Mohan is a family physician and a Postgraduate Associate Dean working in the UK. He has a keen interest in self-regulated learning.
The words 'Robotic Surgery' may at once inspire a sense of awe or strike fear in the heart of a patient. You may, depending on your view of technology, be amazed at the advancement in technical wizardry and start to think about the advantages. Or you may equally be petrified with fear - Put my body at the mercy of a robot? What if things go wrong? Why do they want a machine to operate on me? Have they run out of surgeons?
Firstly lets deal with the major miconception- as it stands now, Robotic surgery is actually 'Robot Assisted Surgery'. It does not eliminate the human surgeons but merely assists them.
The Training, intuition, the skills, the instincts, the vast knowledge and experience of the surgeon is not lost in this method but merely enhanced.
I hope to introduce you to the concept, the technology, its benefits and some potential disadvantages in the course of this hub. So welcome to the world of Robot Assisted Surgery.
'Firstly let us deal with the major misconception- as it stands now Robotic surgery is actually 'Robot Assisted Surgery' and does not eliminate the human surgeons. The surgery is still performed by human surgeons.'
The Natural Evolution of Surgery
Using instruments to enhance surgical precision and skill is not new. Over years Surgeons has developed and honed instruments to aid examination, obtain measurements and perform surgical procedures. Several archaeological digs have unearthed fascinating finds in surgical instruments from ancient Egyptian, Indian, Greek and Roman cultures.
These instruments were and are developed to increase accuracy, develop precision, minimise damage, decrease human error, reduce pain, scarring and recovery periods.
The Robotic systems are no different from these ancient intentions.
In addition there is a new reason for developing Robotic systems- remote surgery. As surgery becomes more and more complex and each surgical specialty branches out more and more, it is difficult for every surgeon to be an expert in every procedure.
Often the person most suited to conduct a particular surgical procedure may be thousands of miles away. with the availability the remote equipment- the expertise required is transferable across airwaves and a surgeon in one continent would be able to operate on a patient in another with the availability of robotic equipment thus providing instant access to expertise without having to travel thousands of miles.
How Instruments Assist Surgery:
Minimise Organ damage
Decrease human error and variation
Decrease Recovery periods.
Reduce operating time
Use of Robotic Technology
- Space Exploration ( Mars Landing, Repairing satellites)
- Agriculture ( planting, harvesting, fertilising)
- Military Expeditions ( Remote spy planes, missile launch, offensive weaponry)
- Manufacturing ( Cars, computers, Cameras and million other uses)
- Clean up Hazardous materials ( Radiation leaks, Chemicals, toxic fumes etc)
- Rescue Missions ( Earthquakes, Fires, Explosions)
The Advent of Robotic Surgery
We all have heard of Laparoscopic surgery - this is a technique through which rather than open up the abdomen in full, tiny incisions are placed to insert a scope/camera, two instrument ports are then introduced. The surgeon then operates through these ports using the enhanced vision available through the camera. This method has been in use now for decades and has been very successful.
As this still requires a surgeon to manipulate the arms and also to wiled the instruments, surgeons realised that despite the minimally invasive nature and advantages of reduced scarring and reduced tissue manipulation, it was hard to eliminate the lack of biofeedback, any natural tremor that may come from holding the instrument for a long time in awkward positions.
At the same time US Military has been quietly spending millions in developing remote medical intervention units to aid battlefield surgeries and the possibility of using robotic arms ( they were already trying this in bomb disposal and exploring dangerous terrains). NASA has already demonstrated that remote sensors can be used to collect soil samples and make readings in distant space.
The Use of Robotic surgery is not new. The very first use of Robotic surgical intervention dates back to 1985 to perform a neurosurgical procedure. PUMA 560 was used in performing a guided brain tissue biopsy successfully.
Within three years, PROBOT was developed and first used to perform Prostate surgery for Men at Imperial College London. Soon an avalanche of possibilities began.
A fully functional Telesurgery Robotic system was gradually developed with collaborative work from several agencies including NASA. Intuitive Surgical trialed and marketed the Da Vinci surgical system which has since been FDA approved and in widespread use.
Prostate Surgery (TURP)
Hip Replacement ( to mill out precision fittings)
Reconnection of Fallopian Tubes
Assisted Heart Bypass
Bypass surgery on a beating heart
Cholecystectomy ( Gall bladder removal)
Bladder Reconstruction in a Child
Robot assisted Kidney Tranplant
The current system in widespread use, Da Vinci Surgical system is essentially made up of three elements:
- A Surgeon's Console with remote controls for operating
- A High Definition 3D Visioning system
- A Patient Side Cart with 4 mechanical arms ( one for controlling the camera and three to hold instruments and perform)
The patient has four ports or cannulae inserted into them which 'dock' onto the four mechanical arms. these ports allow visualising and operating conduits.
The improved visual assistance through the 3D HD technology means everything can be magnified and enhanced to aid mobilising even the smallest vessel while performing highly precise operating movements that are impossible by the human eye- human hand combination.
A human assistant can also participate if needed using additional ports.The Highly refined robotic arms can perform clear, precise and delicate dissection, suturing, anastomosing, and excising by reducing tremor, enhancing skilled movements and eliminating imprecise gestures.
Major Advantages Of Robot Assisted Surgery
As with laparsocopy , the use of small and precise portals means that the patient doesn't require very long incisions to open up the body. Small incisions mean less scarring while allowing the same degree of access.
The 3D HD imaging system is state of the art and capable of magnifying the organ under surgery multiple times. This allows the surgeon to visualise tiny blood vessels, zones of separation and dissection precisely and clearly and allows better procedural decision making.The Three Dimensional imaging gives a fully immersive experience in surgery.
Control and Precision
The Robotic arms that hold the instruments have enhanced Degree of Freedom ( DOF) that allows a 360 degree level of manipulation that improves upon the human hand. The restrictions placed by muscle fatigue and natural physiological limitations are clearly eliminated and the hands retain their precision as much at the end of a long surgery as they do at the beginning.
Database of Expertise
The Robotic device has computerised memory that can store thousands of surgical procedures and hold a database of expertise that can be drawn upon. This is of advantage to every surgeon and may prompt the move to fully independent robotic procedures! A robot performed a surgery for a man with heart arrythmia by using fully Artificial Intelligence systems in 2006. This is being explored further for simple and more complex procedures.
Remote Performance and Telemedicine
although originally developed with an intention of remote operability, the system is now mainly used as on site assistance with the surgeon present in the room. The advances mean that soon the surgeon may be able to operate from a distance, even thousands of mile away. Great way to access expertise from around the world and collaborative working. Not so great if you are a surgeon taking a holiday!
Advantages to Patients:
> Reduced organ damage
> Reduced Blood loss
> Reduced infections
> Less Scarring
> Quicker Post operative recovery
> Decreased bed stay
> Can mobilise quicker
> Access to expertise world over
There are no major disadvantages to the system that cannot be overcome- however the prohibitive cost, the need for intense training, Lack of tactile feedback instrument failure have all been cited as possible causes for worry.
The system costs in the region of 1.5 million dollars and add to this the cost of supplies, maintenance and training. This will escalate the cost of each procedure considerably. However, savings may be made elsewhere with reduced team, reduced hospital stay, reducing complications.
Steep Learning Curve
As with most new technology the surgeon is forced to learn new methods, new technology and need to develop new skills in biofeedback. However, as more on more surgeons come on board and a new generation of medical students used to video game controllers and remote technology will find it considerably easier- this could also become part of core surgical training at varying levels.
Lack of Tactile Feedback
Experienced surgeons also rely on tactile feedback on the organs they handle in order to develop an intuition on what the issues are, where to dissect etc. This is lost in Assisted surgery- however, the enhanced visual feedback and immersive imaging, the use of precision tools and techniques may make up for this.
We all worry about instrument failure. but this is nothing new- foolproof systems and backups are built in just as in airline travel, cars and other day to day technology. While this could be something feared, rationally we face these risks everyday and instruments are far less susceptible to erroneous behaviours than humans in many cases.
Surgical Specialties Currently Using Robot Assisted Methods
- Gastroenterology: Liver Resection, Pancreatic Cancer, Cholecystectomy ( Gall Bladder), Bariatric ( Stomach shrinking)
- Cardiothoracic: Endoscopic Coronary Artery Surgery, Mitral &Aortic Valve Repair, Oesophagectomy, Lung surgery
- Cardiology: Arrhythmia reversal, Conduction systems
- Gynaecology: Fibroids, Uterine Cancers, Tubal procedures, Hysterectomy, Cancers
- Urology: Prostate, Nephrectomy, Bladder procedures, Kidney tumors .
- Orthopaedics: Joint replacement, Ligament surgery such as Anterior Cruciate of Knee, Arthroscopy for joints and other procedures
- Paediatrics: Cardiac procedures, diaphragm repair, congenital defects such as tracheoesophageal fisturla, herniae etc.
- Neurosurgery: Epilepsy eradication, Parkinsons, tumor removal, pituitary, biopsy
Current and Future Possibilities
Robotic surgery has grown tremendously over the last decade and is one of the fastest growing innovations in the field of surgery. There is an expanding evidence base and a long line of patients who have benefited from this.
Every specialty is now considering the use and there are many examples of areas where robot assisted surgery is evolving. In fields such as Cardiac surgery, Abdominal and Pelvic surgery there is a well established experience base. In Men's health Robot assisted Prostatectomy have fast replaced any traditional ( and cruder) methods. Other fields follow. On the right is a list of areas where robot assisted surgery is emerging as front runner.
The most commonly offered procedures are in the field of Cardiology, Gynaecology and Urology.
Many innovative techniques are being pioneered for the future in delicate areas such as Eyes, Ear, Nose and throat and many more.
Anyone who demonstrates a healthy level of concern with robot assisted system is right to do so. In the past people have understandably been cynical and fearful of new innovations: planes, trains, automobiles and many medical interventions. This is our evolutionary prerogative.
It is worth remembering a few points:
- Robotic surgery is actually Robot Assisted surgery- The surgeon is still fully in control
- It enhances the skills rather than reduces it
- It minimises several complications and enhances recovery
- It does still need the Surgeon to take a lot of training and development
- It is very expensive now but may get cheaper
- If given an option of traditional versus robotic surgery, I perhaps will choose robotic depending on the surgeon's expertise, the procedure and the hospitals reputation.
Hope this article has helped inform and alleviate some doubts in your mind. Always consult with your surgeon with an open mind and be well informed before.
Pamela Oglesby from Sunny Florida on September 18, 2012:
Very thorough hub of robotic surgery. This is a fascinating new area of medicine and it seems to be proving very useful for cancer surgeries. I appreciate all the research and work you did to write such a thorough article. Up and awesome.
Mary Hyatt from Florida on September 17, 2012:
This medical procedure leaves me in awe! You have written such an informative Hub that even I have learned something today.
Thanks for this great Hub to share your knowledge on robotic surgery.
I voted this Hub UP, will share, tweet and Pin.
Debby Bruck on August 29, 2012:
Dear Doc ~ WOW! That's about all I can say. Peeling the grape was a feat that showed the delicacy of the robot's ability. With hours of training and dedication this can be accomplished. I liked the idea that much of these surgeries are less invasive. The best is not to have surgery at all, but if you must, call in the transformers! Blessings, Debby
Daisy Mariposa from Orange County (Southern California) on August 29, 2012:
I'm particularly interested in reading Hubs in which I learn something new. You work 70 hours per week in your various medical-related jobs, yet you still find time to write articles for HubPages.
Thank you for your dedication to your profession and for the time you devote to writing articles which persons such as myself can understand.
Michelle Liew from Singapore on August 03, 2012:
Thanks again for sharing your expertise, Docmo! Makes us less afraid of entrusting our lives to surgeons - I know I felt that way before! Very, very detailed and useful information, which I"m sharing.
Mary Craig from New York on August 03, 2012:
I just left a comment saying it was nice to have a nurse "in the family", how much better to have a doctor! Your knowledge is superior and your sharing it with us can often soothe those with irrational fears. Knowledge is one of our best weapons, when it comes to surgery and health matters, and you help to arm us with it. Thank you Mohan for arming us with knowledge!
Voted up, useful, and interesting.
Elena from London, UK on August 03, 2012:
Very interesting and useful to know, so that patients can make wise decisions. Sometimes, people have to decide within 24 hours what surgery option to take.
Mohan Kumar (author) from UK on August 03, 2012:
Thank you Sunshine.. it is truly becoming a safer alternative due ot its many advantages. Understandably people may be reticent if they don't understand the technology...
Linda Bilyeu from Orlando, FL on May 28, 2012:
My husband had a robotic surgery and three of my friends had it also. From everything I witnessed and they shared with me I would go the route of robotic before traditional. My husbands surgeon Vipul Patel who works out of Celebration Hospital in Orlando claims he has performed more prostatectomies then any other urologist. That was five years ago. I wouldn't recommend him to a friend his ego was over inflated. Thank you for creating this hub, many will learn the pros and cons from it.
Mohan Kumar (author) from UK on April 06, 2012:
@WillStarr- thank you.
@chspublish- I am glad you like this info. The future does seem to be aimed at making things better and more precise to minimise trauma and enhance precision. Also it gives access to the best experts wherever they may be on the Globe. Appreciate your visit.
chspublish from Ireland on April 06, 2012:
Great to read a hub like this. I love the idea of precision and control and the lack of 'tremor' by the robotic assisted surgery. All that trauma associated with major surgery will soon be a thing of the past. Hurrah for the advancements in medical science and technology!! Thanks for the hope for the future being a better place for us all.
WillStarr from Phoenix, Arizona on March 16, 2012:
This is the way of the future. It's a wonderful surgical tool.
Mohan Kumar (author) from UK on March 13, 2012:
@ Simone, welcome and thanks for your kind comments- glad this has been fascinating.
Mohan Kumar (author) from UK on March 13, 2012:
Dear Ruby, I am glad you agree that a healthy degree of fear is from unfamiliarity and loss of perceived control- hope this helped to clarify some issues! Thank you!
Mohan Kumar (author) from UK on March 13, 2012:
Drbj- I agree - it is far more advanced and very much widespread than many people think - the expert consensus is almost 75 % of all surgeries will be Robot 'assisted' over the next 2 decades.... Thanks for your visit!
Mohan Kumar (author) from UK on March 12, 2012:
@cabmgmnt- thank you for asking the question- interestingly I was in the middle of editing an article on this subject and your timely question helped me develop this hub!
Simone Haruko Smith from San Francisco on March 12, 2012:
My goodness, this is absolutely FASCINATING!!! Thanks for the awesome overview of robotic surgery tech... I had no idea things were already this advanced. I'm more accustomed to reading about the highly experimental and theoretical stuff.
Ruby Jean Richert from Southern Illinois on March 12, 2012:
I have been reading about robotic surgery, the idea scares me, but i know it is just the unfamiliarity. Thank you so much for an informative hub. Your detailed description is well written and easy to comprehend. Thank you for sharing Docmo...
drbj and sherry from south Florida on March 11, 2012:
Robotic assisted surgery is no longer a fanciful exception. More and more I am seeing hospitals in my area advertise that they have the surgeons, the expertise, and the equipment to perform these procedures. We have seen the future and it is here NOW. Thank you Docmo for this detailed hub on the subject.
Corey from Northfield, MA on March 11, 2012:
Thank you for posting this hub. Everything about this hub: photographs, time line and history, uses in the operating room, training and cost has mezmerized me. I find your dissection of robotic surgery to be helpful to those considering surgery as well as being helpful to those, like me, who were curious about it. Thanks again.