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What is history of Robotic Surgery

Discussion in 'All Categories' started by Peter Stenley - Nov 25th, 2011 9:52 am.
Peter Stenley	Dear Sir I am a research fellow at Cleveland clinic Florida. I am doing research om da vinci robot. I want to know something about history of robotic surgery.
re: What is history of Robotic Surgery by Dr JS Chauhan - Nov 25th, 2011 9:58 am #1
Dr JS Chauhan	Dear Peter Stenley There is Good reputation and history of Robotic surgery R.U.R. is a 1920 science fiction participate in the Czech language by Karel Capek. R.U.R. means Rossum's Universal Robots, an English phrase used because the subtitle in the Czech original. It premiered in 1921 and introduced the word "robot" to the English language and to science fiction in general Since then robots took on increasingly more importance both in imagination and reality. A scene from the play, showing three robots. Karel Capek(1890-1938) The play introduced the word Robot which displaced older words such as "automaton" or "android" in languages all over the world. Within an article in Lidov
re: What is history of Robotic Surgery by Dr JS Chauhan - Nov 25th, 2011 10:00 am #2
Dr JS Chauhan	Dear Peter Stenley There is Good reputation and history of Robotic surgery R.U.R. is a 1920 science fiction participate in the Czech language by Karel Capek. R.U.R. means Rossum's Universal Robots, an English phrase used because the subtitle in the Czech original. It premiered in 1921 and introduced the word "robot" to the English language and to science fiction in general Since then robots took on increasingly more importance both in imagination and reality. A scene from the play, showing three robots. Karel Capek(1890-1938) The play introduced the word Robot which displaced older words such as "automaton" or "android" in languages all over the world. Within an article in Lidové noviny Karel Capek named his brother Josef because the true inventor of the word. In its original Czech, robota means forced labour of the kind that serfs had to perform on the masters' lands, and it is derived from rab, meaning "slave A brief history of robotics in surgery starts with the Puma 560, a robot used in 1985 by Kwoh et al to do neurosurgical biopsies with greater precision. Puma 560 is really a not so complex, six degree-of-freedom (DOF) elbow manipulator 3 years later, Davies et al performed a transurethral resection from the prostate using the Puma 560. This system eventually led to the introduction of PROBOT, a robot designed especially for transurethral resection from the prostate. While PROBOT had been developed, Integrated Surgical Supplies Ltd. of Sacramento, CA, was developing ROBODOC, a robotic system made to machine the femur with greater precision in hip replacement surgeries. ROBODOC was the first surgical robot authorized by the FDA. The ROBODOC was the very first robot to perform automated procedure on humans. Despite it clinical relevance and advanced features, it hadn't sold good enough to sustain the business of ISS. In 1986 Dr. Paul and Dr. Bargar develop the baseline ROBODOC concept. And in 05/90 Dr. Paul performs joint replacement surgery on canines using ROBODOC. Also within the mid-to-late 1980s a group of researchers in the National Air and Space Administration (NASA) Ames Research Center working on virtual reality became thinking about by using this information to build up telepresence surgery. This concept of telesurgery became one of the main driving forces behind the introduction of surgical robots. In the early 1990s, some of the scientists from the NASA-Ames team joined the Stanford Research Institute (SRI). Dealing with SRI’s other robotocists and virtual reality experts, these scientists developed a dexterous telemanipulator for hand surgery. Among their main design goals ended up being to give the surgeon the feeling of operating on the patient rather than from across the room. While these robots were being developed, general surgeons and endoscopists joined the expansion team and realized the possibility scalping strategies been on ameliorating the constraints of conventional laparoscopic surgery. The US Army noticed the work of SRI, and it became interested in the potential of decreasing wartime mortality by “bringing the surgeon towards the wounded soldier-through telepresence.” With funding from the US Army, a system was devised whereby a wounded soldier might be loaded into a vehicle with robotic surgical equipment and be operated on remotely with a surgeon in a nearby Mobile Advanced Surgical Hospital (MASH). This technique, it had been hoped, would decrease wartime mortality by preventing wounded soldiers from exsanguinating before they reached the hospital. This technique continues to be successfully demonstrated on animal models but has not yet been tested or implemented for actual battlefield casualty care. Some of the surgeons and engineers focusing on surgical robotic systems for the Army eventually formed commercial ventures contributing to the introduction of robotics towards the civilian surgical community. Notably, Computer Motion, Inc. of Santa Barbara, CA, used seed money provided by the Army to develop the Automated Endoscopic System for Optimal Positioning (AESOP), a robotic arm controlled through the surgeon voice commands to manipulate an endoscopic camera. Shortly after AESOP was marketed, Integrated Surgical Systems (now Intuitive Surgical) of Mountain View, CA, licensed the SRI Green Telepresence Surgery system. This system underwent extensive redesign and was reintroduced as the Da Vinci surgical system. Within a year, Computer Motion place the Zeus system into production. Between 1993 and 2000 Computer Motion protected itself having a wide variety of patents on various surgical procedures that are crucial for the prosperity of robotic surgery. A few of their main patents include: • Three-dimensional vector co-processor • Automated endoscope system for optimal positioning • Shape memory alloy actuated rod for endoscopic instruments • Method and apparatus for performing minimally invasive cardiac procedures • Head cursor control interface for an automated endoscope system for optimal positioning • Motion minimization and compensation system to be used in surgical procedures • Method and apparatus for performing minimally invasive cardiac procedures • Medical robotic system With all of these patents in hand Computer Motion seemed to become the robotic surgery company of the future, but Intuitive Surgical has devised their very own technology to compete within the robot market. In June 2000 the United States Patent and Trademark Office issued Computer Motion Inc. the ownership of hand tremor elimination with a robotic surgical system during minimally invasive surgery (No. 6,063,095). Law suit was filed against Intuitive Surgical for infringement of Computer Motion patents. The ongoing patent disputes ended using the merge of Computer Motion Inc. and Intuitive Surgical Inc. In 2003 Intuitive Surgical Inc. announced the merge agreement inside a stock swap valued at about $63 million, combining the companiesÕ products for operative surgical robots, telesurgery and operating room integration. After acquiring Computer Motion Inc., Intuitive Surgical Inc. had become the leader in operative surgical robotics. Radiosurgery can also be incorporating advanced robotic systems. In October 1st 2001 CyberKnife developed by Accuray Incorporated received FDA clearance for any compact, lightweight linear accelerator (linac) mounted on a robotic arm providing you with lesions treatments any place in your body using radiation. Stereotactic Radiosurgery System (SRS) utilizes body's skeletal structure like a reference frame and its Dynamic Tracking Software (DTS) technology adjusts minor patient movements to achieve this high level of precision. Lesions are marked with regards to the bone structure using CT images, then during the procedure real time X-ray is used to accurately squeeze linac before delivering radiation beam. CURRENT ROBOTIC SURGICAL SYSTEMS Today, many robots and robot enhancements are now being researched and developed. Schurr et al at Eberhard Karls University’s section for non-invasive surgery allow us a master-slave manipulator system that they call ARTEMIS. This system consists of 2 robotic arms that are controlled with a surgeon in a control console. Dario et al in the MiTech laboratory of Scuola Superiore Sant’Anna in Italy allow us a prototype miniature robotic system for computer-enhanced colonoscopy..This technique offers the same functions as conventional colonoscopy systems but it achieves this by having an inchworm-like locomotion using vacuum suction. By allowing the endoscopist to teleoperate or directly supervise this endoscope along with the functional integration of endoscopic tools, they feel this system is not only feasible but may expand the applications of endoluminal diagnosis and surgery. Several other laboratories, including the authors’, are designing and developing systems and models for reality-based haptic feedback in minimally invasive surgery as well as combining visual servoing with haptic feedback for robot-assisted surgery. Along with Prodoc, ROBODOC and the systems mentioned previously several other robotic systems have been commercially developed and authorized by the FDA for general surgical use. These include the AESOP system (Computer Motion Inc., Santa Barbara, CA), a voice-activated robotic endoscope, and also the comprehensive master-slave surgical robotic systems, Da Vinci (Intuitive Surgical Inc., Mountain View, CA) and Zeus (Computer Motion Inc., Santa Barbara, CA). The da Vinci and Zeus systems are similar in their capabilities but different in their methods to robotic surgery. Both systems are comprehensive master-slave surgical robots with multiple arms operated remotely from a console with video assisted visualization and computer enhancement. Within the da Vinci system which started out the telepresence machines produced for NASA and also the US Army, there are essentially 3 components: an image cart that holds a dual light source and dual 3-chip cameras, an expert console where the operating surgeon sits, along with a moveable cart, where 2 instrument arms and the camera arm are mounted.1 Your camera arm contains dual cameras and the image generated is 3-dimensional. The actual console includes an image processing computer that generates a true 3-dimensional image with depth of field; the view port where the surgeon views the look; foot pedals to manage electrocautery, camera focus, instrument/camera arm clutches, and master control grips that drive the servant robotic arms in the patient’s side.6 The instruments are cable driven and provide 7 degrees of freedom. This system displays its 3-dimensional image above the hands of the surgeon in order that it gives the surgeon the illusion the tips of the instruments are extra time of the control grips, thus giving the sense to be in the surgical site. The Zeus system is composed of a surgeon control console and three table-mounted robotic arms . The right and left robotic arms replicate the arms from the surgeon, and also the third arm is definitely an AESOP voice-controlled robotic endoscope for visualization. Within the Zeus system, the surgeon is seated comfortably upright using the video monitor and instrument handles positioned ergonomically to increase dexterity and permit complete visualization of the OR environment. The system uses both straight shafted endoscopic instruments similar to conventional endoscopic instruments and jointed instruments with articulating end-effectors and 7 degrees of freedom. Timeline 1989 - A high-tech medical device company Computer Motion was founded having a goal to revolutionize surgical practices and to improve patient lives. 1992 - Integrated Surgical Systems introduced RoboDoc for orthopedic surgery, specifically total hip arthroplasty. This robotic system allowed orthopedic surgeons to pre-plan their operations while performing better surgery. This robot gained acceptance for use in Europe but nonetheless hasn't received FDA clearance for marketing within the U.S. November 7, 1992 - The very first robot-assisted human hip replacements using Robodoc, on the 64-year-old man suffering from osteoarthritis. Ten more robot-assisted human hip replacements using Robodoc were performed at Sutter General Hospital, Sacramento, Calif., under an investigational device exemption (IDE) approved by FDA Oct. 9,1992. December 1993 - The AesopTM 1000, a robotic system employed for holding an endoscopic camera in minimal invasive laparoscopic surgery, developed by computer motion was approved by the FDA. 1995 - Frederic Moll, M.D., Robert Younge and John Freund, M.D. formed Intuitive based on foundational robotic surgery technology developed at SRI International (formerly referred to as Stanford Research Institute). 1997 - The da Vinci Surgical System manufactured by Intuitive Surgical Inc., became the first assisting surgical robot to get FDA approval to help surgeons easier perform laparoscopic surgery. 1997 - Jacques Himpens and Guy Cardier in Brussels, Belgium used the da Vinci by Intuitive Surgical Inc. system to do the first telesurgery gallbladder operation. 1997 - Integrated Surgical Systems Inc. purchased Innovative Medical Machines Int. (MMI), its Neuromate System and extended its field of robotic from orthopedics to neurosurgery. May 1998 - Carpentier et al. performed the very first mitral valve repair utilizing an early prototype from the da Vinci articulated intracardiac "wrist" robotic device. 1998 - Dr. Frank Diamiano performed the first procedure in the United States having a reanastomosis of the fallopian tube while using Zeus system. September 24, 1999 - Dr. Boyd of London Health Sciences Centre's (LHSC) university performed the earth's first robotically-assisted closed-chest beating heart cardiac bypass operation on 60-year-old dairy farmer John Penner while using Zeus system. November 22, 1999 - The first closed-chest beating heart cardiac hybrid revascularization procedure is conducted at the London Health Sciences Centre (London, Ontario). Dr. Douglas Boyd used Zeus to perform an endoscopic, single-vessel heart bypass surgery on the 55 year-old male patient's left anterior descending artery. December 9, 1999 - Dr. Ralph Damiano, Jr., in the Milton S. Hershey Medical Center at Penn State College of drugs in Hershey performed the first robotic assisted beating heart bypass in the usa while using Zeus Robotical Surgical System. July 11, 2000 - Intuitive Surgical Inc. received clearance in the FDA to market the da Vinci¨ Surgical System in the usa for use in laparoscopic surgical treatments. March 13, 2000 - Dr. Francois Laborde of L'Institut Mutualiste Montsouris Chiosy performed the very first time pediatric cardiac procedures using Computer Motion's Zeus robotic help perform seven fully endoscopic closures from the patent ductus arteriosis (PDA). October 9, 2001 - ZEUS® Robotic Surgical System from Computer Motion receives FDA regulatory clearance using the FDA decision for U.S. surgeons to use a number of instruments to perform a wide range of robotically assisted laparoscopic and thoracic procedures. August 2001 - The CyberKnife® became the first image-guided robotic technology to receive FDA clearance for non-invasive cancer surgery to provide radio-surgery for lesions anywhere in your body when radiation treatment is indicated. September 7, 2001 - ZEUS robotic system developed by Computer Motion was adopted within the trans-Atlantic operation. A physician in New York removed the diseased gallbladder of the 68-year-old patient in Strasbourg, France. October 1, 2001 - FDA cleared the marketing from the CyberKnife with Dynamic Tracking Software (DTS) developed by Accuray Incorporated to provide radiosurgery for lesions, tumors, and conditions anywhere in your body when radiation treatment methods are indicated. March 7, 2000 - Two leading medical robotic companies Intuitive Surgical Inc. and Computer Motion Inc. announced the merge agreement, combining the companiesÕ products for operative surgical robots, telesurgery and operating room integration. July 7, 2004 - FDA cleared the marketing of the robotic-like system to assist in heart by-pass surgery enabling the surgeon to do heart surgery while seated at a console having a computer and video monitor. Apr 9, 2005 - Surgeons in the University of Illinois Medical Center at Chicago successfully performed a laparoscopic right hepatectomy, removing approximately 60 % of her liver, and the tumor using the da Vinci¨ Surgical System. In May 2006 the first AI doctor-conducted unassisted robotic surgery on a 34 year old male to fix heart arythmia. The results were rated as much better than an above-average human surgeon. The machine were built with a database of 10,000 similar operations, and so, in the words of their designers, was "more than capable of operate on any patient." The designers believe that robots can replace 1 / 2 of all surgeons within Fifteen years.[citation needed In February 2008, Dr. Mohan S. Gundeti of the University of Chicago Comer Children's Hospital performed the first robotic pediatric neurogenic bladder reconstruction. The operation was performed on a 10-year-old girl In June 2008 the German Aerospace Center (DLR) presented the very first robotic system for minimally invasive surgery with force-feedback in 7 dof within the tip of the instrument, distal from the 2-dof handwrist (MiroSurge). In January 2009, Dr. Todd Tillmanns reported the outcomes of the largest multi-institutional study on the use of the da-Vinci robotic surgical system in gynecologic oncology and included learning curves for current and new users as a method to assess their acquisition of skills using the device In January 2009, the first all-robotic-assisted kidney transplant was performed at Saint Barnabas Medical Center in Livingston, New Jersey by Dr. Stuart Geffner. Exactly the same team performed eight more fully robotic-assisted kidney transplants over the next 6 months In September 2010, the Eindhoven University of Technology announced the introduction of the Sofie surgical system, the very first surgical robot to use force feedback In September 2010, the very first robotic operation in the femoral vasculature was performed in the University Medical Centre Ljubljana with a team led by Borut Geršak. The robot used was the first true robot, meaning it wasn't simply mirroring the movement of human hands, but was guided by pressing on buttons. FDA Approval: Date Procedure April 26, 2005 Gynecological Laparoscopic Procedures January 30, 2003 Totally Endoscopic Atrial Septal Defect (ASD) November 13, 2002 Mitral valve repair surgery November 12, 2002 Thoracoscopically-Assisted Cardiotomy Procedures, K022574 July 11, 2000 General Laparoscopic Surgery (gallbladder, gastroesophageal reflux and gynecologic surgery), K990144 March 5, 2001 Thoracoscopic Surgery (IMA Harvesting for Coronary Artery Bypass and Lung surgery), K002489 May 30, 2001 Laparoscopic Radical Prostatectomy, K011002 July 31, 1997 Surgical Assistance, K965001
re: What is history of Robotic Surgery by Peter Stenley - Nov 25th, 2011 10:04 am #3
Peter Stenley	Can you tell me about advantage of Robotic Surgery also please.
re: What is history of Robotic Surgery by Dr JS Chauhan - Nov 25th, 2011 10:04 am #4
Dr JS Chauhan	The Advantages of Robotic Surgery Robotic surgery is more accurate and less painful. Robotic surgery is a growing trend in the medical field that has distinct advantages over traditional health procedures. The technology involved, however, is thoroughly grounded in scientific fact. The da Vinci Robotic System is a state-of-the-art apparatus that doesn’t perform the surgery itself, but rather extends the eyes and hands of an actual surgeon. Documented studies have shown the da Vinci system to be safe and effective after thousands of successful surgeries worldwide. Although the FDA-approved da Vinci system is the most sophisticated, other minimally invasive robotic surgical systems include Zeus and AESOP, both of which are also FDA-approved for surgery. These robotic systems enhance dexterity in several ways. Instruments with increased degrees of freedom greatly enhance the surgeon’s ability to manipulate instruments and thus the tissues. These systems are designed so that the surgeons’ tremor can be compensated on the end-effect or motion through appropriate hardware and software filters. In addition, these systems can scale movements so that large movements of the control grips can be transformed into micromotions inside the patient.6 Another important advantage is the restoration of proper hand-eye coordination and an ergonomic position. These robotic systems eliminate the fulcrum effect, making instrument manipulation more intuitive. With the surgeon sitting at a remote, ergonomically designed workstation, current systems also eliminate the need to twist and turn in awkward positions to move the instruments and visualize the monitor. By most accounts, the enhanced vision afforded by these systems is remarkable. The 3-dimensional view with depth perception is a marked improvement over the conventional laparoscopic camera views. Also to one’s advantage is the surgeon’s ability to directly control a stable visual field with increased magnification and maneuverability. All of this creates images with increased resolution that, combined with the increased degrees of freedom and enhanced dexterity, greatly enhances the surgeon’s ability to identify and dissect anatomic structures as well as to construct microanastomoses. Multiple Treatments The da Vinci system has been used for such diverse treatments as heart and lung surgeries, prostate, colon, uterus, cervix and kidney procedures, and various kinds of cancer care. The robotic system is ideal for treating these health issues over laparoscopic surgery because remote control movement is more efficient than a surgeon’s hands. The more conventional laparoscopic surgery has a miniature camera as its only enhancement. Advanced Technology Robotic surgery uses three high-tech components, the surgeon’s console, four remote robotic arms and a high-definition 3D camera. The surgeon sits a few feet away from the patient, controlling joysticks and foot pedals. The console gives the surgeon better control and neutralizes minute hand tremors. The range of motion and accuracy of these limbs is unprecedented, having the ability to twist, turn and rotate unlike any human doctor. Precision Instruments All the instruments are miniaturized and fit through operating ports, incisions in the body no larger than a dime. The four robotic arms include a tool for grasping, one for the dual purpose of cutting and coagulating, one for irrigating, and a camera. Magnified Imaging The high-definition camera is designed for stereo imaging, allowing depth perception unlike any standard laparoscopic camera. Images are magnified 10 times beyond what the human eye can see. The surgeon also has complete control over the image, without having to rely on an assistant. Less Invasive Because only four to six small incisions are used to insert the instruments, there is lower risk of infection, a shorter hospital stay, less blood loss during the procedure and less pain afterward. According to the University of Maryland Medical Center, the complication rate for those receiving robotic bypass surgery was lower, with 88 percent having none at all. The average length of stay is about four days compared to the usual seven. So even if the robot surgery increases each case by $8,000, those costs are still offset by reduced overall stay, less transfusions, and fewer post-operative complications that might lead to re-admittance, according to the center. Robotic surgery offers many advantages to patients. Most patients are able to go home the day after surgery, reducing the cost of hospitalization and the time away from one's own environment. Pain is usually minimal and can be managed with oral medications beginning on the first post-operative day. Patients are usually off of pain medicines within a week (and some patients only take one pill!). Many patients feel mostly back to normal within two weeks. Patients who can work from home can usually begin working from home a few hours a day after the first week; many patients are back to work in two weeks if their jobs don't require a lot of physical activity. Significantly less pain, less blood loss, and fewer transfusions Smaller incisions and improved appearance Reduced risk of wound infection Shorter hospital stay (one day in most cases) Quicker recovery and return to normal daily activities Better clinical outcomes and patient satisfaction The table below produced by da Vinci compares important clinical points from a study of hysterectomy for benign gynecologic conditions. As you can see, da Vinci hysterectomy shows measurable advantages as compared to both traditional open surgery performed through a large abdominal incision and conventional minimally invasive laparoscopic surgery (referred to as laparoscopy). The daVinci Robotic Surgical System is a supercomputer with mechanical control over tiny surgical instruments. The term robot is a misnomer: the daVinci Robot represents a master-slave relationship. The robot has no autonomous function. Every movement of the robot arms is controlled by the surgeon. The daVinci Robot has multiple features that enable roboticists to perform certain laparoscopic procedures with greater ease, better quality, and on the whole, fewer problems for the patient. The daVinci Surgical System is most beneficial in tight corners of the body, or if there is a challenging reconstructive aspect (eg. prostatectomy in both instances). The following details help to explain why the daVinci Surgical Robot is such a great tool. 3-D Vision Conventional laparoscopy is limited to two-dimensional vision. Targeting tissues properly requires making inferences about spatial relationships, and mini “trial” movements to confirm or refute these inferences. The daVinci Robotic telescope is actually composed of 2 lenses, slightly separated to give different perspectives of the same field. This creates a three-dimensional, or stereoscopic, image which mimics our natural experience. Visual Magnification The daVinci Surgical Robot is capable of magnifying images 10-15 times normal. This is more than what is seen with standard laparoscopy, and of course, much more than the naked eye. This allows the surgeon to be more selective about the dissection of critical structures by fractions of a millimeter. Image Brightness The daVinci Robot telescope is 12mm wide, whereas standard laparoscopes are only 10mm wide. This wider telescope provides for more light, again making it easier for the operating surgeon to see. Motion Scaling In standard laparoscopy, distance of the tissue structure from the port site on the abdomen causes amplification of motion at the instrument tip. A small motion outside the body causes a relatively large motion on the inside. This can frustrate attempts to target tissues. With the daVinci Surgical Robot, motions are filtered and de-amplified up to a scale of 5 to 1. In other words, the surgeon would have to move the manipulators up to 5 inches in order to cause movement of only an inch on the inside of the body. This eliminates natural hand tremor entirely, allows the surgeon to target tissues with much greater ease, and gives the surgeon a certain finesse that surpasses human capabilities in both the open and standard laparoscopic realms. Ergonomics In standard laparoscopy, the surgeon must stand, sometimes in rather awkward positions for several hours. This can be quite fatiguing. With the daVinci Surgical Robot, however, the surgeon is seated comfortably at a console. The hands are positioned in a natural forward position, and the forearms are given a rest to lean on. This configuration relieves much stress on the operating surgeon, and that often translates to a better quality surgery for the patient. Endowrist Technology Standard laparoscopy employs fixed instrument tips. The daVinci Surgical Robot, however, has instrument tips which rotate and angulated in multiple different directions. This allows for imitation of normal wrist and elbow motions. In fact, it’s better than normal human motion – it’s capable of spinning 2 full revolutions, whereas the human hand can only turn about 270 degrees. Gas Insufflations The abdomen is filled with carbon dioxide gas under pressure during robotic surgery. This is no different than what is done during standard laparoscopy. It provides a generous working space and prevents small vessels from bleeding. While it is not unique to robotics, it is one of the key features about laparoscopic surgeries which significantly reduce typical blood losses otherwise noted in open surgery. Summary The combination of these various elements makes it look and feel to the operating surgeon as if the surgeon were actually inside the person, moving about at will. Structures of interest are more easily seen, targeted or avoided. The daVinci Surgical Robot makes it easier to perform certain operations laparoscopically. For you, the patient, the generic benefits of laparoscopy include smaller incisions, less scarring, less blood loss, fewer infections, shorter hospital stays, and quicker return to normal activities. Robotic surgery versus normal laparoscopic surgery: The remotely controlled robotic system has several advantages over normal laparoscopic surgery: The instruments used allow much more movement, meaning the surgeons can do more detailed work; The camera takes two different images at the same time. This acts just like the human eyes, allowing depth perception and providing a high quality, three dimensional image; The image can be magnified up to 10 times, allowing very precise control; The machine can be set so that when the surgeon moves his hand, the machine only moves half that amount, allowing much finer control; Motion tremor is filtered out, allowing precise, tremor free movements; The surgeon can very easily control the movement of the camera.

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