Robotic Robotic Surgery Surgery

Medical science has advanced much beyond what we expected. Technology adoption in health care, generally motivated by the potential to improve health outcomes, has also been identified as a significant driver of health care expenditure for most developed countries Robotic Surgery is one such breakthrough in the field of procedural medicine.

In the case of robotically assisted minimally-invasive Surgery, instead of directly moving the instruments, the surgeon uses one of two methods to administer the instruments These include using a direct telemanipulator or through computer control A telemanipulator is a remote manipulator that allows the surgeon to perform the normal movements associated with the Surgery. The robotic arms carry out those movements using end- effectors and manipulators to perform the actual Surgery. In computer-controlled systems, the surgeon uses a computer to control the robotic arms and their end-effectors, though these systems can also still use telemanipulators for their input.

A surgical robot is a computercontrolled device programmed to aid the positioning and manipulation of surgical instruments Surgical robotics is typically used in laparoscopy rather than open surgical approaches. Since the 1980s, surgical robots have been developed to address the limitations of laparoscopy, including two-dimensional visualization, incomplete articulation of instruments, and ergonomic constraints.

Surgical robotics was first used in 1985 in neurosurgery; applications soon followed in urology and orthopaedics. First robot-assisted Surgery was done in 1985 The PUMA 560 was used to orient a needle for a brain biopsy under computerized tomography guidance Robot-assisted Surgery was extended to urology in 1988, orthopaedics in 1992, and gynaecology in 1999. Finally, a Robot-assisted laparoscopic camera holder was introduced in 1994. Since then Robotic Surgery has been extended to involve almost every Surgery of any body organ.

Available robotic surgery systems include:

1. The robotic camera holder (AESOP)

2.An immersive telerobotic surgical system (e.g., da Vinci)

3.Open remote-control stations (e.g., Senhance or Versius).

The Versius system is available in the United Kingdom and is undergoing FDA trials in the United States

The major advantages of Robotic Surgery over conventional Surgery are:-

Superior visualization –A robotic system affords a 3D vision while allowing rapid zooming and panning of the camera. The newer systems have enhanced visualization with automatic white balancing, calibration, and focus

Mechanical improvements – A fulcrum effect is created when rigid conventional instruments pass through the incision. When an instrument is introduced into a trocar, the abdominal wall is the fulcrum. When a surgeon ' s hand moves in one direction, the instrument moves in the opposite direction If a patient is obese, more torque is placed on an instrument, and the rigid smaller calibre instruments, such as laparoscopes, may fracture. Robotic instruments are less likely to break; This is because all robotic instruments are 8 mm wide and attached to the robotic arms, which in turn are attached to the robotic cannulas (trocars)

Stabilization of instruments within the surgical field – In conventional laparoscopy, small movements by the surgeon are amplified (including errors or hand tremors). Robotassisted Surgery minimizes surgeon tremors.

Improved ergonomics for the operating surgeon – Having the surgeon be seated while using telerobotic systems provides significant ergonomic benefits, particularly when compared with open abdominal Surgery.

Limitations of robotic surgery — The limitations of robotic technology include:

Additional surgical training.

Increased costs and operating room time.

Bulkiness of the devices.

Instrumentation cost and limited uses for instrumentation

Lack of haptics (tactile feedback)

Risk of mechanical failure

Training and credentialing standards have not yet been established for robotic surgeons Robotic training programs have become part of many surgical residency and fellowship programs, but such training is not standardized.

Surgeons should set up three robotic cases after scheduled training in an animal laboratory at various robotictraining centres so they can immediately implement the training and reinforce what they learned in the animal or cadaver laboratory Trainees must also pass five online training modules to obtain a certificate that documents their training experience.

In nutshell, Major obstacles to the clinical use of robots are cost, training of physicians and nursing teams, and lack of outcome data. But There is no doubt that robotic technology is fulfilling its promise to allow both generalists and subspecialists to gain competence in complex laparoscopic procedures.

Article by — Sugandh Goyal MBBS Batch:- 2020 AIIMS, Rishikesh