The field of robotics is one that’s synonymous with innovation, and it’s slowly, but surely transforming the way we live and work.
One area that we see robotics making increasing inroads is in the field of surgery.
The first recorded use of robotics in surgery occurred in 1985, when a robotic surgical arm was used in a neurosurgical biopsy.
This was then followed by the first minimally invasive surgery involving a robotic system, a cholecystectomy (removal of the gallbladder), in 1987.
This was followed by a few other surgeries, before the robotic da Vinci Surgery System was approved by the US Food & Drug Administration (FDA) for general laparoscopic surgery in 2000.
Today, robot-assisted surgery allows surgeons to perform different types of procedures with more precision, flexibility and control than is possible with conventional techniques.
According to Sunway Medical Centre’s (SunMed) consultant urologist Dr Badrulhisham Bahadzor, “Robotic surgery is a type of minimally invasive surgery utilising a robotic system, which can be considered similar to a surgical manipulator that is designed to offer more precision, better visualisation and increased dexterity.
“The robotic manipulators (arms) are the extension of the surgeon’s hands. The movement of the arms and the surgical instruments replicate the skilled movements of the surgeon done remotely at the operating console.
“The superior ergonomics overcome some of the technical limitations of current minimally invasive or keyhole surgery by providing alternate tools for the surgeon to perform more complex surgery through smaller incisions.”
The da Vinci Surgical System has now become synonymous with robotic surgery, and it’s currently in its fourth iteration.
The system enables the surgeon to operate from a comfortable, seated position at a console, with a magnified, high-definition 3D view of the targeted part of the body.
The 3D magnification system allows the surgeon to view the surgical area with higher clarity.
The surgeon uses controls to move the instrument arms and camera of the robotic system.
The system then mimics the surgeon’s hand, wrist and finger movements in real time.
The robotic arms precisely replicate the movements of the surgeon at the controls, greatly enhancing accuracy, especially in small, hard-to-reach operating spaces.
The system needs to be manipulated by the surgeon, and it cannot be programmed or act in any way without the surgeon’s input.
The advantages the system offers include:
> Enhanced visualisation, including hard-to-see areas
> A greater degree of surgical precision
> Improved dexterity
> Increased range of motion
> Improved access to hard-to-reach areas
Says Dr Badrulhisham, “You can reach body cavities which are hard to access or see clearly with the naked eye. One example is with surgical removal of prostate cancer (radical prostatectomy), in which the prostate gland is located in a narrow pelvis.”
Before the advent of robotic surgery, surgeons did minimally invasive surgery by manipulating laparoscopic surgical instruments with their hands.
“The robotic surgical system provides all the benefits of minimally invasive surgery in terms of smaller cuts, less pain, better cosmesis, less blood loss, faster recovery, shorter hospital stay and a much faster return to normal activities,” he adds.
According to Dr Badrulhisham, the robotic system is not just used by urologists, but also by other specialists in, for example, gynaecological operations, general surgery, cardiac surgery, and ear, nose and throat surgery.
However, he notes that the system is most often used in urology and gynaecology.
“In urology, the most widely performed procedure is robotic radical prostatectomy for prostate cancer.
“The system has also been used for cancer of the kidney, especially when only the cancerous part of the kidney needs to be removed (robotic partial nephrectomy).
The consultant urologist adds that the duration of the surgery – whether robotically-assisted or otherwise – doesn’t differ much.
However, he notes that experienced surgeons who have extensively used the robotic system may carry out the surgery faster.
“What the robotic system provides is surgical precision and superior visualisation. In theory, with these technologies, the surgeon should be perform better dissection, incision and surturing during the operation.
“A good example is in radical prostatectomy.
“In theory, the robotic system should help the surgeon remove the cancerous gland completely without leaving anything behind, and avoid complications such as urinary incontinence and erectile dysfunction by preservation of critical nerve bundles running alongside the prostate.
“However, in practice, this has not been seen consistently as there are many other factors aside from the robotic system itself that can influence the overall outcome of surgery.
“There have been a number of studies carried out on this, and the debate is still ongoing.”
The benefits of minimally invasive surgery include:
> Fewer complications, such as surgical site infection
> Less pain and blood loss
> Quicker recovery
> Smaller, less noticeable scars
Robotic-assisted surgery also has similar risks to conventional open surgery, although the complication rates tend to be lower.
According to Dr Badrulhisham, robotic surgery isn’t an option for everyone.
You need to talk with your doctor about the suitability, benefits and risks of robotic surgery, and how it compares with conventional techniques, such as open or laparoscopic surgery, before making any decision.