Definition & Overview

Robotic surgery is an FDA-approved surgical technique that uses robotic technology. Also known as robot-assisted or computer-assisted surgery, this innovative technique allows surgeons to perform even the most complex surgeries in a minimally invasive manner and with increased control and precision.

Following its FDA approval in 2000, the technique has since been adopted by a large number of hospitals for the treatment of a wide range of medical problems. This has resulted in the technology’s rapid advancement and introduction of several different robotic surgical systems, with the da Vinci Surgical System currently being the most popular.

Who Should Undergo and Expected Results

Robot-assisted surgery is now widely used in the treatment of a long list of medical conditions, including:

  • Cardiothoracic problems, such as:
  • Heart disease
  • Coronary artery disease
  • Mitral valve repair or replacement
  • Cancer or tumour
  • Lung disease
  • Gallbladder disease
  • Kidney disease
  • Fibroids
  • Endometriosis
  • Uterine prolapse
  • Achalasia
  • Gastroesophageal reflux


More specifically, the following surgical procedures are now widely performed using the robotic method:

  • Hysterectomy
  • Kidney removal/transplant
  • Organ transplantation
  • Colon and rectal surgery, such as tumour removal and colon resection
  • Pancreatectomy
  • Oesophagectomy
  • Gastrointestinal surgery
  • Bariatric surgery
  • Orthopaedic surgery, such as joint replacement surgery
  • Gastrectomy
  • Oesophageal fundoplication
  • Heller myotomy
  • Myomectomy
  • Lymph node biopsy
  • Urology
  • Vascular surgery
  • Radical prostatectomy
  • Radical cystectomy
  • Anterior cruciate ligament (ACL) reconstruction
  • Pyloroplasty
  • Pyeoloplasty, a surgical procedure used to correct ureteropelvic junction obstruction


This surgical technique is also especially beneficial for patients who suffer from certain conditions that are difficult or impossible to resolve through traditional surgical methods.

Robotic surgery offers greater precision that leads to better results and a reduced risk of complications and errors. As such patients can expect faster recovery time and a significantly lower risk of pain, blood loss, and scarring post-surgery.

How is the Procedure Performed?

There is a large number of robotic surgical systems that are currently in use, with the da Vinci system being the most popular. It is made up of a camera arm, mechanical robotic arms, and an assortment of surgical instruments attached to both arms. The surgeon controls the robot’s arms using controls on a computer, with the robotic arm mimicking the movements of the surgeon’s. To guide the surgeon through the process, the computer produces a magnified 3D view of the surgical site.

In the field orthopaedics, robotic surgical systems that are currently in use include RIO, or the Robotic Arm Interactive Orthopedic System, which uses a combination of robotics, haptics, and navigation system to perform partial and total hip and knee replacements. Other systems used for this specific application include the ROBODOC, the Acrobot Sculptor, the Navio Surgical System, and the CASPAR robot.

Another popular type of robotic surgical system is the CyberKnife Robotic Radiosurgery System, which is mainly used for the treatment of tumours that form on any part of the body. The system works by transmitting high-energy beams from various directions straight into the tumour.

Regardless of what system is used, robotic surgery is performed under general anaesthesia, which means that the patient is asleep throughout the procedure and free from any pain. It involves making small incisions in selected body parts where tiny surgical instruments are inserted. Due to the minute size of the incisions, no sutures are typically required and the recovery period is significantly shortened.

After the procedure, patients are taken to a recovery room where they are closely monitored until the effects of the anaesthesia wear off. In some cases, they may be advised to stay in the hospital for a night or two, depending on their individual conditions. The hospital stay is generally shorter on average compared to the average length of hospitalisation that follows a traditional open surgery.

Possible Risks and Complications

Despite revolutionising the surgical field, robotic surgery is not exempt from risks, which are no different from the ones linked to traditional open surgery.

These include:

  • Infection
  • Allergic reaction to anaesthesia
  • Bleeding
  • Breathing difficulties


However, patients who undergo robotic surgery face a lower risk of suffering from complications when compared to traditional open surgery patients.

References:

  • Barbash GI., Glied SA. “New technology and health care costs – The case of robot-assisted surgery.” N Engl J Med 2010; 363:701-704. http://www.nejm.org/doi/full/10.1056/NEJMp1006602#t=article

  • Shukla PJ., Scherr DS., Milsom JW. “Robot-assisted surgery and health care costs.” N Engl J Med 2010; 363-2174-2176. http://www.nejm.org/doi/full/10.1056/NEJMc1010658#t=article

  • Lanfranco AR. “Robotic surgery.” National Center for Biotechnology. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1356187/

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