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Robotic surgery, or robot-assisted surgery, is a type of surgery where doctors are able to perform complex procedures with more precision and control, through the use of small robotic devices. Usually, these surgeries are carried out with the use of the da Vinci TM surgical system, which consists of a set of technologies made of specialized “arms” for holding instruments, and cameras, as well as visualization screens and consoles [1] [2].
These robotic devices are usually applied in minimally invasive surgeries, which are procedures done with only small incisions, not exposing the human body. Thus, the surgeon makes these incisions in the body and inserts the robotic instruments and a high-definition three-dimensional camera. After that, by using the console, the surgeon is able to manipulate and control the instruments to perform the operation with a high degree of detail [2].
The Robotic system can be compared with a video game, where a console with buttons is used to control a given machine, mimicking the surgeon’s movements into precise movements inside the body[2] [3].
These surgeries were easily adopted by hospitals around Europe and the United States, with a wide application to the treatment of different conditions and diseases. Thus, robotic surgery is useful for a variety of surgeries, allowing more controlled methodologies and less recovery time to the patients. Furthermore, as mentioned, it enhances precision and flexibility during the operation, resulting in the possibility of developing more delicate and complex procedures. In addition, since these surgeries are minimally invasive, there are fewer complications or infections, less pain and blood loss, a faster recovery and small scars [1] [2].
However, there are some risks associated with these procedures, which usually are similar to the ones associated with the surgery to be performed and others that are common to all surgeries, such as possible risk of infections and other complications. Nonetheless, it is important to understand that robotic surgery may not be fit for everyone or every surgery, and also acknowledge the possibility of not being available at every medical center. Thus, this option must be further discussed with the medical team, so as to understand the benefits and risks and, subsequently, make the most correct decision.
Nevertheless, if this kind of surgery is suggested by the doctor, there’s no need to be concerned, since the surgeon is always in control and the Robotic Surgical System cannot make decisions or perform movements on its own. During the procedure, after doing the tiny incisions in the body and inserting the miniature robotic instruments, the surgeon does not stand over the body. Instead, he will be sitting in a nearby area with the console (a large screen and computer), directing the procedure from there. At the console, the site of operation is highly magnified, with a good resolution and the system only responds to the surgeon’s hand and finger movements. Having this said, these robotic surgeries can be considered safe and rather useful procedures [2].
Some of the most common conditions that can be treated using the Robotic-assisted surgery are the colorectal surgery, the general surgery, the heart, thoracic and urologic surgery, as well as the head and neck surgery, among others [1]. Nonetheless, not every doctor has the proper training to perform robotic surgeries, only specialized professionals are licensed to operate using the Robotic Surgical System .
In an investigation conducted by Rodolfo J. Oviedo et al. [4], the first 101 robot-assisted cases performed by a surgeon in a small community hospital were analysed, conveying the procedures completed from March 2014 to August 2015. These surgeries included laparoscopic cholecystectomies, inguinal hernia repairs; ventral incisional and umbilical hernial repairs; colorectal, bariatric, and miscellaneous procedures. From these, there were only 8 complications, all of them resolved with good outcomes, and no mortalities occurred, indicating that the robotic general surgery can be safely implemented and obtain positive outcomes.
Furthermore, in 2018, a full robotic radical gastric cancer surgery [5], with intracorporeal robot-sewn anastomosis, in a patient with the anatomical abnormality of situs inversus totalis, was successfully conducted, using the Da Vinci surgical robot.
In addition, in the same year, the robot-assisted procedures accounted for 15.1% of all the general surgeries, compared with the 1.8% reported in 2012. The robotic surgery climbed 8.8% in the first four years, after the hospitals introduced it, leading to an increase from 0.7% to 28.8% for inguinal hernia repair and from 0.5% to 22.4% for ventral hernia repair, among other procedures. These data show that robotic surgery for common surgical procedures is on the rise, however, it is also important to understand that not all surgeries can be done with these robotic equipments, such as in cases like breast and cervical cancer treatments [6].
Having this said, it can be concluded that robotic surgeries convey promising techniques, which allow for minimal invasive procedures to be applied, resulting in less painful and time-consuming recoveries. During the past years, there was a significant increase in its application, with successful outcomes [7], demonstrating the potential of robotic surgery procedures. It is possible that, in the future, an increased number of surgeries may be performed using this robotic system, which will progressively lead to a high level of technology used in the operations room on a daily basis.
Bibliography:
[1] “Robotic surgery – Mayo Clinic”, Mayoclinic.org, 2021. [Online]. Available: https://www.mayoclinic.org/tests-procedures/robotic-surgery/about/pac-20394974. [Accessed: 30- Jun- 2021].
[2] “About Robotic Surgery: What is Robotic Surgery? | UCLA Health”, Uclahealth.org, 2021. [Online]. Available: https://www.uclahealth.org/robotic-surgery/what-is-robotic-surgery. [Accessed: 30- Jun- 2021].
[3] “What Is Robotic Surgery”, Nyulangone.org, 2021. [Online]. Available: https://nyulangone.org/locations/robotic-surgery-center/what-is-robotic-surgery. [Accessed: 30- Jun- 2021].
[4] R. J. Oviedo, J. C. Robertson, and S. Alrajhi, “First 101 robotic general surgery cases in a community hospital,” J. Soc. Laparoendosc. Surg., vol. 20, no. 3, pp. 1–6, 2016, doi: 10.4293/JSLS.2016.00056.
[5] Dai, HB., Wang, ZC., Feng, XB. et al. Case report about a successful full robotic radical gastric cancer surgery with intracorporeal robot-sewn anastomosis in a patient with situs inversus totalis and a two-and-a-half-year follow-up study. World J Surg Onc 16, 41 (2018). https://doi.org/10.1186/s12957-018-1311-z
[6] S. Kelly, “Robotic surgeries surge to 15% of all procedures, despite limited evidence”, MedTech Dive, 2021. [Online]. Available: https://www.medtechdive.com/news/robotic-surgeries-surge-to-15-of-all-procedures-despite-limited-evidence/570370/. [Accessed: 30- Jun- 2021].
[7] “Case Studies: The Role of Minimally Invasive Robot-Assisted Surgery in Urology”, Consult QD, 2021. [Online]. Available: https://consultqd.clevelandclinic.org/case-studies-role-minimally-invasive-robot-assisted-surgery-urology/. [Accessed: 30- Jun- 2021].
