Robotic surgery is the use of robots in performing surgery. It started in 1985 when used for placing a needle for a brain biopsy using CT guidance and now it is being used for a variety of delicate procedures like Total Endoscopic CABG, Valve repairs/replacements, Pancreatectomy, Prostatectomy, Whipples surgery, Cholecystectomy, Pediatric surgery and Hip and Knee replacement surgery.
The system comprises of three components: A surgeon’s console, a patient-side robotic cart with 4 arms, and a high-definition 3-D vision system. Articulating surgical instruments capable of cutting, dissecting, suturing are mounted on the robotic arms which are introduced into the body through cannulas.
In using “da Vinci” (the most advanced robotic system) for surgery, a human surgeon makes three or four incisions—no larger than the diameter of a pencil—in the patient’s body, which allows the surgeons to insert three or four stainless-steel rods.
Image Source: penrosestfrancis.org
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Unlike in conventional surgery, the doctor does not touch these surgical instruments directly. Sitting at the control console a few feet from the operating table, the surgeon looks into a viewfinder to examine the 3-D images being sent by the camera inside the patient.
The images show the surgical site and the two or three surgical instruments mounted on the tips of the surgical rods.
The surgeon uses joystick-like controls located underneath the screen to manipulate the surgical instruments in sync with the maneuvering of the joysticks by the surgeon’s hands.
1. Advantages of Robotic Surgery:
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Major advantages of robotic surgery are precision, miniaturization, smaller incisions, decreased blood loss, articulation beyond normal manipulation, high definition, 3-D images, less fatigue of surgeons during long surgeries.
Saving of manpower and benefits of robotic tele surgery on the front lines of combat zones to the patients too, robotic surgery offers certain benefits such as reduced pain and trauma, less blood loss, less postoperative pain, less risk of infection, shorter hospital stay, faster recovery and less scarring.
Robotic surgery is being done in India also. However, because of the prohibitive cost, it is limited only to some select centers by surgeons trained at centers abroad.
2. Patient’s Safety Aspects in Robotic Surgery:
i. Requirement of informed consent of the patient not just for the surgical procedure but for performance of the procedure by the robotic surgeon.
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ii. Adequate training of not just the surgeon but also the rest of the team in robotic surgery.
iii. Need to assess the competence of human surgeons for robotic surgery before allowing them to perform robotic surgery.
iv. There’s no room for error. These robots can’t make adjustments in real time if something goes wrong. Surgeons must watch over the robot’s actions and be ready to intervene if something doesn’t go as planned.
v. A major obstacle in robotic/telesurgery has been latency—the time delay between the doctor moving his or her hands and the robotic arms responding to those movements.
If the surgeon is at a different geographical location, the latency can be hazardous. The doctor must be in the room with the patient for robotic systems to react instantly to the doctor’s hand movements.
vi. Potential contraindications to robotic surgery such as history of a bleeding disorder, prior surgery in the target area (which may leave internal scar tissue), obesity, pregnancy and significant heart or lung problems must be ruled out to prevent any operative hazards.
vii. Since the surgery is performed through online communication to the robot, confidentiality and security of information needs to be protected from hacking/ corruption.
viii. Legal responsibility for any mechanical/electrical malfunctioning of equipment and damages to patient, if any, must be fixed.
ix. Ethical guidelines will have to be put in place to regulate the robotic surgery and protect the interests of the patients who may be exploited for commercial reasons.
x. There should be a program of planned preventive maintenance of equipment to ensure high quality flawless performance.
xi. Being high precision equipment, periodic recalibration by the supplier would be of utmost importance.
Robotic surgery is the most modern modality in the field of surgery. Highly advanced as it is, the facilities and knowhow are available only at a few limited places in India. The high cost of robotic surgery and the issues discussed above are important practical considerations.
Unless performed at highly specialized centers and for ultra delicate procedures outside the competence of human surgeons, surgery by robots may not inspire much confidence among the patients as of now.