# Review of Advanced Medical Telerobots
## 1 Introduction
### History of Telerobotics in Medicine  
The first medical robot was developed in Vancouver B.C., Canada, in 1983, while the first use of a (non-medical) robot for medical purpose happened on 11 April 1985, at the Memorial Medical Center of Long Beach (California) during a stereotactic brain surgery [24]. During this kind of operation, a stereotactic probe is manually inserted in the brain so that its tip is exactly positioned at the location of a tumor located employing a computerized tomographic (CT) scanner. The surgeon can use this probe as a frame to safely perform a biopsy or any other neurosurgery operations. Yet, the insertion of the probe through a straight-lined trajectory required much experience to limit the lateral damages. In this application, a Puma 200 6-degree-of-freedom (DoF) industrial robot (Unimation) held this probe and performed a linear trajectory to install the probe according to the target position and the approach orientation determined from the CT pictures. See [25] for an overview of the use of industrial robots in surgery. The first medical robots (specifically manufactured for medical application and not a modified industrial robot) have been introduced in operating rooms a few years later (in the late 1980s and early 1990s), mainly to assist surgeons for needle placement with the patient located inside an imaging system (see [26] for a recent detailed historical review), but their rise happened with teleoperated robots for Laparoscopy, where the need of controlling the endoscope was the first widespread robotic application. To understand this craze, it is necessary to distinguish between remote operation robots, guidance robots, telerehabilitation, and robotic simulators for training hospital staff [27; 28]. In 2001, [PERSON] et al. stated that laparoscopy had changed the way surgeons perceive and practice surgery [29]. Indeed, laparoscopy was a new surgery technique, under the umbrella of Minimally Invasive Surgery (MIS), which involved only small incisions in the abdomen to install a laparoscope surgical tool from the outside of the patient's body. The main benefits of this technique, such as reduced blood loss [30], reduced damage to the tissues [31], reduced risk of infection [32], reduced recovery time [33], and cosmetic benefits [34], were provided for the patients while it was also a new challenge for surgeons to manipulate such tools. The limited sensory awareness has been a conventional bottleneck for manual MIS [35; 36]. It led to the need for extensive and specialized sensorimotor training; however, even with such training, experienced surgeons had difficulties in efficiently perceiving the surgical site (putting a significant amount of mental and physical burden on them [37; 38; 39]) and raising concerns about the need for extensive training and possible restrictions for conducting a variety of surgical tasks [1; 20; 40; 41]. De facto, indirect manipulation, limited perception, mirrored motion, and degraded hand-eye coordination led to the design of the first teleoperated endoscope, named AESOP (Automated Endoscope System for Optimal Positioning) [42]. Using AESOP, the surgeon, located at a very short distance, could move the laparoscope in every direction in the field of view of the video feedback by giving commands through foot pedals and sensorized hand controllers. The experience gained through the use of AESOP motivated the development of a wide range of assistive robots in the operation rooms resulting in several subsequent technologies, such as the Laparoscopic Assistant Robot System (LARS by IBM, Armonk, NY, USA) [43], which was used to manipulate surgical instruments in delicate surgeries resulting in \"Steady Hand\" and cooperative control. Later on (1998-2003), Zeus (Computer Motion Inc., Goleta, CA, USA) [44], built upon AESOP by adding new arms manipulating surgical, was used for the first transatlantic telesurgery \"Operation Lindbergh\" [45].