Nowadays, many facing surgery are asked if they are willing to undergo robotic surgery. For those unfamiliar, robotic surgery can sound very futuristic and a bit daunting. Robotic surgery or robot-assisted surgery enables surgeons to utilize computers and specialized robotic tools to perform several different types of surgeries. Understanding the advent of this modern day marvel and some of the benefits and limitations should help patients decide if robot-assisted surgery is a good choice for them.
According to Intuitive Surgical, the manufacturer of the da Vinci surgical systems that is one of the forefathers of the field, timing was everything. The general field of robotics began to burgeon in the early 1980s with the advent of the first master/slave manipulators. These items were chiefly used early on to perform industrial type work like disposal of materials. For instance, the Atomic Energy Commission used these manipulators to handle radioactive material.
Concurrently with these engineering achievements came the beginnings of laparoscopy in medicine. Laparoscopy is a surgical procedure in which a fiber-optic instrument is inserted through the abdominal wall to view the organs and permit a surgical procedure. Hence, the beginning of minimally invasive surgery was born and in many cases replaced the need for larger abdominal incisions. By 1987, French surgeon, Dr. Philippe Mouret had successfully removed a patient’s gallbladder.
The great enthusiasm for laparoscopy was warranted by the decreased healing time and reduced infection rates of its predecessor. However, laparoscopy had its limits in the types of surgeries in which it could be used. The 1990s brought some new innovations including tools to staple and close tissue. The fusion of robotic technology or tele-robotic and minimally invasive surgical techniques spurred the development of robotic surgical systems like da Vinci. Throughout the late 1990s and into the 1st half of the 21st century, robotic development companies and esteemed medical centers have collaborated to develop and improve the functionality of these robotic surgery systems.
Today, most major hospital centers offer robot-assisted surgery options to their patients across a wide variety of surgery types including cardiac, colorectal, general, and gynecologic surgeries, as well as head and neck, thoracic, and urologic procedures. All surgeons who perform robot-assisted surgery must undergo extensive training and are required to be credentialed by their hospitals to preform such surgeries. Since FDA cleared da Vinci in 2000 to be used in general laparoscopic surgery, over 3 million procedures have been performed, including removal of prostate, bladder, kidney, and uterine cancers, hysterectomies, colorectal repairs, and cardiac surgeries including mitral valve repair and pulmonary resections.
The basic difference between robot-assisted surgery and traditional laparoscopic surgery, both of which are considered minimally invasive, is the manipulation of the instruments used to perform the surgery. Unlike the endoscopic instruments used in a traditional surgery, robot-assisted instruments have several enhancements, including three-dimensional visualization and increased range of motion. With traditional laparoscopy, the surgeon performs the surgery by visualizing the surgical field on a monitor through the endoscopic camera and rotates instruments with four degrees of movement. The instruments actually move in the opposite direction of the surgeon’s hands because of the design.
Robotic surgery involves the surgeon manipulating the master controls with his or her hands and the wrist naturally relative to their body. In both cases the surgeon is at all times in control of the movements of the instrumentation. However in the case of the robotic-assisted surgery, 3 or 4 robotic arms carry out the surgeon’s commands in real time. The robot actually offers greater range of motion than the human wrist, and that is one of its greatest advances.
Many will argue that as technologically advanced as robotic surgery is now, we are really in the infancy of this technology. Robotic surgery may soon become the standard bearer of its generation, much like laparoscopy was of its era. Some detractors question the additional expense of robot-assisted surgery systems when compared to traditional laparoscopic surgeries, both of which offer fewer complications of infection, quicker recovery, less pain and blood loss, and minimal scarring. Patients definitely appreciate the opportunity to return to work faster and resume normal activity more quickly.
If you find you are in need of a surgery, don’t be surprised if the topic of robotic surgery is brought up. Robot-assisted surgery has boomed over the last decade, and it does not seem to be abating anytime soon. Ask your surgeon if robotic surgery might be right for you.
Dr. Hardy practices obstetrics and gynecology at Atlantic Ob/Gyn located in Va. Beach and Chesapeake. Please visit www.atlanticobgyn.com.