Robot Assisted Surgery

Robot-assisted surgery, represents a category of surgical techniques executed with the aid of robotic systems. Its development aimed to address the constraints of existing minimally invasive procedures and augment the capabilities of surgeons in traditional open surgery.

In the realm of robotically assisted minimally invasive surgery, the surgeon delegates tasks such as dissection, hemostasis, and resection through either direct telemanipulation or computer control, rather than directly maneuvering the instruments.

• At the core of this system lies the Surgeon’s Console, a setup of remotely operated manipulators enabling the surgeon to conduct procedures in real-time with stereoscopic vision from a separate control console.
• Adjacent to the patient, the Patient Cart, equipped with robotic arms, executes maneuvers akin to endoscopy via end-effectors inserted through specialized trocars. Despite automation, the presence of a surgical assistant and scrub nurse at the tableside remains crucial for instrument switching and additional support.
• The Vision Cart houses the computer-controlled system is responsible for image processing. Through this system, the surgeon directs the robotic arms and end-effectors, utilizing either direct control or telemanipulation. Notably, this computerized approach facilitates remote surgery, including the potential for AI-assisted or automated procedures, as the surgeon's physical presence on-site becomes unnecessary.

Memory devices play a vital role in ensuring seamless operations in robot-assisted surgery. These storage solutions serve various functions based on the patient's medical history, including calibrating offsets to detect misalignment within the storage drive system and managing data lifespan. Despite its advantages, robotic surgery faces criticism due to its associated costs.

Advantages and Disadvantages of Robot Assisted Surgery

Table 1: Comparison of Robot Assisted Surgery with Laparoscopic Surgery

Table 2: Comparison of Robot Assisted Surgery with Conventional Surgery

Due to limitation of technology and added costs, Robot Assisted Surgery have been adopted only by few specialities on a regular basis. However, there is a huge surge in the addition of indications in the last decade due to consistent technological advancements and more specialities are being added to the cart of procedures where Robot has been seen beneficial.

Ophthalmology remains a frontier in the realm of robotic-assisted surgeries, with a few robotic systems demonstrating proficiency in conducting procedures successfully. These systems are utilized in vitreoretinal surgeries, as well as for procedures such as pterygium repairs and ex-vivo corneal surgeries.

The utilization of robotic surgery in urology has become widespread. The inaugural robot-assisted laparoscopic radical prostatectomy took place in 2000. Some studies suggest potential benefits such as more thorough cancer removal and reduced post-operative side effects compared to traditional prostatectomy methods. Additionally, robotic surgery has found application in radical cystectomies, with a review from 2013 indicating fewer complications and superior short-term outcomes compared to open surgical techniques.

Robotic surgical systems are proving advantageous in paediatric procedures, particularly due to the smaller abdominal size which often restricts the viewing field in urology procedures. These systems aid surgeons in overcoming such limitations. Robotic technology facilitates various procedures including Pyeloplasty, Ureteral reimplantation, Ureteroureterostomy, as well as Nephrectomy and heminephrectomy.

The first instance of robotic surgery in gynaecology was documented in 1999 by the Cleveland Clinic. The integration of robotic surgery has played a role in the proliferation of minimally invasive procedures for gynaecologic conditions. Robotic surgery is applied in addressing a spectrum of gynaecologic issues including fibroids, irregular menstruation, endometriosis, ovarian tumours, uterine prolapse, and female cancers. Through robotic systems, gynaecologists are equipped to perform procedures such as hysterectomies, myomectomies, and pelvic lymph node dissection. Notably, there are robotic systems tailored to furnish a robotic platform for natural orifice transluminal endoscopic surgery (NOTES), facilitating myomectomy via the vaginal route.

Concerning robotic surgery, its optimal application lies in single-quadrant procedures at present, wherein operations are conducted in any of the abdominal quadrants. While cost disadvantages are associated with procedures like cholecystectomy and fundoplication, they present favourable opportunities for surgeons to enhance their proficiency in robotic surgery. With advancements in the boom platforms and independent patient arm based platforms, multi quadrant surgeries are more feasible with indications making general surgery the fastest growing speciality using robotic platforms.

Multiple types of procedures have been performed including Bariatric surgery and Oncosurgery. Surgeons at various universities initially published case series demonstrating different techniques and the feasibility of GI surgery using the robotic devices. Specific procedures have been more fully evaluated, specifically fundoplication for the treatment of gastroesophageal reflux[ and Heller myotomy for the treatment of achalasia. Robot-assisted pancreatectomies have been found to be associated with "lower estimated blood loss, a higher spleen-preservation rate, and shorter hospital stay[s]" than laparoscopic pancreatectomies;

The first fully robotic kidney transplantations were performed in the late 2000s. It may allow kidney transplantations in people who are obese who could not otherwise have the procedure. With recent advancements in the platforms, liver transplant is being performed increasingly in the last few years. For women with absolute uterine factor infertility, the robotic uterus transplant offers life-changing moment by providing a solution to infertility.

Over the past several decades, there have been great advances in the field of abdominal wall and hernia surgery especially when it comes to robotic-assisted surgery. Unlike laparoscopic surgery, the robotic platform allows for the correction of large hernia defects with specialized techniques that would traditionally only be performed via an open approach. The first robotic inguinal hernia repairs were done in conjunction with prostatectomies in 2007. The first ventral hernia repairs were performed robotically in 2009. Since then the field has rapidly expanded to include most types of reconstruction including anterior as well as posterior component separation. With newer extraperitoneal techniques, major reconstruction of large hernias can be done without added postoperative morbidity.

Robotic surgery has become more widespread in thoracic surgery for mediastinal pathologies, pulmonary pathologies and more recently complex esophageal surgery. The Robotic system is used for lung and mediastinal mass resection. This minimally invasive approach as a comparable alternative to video-assisted thoracoscopic surgery (VATS) and the standard open thoracic surgery.

The first successful robot-assisted cochlear implantation in a person took place in Switzerland in 2017. Surgical robots have been developed for use at various stages of cochlear implantation, including drilling through the mastoid bone, accessing the inner ear and inserting the electrode into the cochlea. The surgical robots also allow surgeons to reach the inner ear in a minimally invasive way. Challenges that still need to be addressed include safety, time, efficiency and cost.

The indications for robotic heart surgery generally revolve around mitral valve disease, although there are many other indications where it is presently considered — tricuspid valve replacement, small cardiac tumours, selected congenital heart defects, septal defects and other structural problems that fall into the congenital arena. In addition, aspects of coronary bypass surgery are done robotically on a more consistent basis, and selected arrhythmia procedures are also done robotically.

Robots have started being used in orthopedic surgery. ROBODOC is the first active robotic system that performs some of the surgical actions in a total hip arthroplasty (THA). It is programmed preoperatively using data from computer tomography (CT) scans. Acrobot and Rio are semi-active robotic systems that are used in THA. Mazor X is used in spinal surgeries to assist surgeons with placing pedicle screw instrumentation.

Robotic devices started to be used in minimally invasive spine surgery starting in the mid-2000s. There were too few randomized clinical trials to judge whether robotic spine surgery is more or less safe than other approaches. As of now, the application of robotics in spine surgery has mainly been limited to pedicle screw insertion for spinal fixation. In addition, the majority of studies on robot-assisted spine surgery have investigated lumbar or lumbosacral vertebrae only.

Haptic feedback, advanced instrumentation, multi quadrant surgeries and tissue differentiation are few of the technologies that are in the pipeline to enhance the Robotic experience and add more indications and specialities to the armamentarium.

Experts anticipate that the integration of AI and machine learning algorithms into robotic surgery will play a more prominent role in the future. These technologies can assist in real-time decision-making, improve surgical planning and enhance the precision of robotic procedures.

Microbots with faster, and more efficiency than traditional robots, will have a range of applications: surgery, of course, but also in assisting in drug delivery and targeted therapies to fight cancer.

Lack of access to basic healthcare providers, let alone complex surgical resources is one of growing challenge around the globe. Telepresence and remote surgery could enhance access to high-quality health care and improve overall health outcomes. It’s also useful to note that telepresence can be used for mentoring, as well, so that highly skilled surgeons can provide real-time guidance and technical assistance in surgical procedures. Scientists and engineers are working to make affordable high-speed networks, and cybersecurity to make this approach to healthcare delivery a reality.