ROBOTIC SURGERY/ DA VINCI SURGERY
(Minimally invasive surgery)
DEFINITION OF ROBOTIC SURGERY
Robotic surgery is a method to perform surgery using very small tools attached to a robotic arm. The surgeon controls the robotic arm with a computer.
Robotic surgery is also called Minimally Invasive Surgery, which is very important aspect in any surgery.
Robotic surgery, or robot-assisted surgery, allows doctors to perform many types of complex procedures with more precision, flexibility and control than is possible with conventional techniques. Robotic surgery is usually associated with minimally invasive surgery — procedures performed through tiny incisions. It is also sometimes used in certain traditional open surgical procedures.
INTRODUCTION OF ROBOTIC SURGERY
Robotic surgery with the da Vinci Surgical System was approved by the Food and Drug Administration in 2000. The technique has been rapidly adopted by hospitals in the United States and Europe for use in the treatment of a wide range of conditions.
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, 3-D view of the surgical site. The surgeon leads other team members who assist during the operation.
With already over 210 devices in use throughout the United States, Europe, and Japan, Intuitive Surgical is the leading company in the field of digital surgery with its da Vinci? Surgical System. Approved in July 2000 to perform advanced surgical techniques such as cutting and suturing, this system is the first operative surgical robotic system to be cleared by the FDA, giving it a first-mover advantage over its competitors. Though Intuitive Surgical has had to overcome many obstacles in order to dominate the digital surgery field, it is now a multimillion-dollar business that continues to grow.
HISTORY OF ROBOTIC SURGERY
- In 1985 a robot, The PUMA 560, was used to place a needle for a brain biopsy using CT guidance. Three years later the same machine was used to perform a transurethral resection.
- In 1987 robotics was used in the first Laparoscopic surgery, a cholescystecotomy.
- In 1988, The PROBOT, developed at Imperial College London, was used to perform prostatic surgery.
- The ROBODOC from Integrated Surgical Systems was introduced in 1992 to mill out precise fittings in the femur for hip replacement.
- Further development of robotic systems was carried out by Computer Motion with the AESOP and ZEUS Robotic Surgical Systems and Intuitive Surgical with the introduction of The da Vinci Surgical System.
In 2000, the da Vinci Surgery System broke new ground by becoming the first robotic surgery system approved by the FDA for general laparoscopic surgery. This was the first time the FDA approved an all-encompassing system of surgical instruments and camera/scopic utensils. Its predecessors relied upon the use of endoscopes and numerous surgical assistants to perform surgery. The da Vinci robotic surgery system’s three dimensional magnification screen allows the surgeon to view the operative area with the clarity of high resolution. The one centimeter diameter surgical arms represent a significant advancement in robotic surgery from the early, large-armed systems such as the PUMA 560. With such miniaturized operating arms, the da Vinci robotic surgery system removes the need to leverage the sides of the incision walls. This advancement allows for less contact between exposed interior tissue and the surgical device, greatly reducing the risk of infection. The “Endo-wrist” features of the operating arms precisely replicate the skilled movements of the surgeon at the controls, improving accuracy in small operating spaces.
The da Vinci system has been approved by the FDA for use in both adult and pediatric robotic surgery procedures in the following areas:
General laparoscopic surgeries
General non-cardiovascular thoracosopic surgeries
Thoracoscopically-assisted cardiotomy procedures
PROCEDURE OF ROBOTIC SURGERY
Robotic surgery is similar to laparoscopic surgery. It can be performed through smaller cuts than open surgery. The small, precise movements that are possible with this type of surgery give it some advantages over standard endoscopic techniques.
The surgeon can make small, precise movements using this method. This can allow the surgeon to do a procedure through a small cut that once could be done only with open surgery.
Once the robotic arm is placed in the abdomen, it is easier for the surgeon to use the surgical tools than with laparoscopic surgery through an endoscope.
The surgeon can also see the area where the surgery is performed more easily. This method lets the surgeon move in a more comfortable way, as well.
Robotic surgery can take longer to perform. This is due to the amount of time needed to set up the robot. Also, many hospitals may not have access to this method.
Robotic surgery may be used for a number of different procedures, including:
- Coronary artery bypass
- Cutting away cancer tissue from sensitive parts of the body such as blood vessels, nerves, or important body organs
- Gallbladder removal
- Hip replacement
- Kidney removal
- Kidney transplant
- Mitral valve repair
- Pyeloplasty (surgery to correct ureteropelvic junction obstruction)
- Radical prostatectomy
- Tubal ligation
COMPLEX SURGERIES & ROBOTIC SURGERIES LIMITATIONS
Robotic surgery cannot be used for some complex procedures.
RISKS OF ROBOTIC SURGERIES
The risks for any anesthesia are:
- Reactions to medications
- Problems breathing
The risks for any surgery are:
Robotic surgery has as many risks as open and laparoscopic surgery. However, the risks are different.
RECOVERY FROM ROBOTIC SURGERIES
Surgical cuts are smaller than with traditional open surgery. Benefits include:
- Faster recovery
- Less pain and bleeding
- Less risk of infection
- Shorter hospital stay
- Smaller scars
CONSIDERATIONS ABOUT ROBOTIC SURGERIES:
Along with improved patient care, another aim of making medical robotics mainstream is to cut down on medical costs. However, this is not always the case. Some robotic surgery systems cost more than $1 million to purchase and $100,000 a year or more to maintain.
This means that hospitals must evaluate the cost of the machine vs. the cost of traditional care. If robotic surgery cuts down on the trauma and healing time, there is money saved in terms of the number of days the patient stays in the hospital.
There is also a reduction in the amount of personnel needed in the operating room during surgery.
In contrast, extensive training time is required for physicians to learn to program and operate the machines. Another concern is that there are very few manufacturers of medical robotics. With very little competition, the few manufacturers that exist can set their own prices.
WARNING FOR ROBOTIC SURGERY:
Medical robotics is still a very new idea, and there is much more work to be done. It is still very expensive, which can make it prohibitive for many hospitals and health-care centers.
There are also still issues with latency. This refers to the time lapse between the moments when the physician moves the controls and when the robot responds. Also, there is still a chance for human error if the physician incorrectly programs the robot prior to surgery. Computer programs cannot change course during surgery, whereas a human surgeon can make needed adjustments.
As surgeons become more familiar with using robots for surgery, and as more companies provide medical robots, there will come a day when robots are used in almost every hospital. However, this is still far off in the future.
THE FUTURE OF ROBOTIC SURGERY
The future of robotic surgery is nearly as promising as the human will to invent better ways of accomplishing delicate medical procedures. It is reasonable to assume that the current advantages of robotic surgery systems will be expanded upon in the next generation of medical robotics. Removing human contact during surgery may be taken to the next level with robotic surgery systems capable of functioning at greater distances between surgeons control console and the patient side table robotics. This would allow robotic surgery to be conducted with patients in a nearby “clean room,” reducing or eliminating intraoperative infection. It is possible for next generation medical robotics and robotic surgery to conduct surgical prep work remotely as well.
Advancements in making robotic surgery systems more capable of replicating the tactile feel and sensation a surgeon experiences during more invasive traditional procedures would give the surgeon the best of both worlds. The surgeon would gain the precision and advantages of minimally invasive procedures without losing the sensory information helpful in making judgment calls during robotic surgery.
CAN YOU GO FOR ROBOTIC SURGERY?
Robotic surgery isn’t an option for everyone. Talk with your doctor about the benefits and risks of robotic surgery and how it compares with other techniques, such as other types of minimally invasive surgery and conventional open surgery.
Across the United States, the extent to which robotic surgery is used varies widely. Its use depends on a variety of factors. These may include physician training, equipment availability and cultural factors, such as what people are most comfortable doing and what other surgeons in the area do. One study of U.S. hospitals showed that some institutions have a culture that prefers traditional open surgery, while others prefer minimally invasive surgery.