Robotic Surgery: The Future is Here

  •   Wed, Dec 27 2017
  •   By Dr Nischith D'Souza

December 27, 2017


The technological developments of the last decade have revolutionized healthcare. Minimally invasive surgery i.e. Laparoscopic (Keyhole) and Robotic surgery have redefined the standard of surgical care, by outdoing the traditional style of open surgery.

Laparoscopic surgery, from the 1990’s, became the standard of care for many procedures. This was conducted by making small incisions in the abdomen through which cylindrical ports called trocars were inserted. A lighted camera called laparoscope gives a complete view of the abdomen. The various instruments used in the surgery are specially customized scissors, graspers etc. Surgery performed in this manner makes it easier for the patient to recover faster, with early return to normal activity.

However, the essential disadvantages of laparoscopic surgery are the two-dimensional view, difficulty in movements, long learning curve, limitation of the clarity of depth, dependence on assistant held camera and when that is coupled with hand-eye coordination and operating fatigue, it can become quite tedious to operate, particularly for long surgeries.


The latest addition: Robot-assisted surgery

The latest addition to the open and laparoscopic surgery is robot-assisted surgery. The robot can help overcome the challenges faced by laparoscopic surgery.


Evolution of robots

The genesis of robots goes back to the 1980s when researchers at NASA collaborated with engineers of Stanford Research Institute to develop robots for surgery. The US Department of Defense later got interested in this technology, as they wanted a remote-operated surgical system wherein the wounded in the battle could be operated upon by surgeons away from the frontline. This was utilized during the Gulf war in 1990. This concept could not be further developed in the military, and was adapted by a private firm, Intuitive Surgical which led to the eventual development and marketing of the “da Vinci” Robotic Surgical System in April 1997. It received FDA approval in 2000 for minimally invasive surgeries.

Today the da Vinci robotic surgical system is being used in urology, oncology, gynecology, cardiothoracic surgery and general surgery.


About Robotic Surgery

During the procedure, while the surgeon operates the sophisticated robot from a computerized console placed at a distance, the bedside surgeon is responsible for direction and placement of the robot into the patient and assisting the primary surgeon.

The console translates the surgeon’s hand movements into corresponding micro-movements of instruments inside the patient’s body, which are placed through small incision ports on the patient’s body. The robot can accomplish in surgery what the human surgeon cannot, because of its ability to mimic the human hand within a small, contained space. This translates to better visualization, dexterity, control and precision than open and laparoscopic surgery.

3D HD Vision

The robotic system provides unparalleled 3D, high definition vision inside the patient’s body with depth perception and magnification for more precise tissue identification. This is especially useful for cancer surgery like nerve sparing radical prostatectomy for prostate cancer.


Endo Wrist Instrumentation, Motion Scaling and Intuitive Motion

The range of movements of the Endo Wrist instruments of the Robot is far greater than the human hand. This improves dexterity and reduces hand tremors of the surgeon. It also helps in natural (intuitive) movements similar to open surgery, unlike laparoscopic surgery.


Superior Ergonomics

It is the only surgical system that allows doctors to operate while seated away, and not standing beside the patient. It is more comfortable, and clinically advantageous than laparoscopy due to reduced surgeon fatigue, especially while conducting long surgeries.

The System's robotic arms hold the camera and instruments steady. This translates to less assistance needed and reduced fatigue for the surgeon and also less potential for trauma to the body and hence less pain for the patient.

Benefits to patients

The benefits to the patient are shorter hospital stay, less blood loss, less pain, fewer complications, including less risk of infection and faster return to normal activities.


Disadvantages

The da Vinci robotic system costs Rs. 8 to 15 crores with annual maintenance costs of more than 60 lakhs. It is estimated that robotic surgery increases the cost of surgery by Rs 50,000 to 1 lakh. The biggest roadblock to robotic surgery as of today is the cost of instrumentation, maintenance and expenses per procedure.

The present da Vinci system is manufactured worldwide by only a single company Intuitive Surgical Inc. Ongoing research is going on at Google and Johnson & Johnson to develop such a prototype surgical robot, which may compete and reduce costs eventually.

Robotic Procedures in Urology

KIDNEY:

Removal of kidney tumors (complete or partial nephrectomy/kidney preserving surgery for cancer)
Removal of large kidney stones (pyelolithotomy)
Repair of PUJ (kidney) obstruction in children and adults (pyeloplasty)

URETER:

Repair and reconstruction of ureter (re-implantation, ureterolysis, ureteroureterostomy)

BLADDER:

Removal of urinary bladder for cancer (radical cystectomy)
Repair of vesicovaginal fistula secondary to obstetric or gynecological conditions (VVF repair)

PROSTATE: 

Removal of prostate, usually as a primary treatment for early prostate cancer (radical prostatectomy)

ADRENAL:

Removal of adrenal gland for tumours (adrenalectomy)

FEMALE UROLOGY:

Surgery for vault prolapse (colposuspension)

The Future

The future of surgery is data driven and artificially intelligent robots. Can it replace the surgeon? No, as of now, as it is a slave robot, completely under the control of the surgeon. But that day may not be far away.


Conclusion

Robotic assisted surgery is the most modern, technologically superior and safe surgical procedure performed by highly trained and experienced surgeons. This system enhances the capabilities of surgeons to perform major surgeries by offering greater surgical precision, range of motion, visualization and access. This also leads to several advantages for patients such as small incision, less pain, faster recovery, shorter hospital stay and early recovery to normal activity.

The future of surgery is Robotic Surgery. The future of surgery is here!


About the Author


(The writer is a senior Urologist and Robotic Surgeon with special expertise in Robotic Surgery of Kidney, Urinary Bladder and Prostate Cancer, at Yenepoya University, the only Institution which offers Robotic Surgery in this part of the world. For further details, contact on nish25@gmail.com or 9945087949.)

Dr Nischith D'Souza can be contacted at:
Mangalore Kidney Care
Falnir Clinic
Mangaluru
Ph: 0824 - 2422166/2422167
Email: nish25@gmail.com
Website: http://www.mangalorekidneycare.com
By Dr Nischith D'Souza
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Comment on this article

  • Raman Nambiar, MANIPAL

    Tue, Jan 09 2018

    Since India is facing a shortage of Doctors this invention will replace the DOctors. So robots are welcome to operate. Moreover Robots, unlike human beings, are unlikely to make mistakes. So, in my opinion, this is a welcome change. In an era where Doctors get beaten often for mistakes the public also cant misbehave this RObots That's one more advantage I feel

  • Avinash Saldanha, Belman/Dubai

    Sat, Jan 06 2018

    Very informative article indeed Dr Nishchith. Explained in minute details on the future of the medical field. Pls continue writing on related topics to enlighten us on the latest developments in medical field.

  • Joe Britto, Nakre/Mangalore

    Thu, Jan 04 2018

    Nice informative article.Thanks Dr Nischith D'Souza.

    Could you confirm if this can be done successfully for hysterectomy .
    If so which are the Hospitals in Bangalore/Mangalore where their are experienced doctors with high success operation rate.


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