacturer; produce - production - productive - productivity; require - requirement; evaluate- evaluation; realize - realization; act- action- transaction; term - terminate - determine –- indeterminacy; obsolete - obsolescent - obsolescence.

EXERCISE 5

Read and translate the following word combinations.

Innovative project, company risks, developing pharmaceutical products, salvage value, exercise of option, underlying assets, estimated revenue, to appear economically unfavorable, discount rate, negligible effect, reimbursement of expenses, terms of acquisition, in conditions of indeterminacy, underestimation of the project profitability, costs of engineering setup, recoupment of investments, to be attributed to the terms of acquisition, progress of the project implementation, versatility and theoretical validity, rapidly changing economic environment, income approach.

EXERCISE 6

Make up the short plan for discussion of the text.

EXERCISE 7

Conversation. Tell what information in Text 1 is new for you and what is already known. 

EXERCISE 8

What features, as you think, make advantages and disadvantages of the income approach?

EXERCISE 9

Summarize the content of the text. Write the annotation.

EXERCISE 10