Robotic Surgery: What is it, and Why is it here to stay?

By Winifred Agbu

When your doctor says you're going to need surgery, you may become concerned and full of fear, imagine your reaction when you realize the surgery will be carried out by a robot? The good news is that robotics, also known as robot- assisted surgery, is minimally invasive and allows doctors to carry out many types of surgical procedures with more control than the traditional way.  

The use of robotic assistance in surgery has expanded exponentially since it was first approved in 2000. It is estimated that, worldwide, more than 570,000 procedures were performed with the da Vinci robotic surgical system in 2014, with this figure growing almost 10% each year.

Robotic-assisted surgery (RAS) has found its way into almost every surgical subspecialty and now has approved uses in urology, gynecology, cardiothoracic surgery, general surgery, and nanotechnology. RAS is most commonly used in urology and gynaecology; more than 75% of robotic procedures performed are within these two specialties. Robotic surgical systems have the potential to improve surgical technique and outcomes, but they also create a unique set of risks and patient safety concerns.(Psnet, 2016) 

Technologies, such as Haptics, telemonitoring , VR (virtual reality), Artificial intelligence can merge with surgical robots to improve simulation of all the operations that can be done by the robot. In order for the robot to perform a surgery, specialized training is required. 

The most widely used clinical robotic surgical system includes a camera arm and mechanical arms with surgical instruments attached to them. The surgeon controls the arms while seated at a computer console near the operating table. The console gives the surgeon a high-definition, magnified, 3D view of the surgical site. The surgeon leads other team members who assist during the operation.(Mayo clinic, Robotic surgery 2022) 

Robotic surgery has its advantages and disadvantages, it is very important to consult a medical professional before undergoing this surgery, the medical professional will then discuss the advantages and disadvantages of the surgery with the patient and how it compares  to other types of surgery like minimally invasive surgery and traditional surgery. 

Robotic surgery offers advantages over conventional endoscopic surgery in visualization, dexterity and ergonomics, while maintaining the preoperative benefits of minimally invasive surgery.The dual camera system offers 3D views with depth perception, unlike conventional endoscopic views. Precision features include articulated ‘EndoWrist’ instruments with increased degrees of freedom, removal of the fulcrum effect and motion scaling with tremor filtration Accordingly, objective advantages over laparoscopic techniques in terms of dexterity and muscle fatigue have been demonstrated(Goh & Ali, 2022) 

Many people wonder if robotic surgery is safe , it is very common for patients to be worried when their doctors suggest robotic surgery to them. Robotic surgery isn't just safe, it also has other benefits that the conventional surgical method does not have, these benefits include smaller incisions during and after surgery, faster recovery time, and less pain after surgery because the procedure is minimally invasive . What most patients do not know is that robotic surgery Robotic surgery is feasible for numerous general surgical procedures, pending cost and operative time considerations, which will improve with technological advances. It has been used for rectal cancer resection, with the 2017 ROLARR trial finding comparable open conversion rates with laparoscopic techniques , and Lee et al.’s large cohort study finding comparable resection quality with trans anal techniques (Goh & Ali, 2022) 

The advantages of robotic surgery outweigh the disadvantages, in a case where there are complications after a robotic surgery wound infections, ureteral injuries, hematomas are usually lower than that of conventional surgeries. Studies have shown that there is still room for improvement in the area of robotic surgery especially in the areas of staff training and patient education. 

Robotic surgery is an emerging modality across numerous surgical specialties. It offers advantages over conventional endoscopic surgery in visualization, dexterity and ergonomics, while maintaining the benefits of minimally invasive surgery. Feasibility, efficacy and cost concerns may be ameliorated with technological advances and increased uptake. Robust longitudinal comparisons with established treatment modalities are imperative to support this evolution in practice.(Goh & Ali, 2022) 

Compared to open surgery (traditional surgery with incisions), robotic and minimally invasive surgery results in smaller incisions resulting in less pain and scarring. Robotic surgery allows surgeons to perform complex surgical tasks through tiny incisions using robotic technology. Surgical robots are self-powered, computer-controlled devices that can be programmed to aid in the positioning and manipulation of surgical instruments. This provides surgeons with better accuracy, flexibility and control.(UC health,  2023) 

Technological advancement have made robot assisted surgery possible for so many surgical procedures, these include joint replacements, hysterectomy,prostatectomies, etc. it is believed that robotics will become an essential part of surgery in the near future, replacing open surgical procedures in many settings, nevertheless the transformation should be monitored. With the combination of artificial intelligence and robotic surgery , some tasks will no longer be necessary and new routines will be added. Although people fear that robotic surgery will take the place of a doctor, Although the chances of this happening are almost impossible. 

 Although still in its infancy, robotic surgery has already proven itself to be of great value, particularly in areas inaccessible to conventional laparoscopic procedures. It remains to be seen, however, if robotic systems will replace conventional laparoscopic instruments in less technically demanding procedures. In any case, robotic technology is set to revolutionise surgery by improving and expanding laparoscopic procedures, advancing surgical technology, and bringing surgery into the digital age. Furthermore, it has the potential to expand surgical treatment modalities beyond the limits of human ability. Whether or not the benefit of its usage overcomes the cost to implement it remains to be seen and much remains to be worked out.

Although feasibility has largely been shown, more prospective randomized trials evaluating efficacy and safety must be undertaken. Further research must evaluate cost effectiveness or a true benefit over conventional therapy for robotic surgery to take full root. (Lanfranco et al., 2004) 

While robotic surgery might not yet be recognized in every part of the world as it is still in its infancy, it is a development that will change the healthcare industry and the world.This technology allows doctors to perform delicate surgeries while improving precision . robotic surgery is safe and not as invasive as conventional surgery, there have also been many cases of favorable outcomes from robotic surgery. Robotic surgery also stands out to patients who have no direct access to a surgeon although it is really expensive and not as affordable as the conventional surgery. 

 

By Winifred Agbu

Keywords: Robotic, Robotic-assisted surgery, surgery, technology, Haptics, doctors, patients, conventional surgery.

REFERENCES 

Benefits of robotic surgery (2023) UC Health. Available at: https://www.uchealth.com/services/robotic-surgery/patient-information/benefits/ (Accessed: March 2, 2023).  

Goh, E.Z. and Ali, T. (2022) “Robotic surgery: An evolution in practice,” Journal of Surgical Protocols and Research Methodologies, 2022(1). Available at: https://doi.org/10.1093/jsprm/snac003.  

Lanfranco, A.R. et al. (2004) Robotic surgery: A current perspective, Annals of surgery. U.S. National Library of Medicine. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1356187/ (Accessed: March 6, 2023).  

Robotic surgery (2022) Mayo Clinic. Mayo Foundation for Medical Education and  Research. Available at: https://www.mayoclinic.org/tests-procedures/robotic-surgery/about/pac-20394974 (Accessed: March 1, 2023). 

Robotic surgery: Risks vs. rewards (no date) Patient Safety Network. Available at: https://psnet.ahrq.gov/web-mm/robotic-surgery-risks-vs-rewards (Accessed: March 1, 2023).  

What is robotic surgery? (2023) UCLA Health System. Available at: https://www.uclahealth.org/medical-services/robotic-surgery/what-robotic-surgery (Accessed: March 1, 2023).