The prevalence of robotic surgery in the medical field has been increasing with numerous benefits offered to physicians and patients.
According to UCLA Health, robotic surgery (or robotic-assisted surgery) is a surgical method that relies on minimally invasive techniques to perform complex surgical procedures.
Compared to traditional open surgery, robotic surgery is less invasive. Instead of requiring a centralized incision down the abdomen, robotic surgery only needs a few small incisions where surgeons can insert miniature tools and a hi-definition camera to navigate and visualize the surgical site while inside the body.
This is primarily accomplished using the da Vinci™ surgical system, which translates a surgeon’s hand movements on the control system precisely onto a set of highly maneuverable robotic appendages. The extreme dexterity and precision of appendages coupled with the visibility granted by the camera allows surgeons to operate quickly and efficiently with just a few small incisions.
Because of its ability to provide the same level of precision as open surgery, an increased number of physicians and patients have been attracted to the benefits of robotic surgery.
“Visualization definitely [has been] improved with the capability to go into deeper and more restricted spaces,” Dr. A. Daniel Guerron, a General and Bariatric Surgeon and Assistant Professor of Surgery at Duke University, said. “You have full control over the operation and dissection, and you get a clearer view. You also have better access over retraction, triangulation and presentation of the tissues …You have more access and more ranges of freedom.”
Not only does robotic surgery introduce benefits in visualization and navigation of the surgical site, it is also less physically demanding. When compared to open or laparoscopic surgeries, robotic surgery places much less of a burden on the body. A comprehensive literature review on the ergonomic benefits of robotic surgery found that surgeons experienced less discomfort during operations despite the longer durations of surgeries. In contrast to 20.9% of surgeons reporting wrist pain in laparoscopic surgery, none of the surgeons who used robotic means complained about having wrist pain.
This is a large benefit for surgeons who operate frequently, Guerron added.
“I think ergonomics are always going to be an issue with any technique that requires repetitive movement … But it does improve at the end of the day. I can do three to four bariatric cases on the robot and I’m still O.K., while doing laparoscopic surgery you really feel it at the end of the day as you’ve been working with your shoulders,” Guerron said.
The benefits of robotic surgery are also reflected in patient testimonials. According to MedStar Health, a non-profit healthcare network based in Columbia, MD, the minimally invasive nature of robotic surgery leads to faster healing times and earlier hospital discharges as compared to a manual open surgery. Patients also experienced significantly reduced pain, less scarring and faster recoveries as a result.
A study published in the 2018 edition of the Journal of Robotic Surgery that studied patient satisfaction in the Gynecology Oncology department at Sheffield Teaching Hospitals found strong patient support for robotic surgical procedures. 99% of surveyed patients who had undergone robotic surgery were pleased with care received overall compared to the 88% national percentage for traditional surgery. Furthermore, 91% of patients stated “yes, definitely” when asked if they would recommend robotic surgery.
Another study found a difference between traditional and robotic surgical methods in knee surgery. After comparing total knee arthroplasty procedures between manual and robotic surgical methods with the exact same conditions (i.e. operating technique, post-operative care treatments), 94% of surveyed patients who had the robotic surgical treatment expressed satisfaction versus the 82% who had the manual surgical treatment. It was also observed during the study that the measurement and calibration of robotic methods allowed surgeons to operate more precisely, making more precise bone cuts and creating fewer soft tissue injuries than manual methods.
However, robotic surgery is not completely without its risks. A literature review on the complications of robotic surgery published in the Surgical Clinics of North America medical journal, described the training, setup and possible malfunctions of robotic surgical procedures that may occur. Due to robotic surgery still being a novel technology in the medical field, longer setup times are often required to prepare the robot for surgery. Specially trained teams also need to be present to operate the robot, which prolongs preparations. A higher maintenance cost is also associated with the supplies and maintenance compared to manual surgery.
“Manual procedures are much more dynamic because you can change [an instrument] at will as many times as you want. You don’t have to stop the operation to remove an arm, then get what you need, put it back in, lock it, and then there are all these motors that need to be coordinated by the computers. It takes time for the sensors to feel which instrument you have,” Guerron said.
Patient positioning during robotic procedures and mechanical malfunction is also an issue in some cases, as described by the Advanced Urology Institute (AUI). Although a rare occurrence, components of the robot such as the instruments and appendages can still fail during a procedure. Additionally, improper patient positioning could lead to unintentional collision and compression injuries during the procedure. However, most foreseeable injuries in the operating room are caused by knowledge gaps due to how new the technology still is.
“What I’ve seen is higher instances of failure with controlling the room, problems with team dynamics, people not knowing how to move or dress the robot,” Guerron said. “Another thing that we see is lack of access, or lack of uniformity of training and that’s a challenge. Most of our preceptors have been doing [robotic surgery] for only maybe five years.”
Robotic surgery has been making its lasting mark on the medical field and has established a solid foundation for further technological development.
“Nowadays I am a firm believer that this is the future. I think there are certain procedures that will enhance your chances of excellent outcomes. I think it’s a very good opportunity to learn,” Guerron said.