admin The healthcare industry is approaching an era of transformation, which is currently being shaped by the assimilation of robotics into the practice of surgery. Healthcare systems worldwide are facing increased prevalence of chronic diseases and an aging population, necessitating the incorporation of long-term complications and the incalculable rise in surgical demands. Robotic-assisted surgery has transformed the field of surgery by breaking boundaries, providing an unprecedented level of precision and improving outcomes for the patient.
Historical Development of Robotic Surgery
The idea of robotic surgery finds its roots in the early 1970s after the United States Defense Research and Advanced Projects Agency and NASA undertook a mission to develop remote-controlled surgery. In 1985, the first functional use of the Programmable Universal Machine for Assembly 560 (PUMA 560) was made in neurosurgical biopsies. The groundbreaking invention of the da Vinci Surgical System, introduced by Intuitive Surgical in 1999 and FDA-approved in 2000, has indeed changed the course of surgical history. Subsequent improvements in robotic systems, such as the 2014 da Vinci Xi platform, have been continuously developed to increase its surgical capabilities.
Transformational Change in Surgical Specialties
Robotic systems have brought transformational changes not only in the field of general surgery but also in urology, gynecology, and cardiac surgery. The precision of the robotic-assisted procedure has empowered surgeons to travel through the complex anatomical structures with augmented vision and control. This translates into minimal pain, reduced complications, and rapid recovery for the patient.
1. General Surgery:
• Colorectal Surgery: Robotic systems work admirably in technically demanding procedures such as total mesorectal excision and complete mesocolon excision in difficult anatomical spaces.
• Bariatric Surgery: Robotic assistance in Roux-en-Y gastric bypass and sleeve gastrectomy provide better outcomes with reduced complications.
2. Urology:
• Prostatectomy: Robotic-assisted prostatectomy is performed using better precision and three-dimensional vision and is associated with reduced blood loss and length of recovery time and favorable functional outcomes compared to conventional surgery.
3. Gynecology:
• Hysterectomy and Myomectomy: The robotic system provides the ability to perform less-invasive surgery with superior precision, therefore recovery occurs faster and is associated with fewer complications.
4. Cardiothoracic Surgery:
• Mitral Valve Surgery: With robotic mitral valve surgery and due to the associated superior outcomes, hospital stay is reduced, and recovery time is faster. Patients experience less postoperative complications and recover earlier with robotic surgery when compared to all other methods.
• Coronary Artery Bypass Grafting (CABG): Robotic-assisted methods in CABG have reduced the incidence of pneumonia and wound infection along with the decreased ICU stay compared to the standard techniques.
Pros and Cons of Robotic Surgery
Pros:
• Increased Precision: Robotic systems offer surgeons unmatched precision, allowing them to perform surgery at anatomical sites which could not be operated on before.
• Better Visualization: High-definition and three-dimensional visualization of the surgical site aids better decision-making and accuracy.
• Less Blood Loss: Less blood loss during the surgery due to minimally invasive techniques.
• Short Recovery Time: Short recoveries and hospital stays.
• Lower Complication Rates: Robotic surgery has been shown to decrease the incidence of postoperative complications.
Cons:
• Huge Initial Costs: Robotic systems are costly to acquire, which is one of the biggest challenges healthcare institutions face.
• Extended Operating Times: The procedures will take a longer time due to the complexity of the system and the procedure.
• Maintenance and Training: There will be additional costs due to maintenance, and the surgical teams need to be trained differently than before.
• Limited Access: Financial and logistical barriers could limit the widespread use of robotic surgery, giving rise to inequities in access.
Cost Issues and the Issue of Equity
Robotic surgery has offered plenty of benefits, but at the same time, it has been extremely expensive for hospitals to procure and maintain robotic systems. The number of 349 procedures is an estimate that is considered necessary to be performed in a year to break even from the cost of acquiring the machine. These barriers need to be addressed to ensure equitable access to this disruptive technology.
Robotic Surgery in Pediatric and Cardiac Procedures
With the advancement of robotic surgery, it has now also been performed on pediatric and cardiothoracic patients due to precision and minimal invasiveness.
1. Pediatric Surgery:
• Urology: Robotic-assisted laparoscopic pyeloplasty (RALP) significantly reduces the operative time and the stay in the hospital.
• General Surgery: Fundoplication is one of the most common pediatric robotic surgeries, and it is very beneficial due to the increased precision provided by robotic systems, followed by better postoperative results.
2. Cardiothoracic Surgery:
• Mitral Valve and Coronary Artery Bypass: The technique of robotic mitral valve surgery has significant clinical benefits, including less blood loss and fewer infection rates.
• Complex Adult Congenital Heart Disease: The views and flexibility of robotic platforms are exceptional in complex anatomical repairs, with improved outcomes in congenital cases.
The robotic surgery is a new era that introduces precision to a new level in the field of surgery, enhancing the patient’s outcomes in all possible ways, even across specialties. On the other hand, the high cost is a big challenge, but the benefits of this particular technology in surgery are also amazing, and so it is being adopted at an accelerating rate. With the ongoing research in the field, its use in surgery is going to be a new revolution in healthcare, designing the future of surgeries across the world.
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