[(PICTURE ) Da Vinci Surgical System: Robot (On the right) & Console (On the left)]

One of the greatest advances in medicine in the past decade has been the development of robotic surgery. When I first heard of the term “robotic surgery” as a 6^th grader, I believed that actual robots would do surgery on human beings. I found out that this was not the case—robotic surgery is actually a type of surgery in which robots help surgeons operate on the patient. Robotic surgery is better referred to as robot-assisted surgery.

Robotic surgery is a relatively new idea, and there are many questions regarding its capabilities and role in surgery. The purpose of this article is to answer common questions about robotic surgery.

Does the robot really do surgery?

This is wishful thinking, but it is false. In Robot-Assisted Surgery, human surgeons perform the surgery with the help of robotic arms. In this type of surgery the surgeon makes a small incision through which the robotic arms enter the surgery region. There are typically three or four robotic arms and a camera. The role of the arms is to hold the surgical tools such as the scalpel, forceps, dissectors, etc. The role of the camera is to give the surgeon a view of what is inside the body. Since the surgeon does not make a large enough incision to see inside the patient, the camera relays visual information to the surgeon. Once the robotic arms enter the body, the surgeon sits at a console to begin the surgery. The console contains a screen that displays a real-time, high-definition image of what the camera sees. The surgeon then begins the operation. The hand movements of the surgeon are scaled and replicated by the robotic arms. In essence, the surgeon controls the robotic arms and surgical tools held by those arms.

What are the benefits of Robotic Surgery?

The beauty of robotic surgery lies in the benefits to both the patient and the surgeon. Patients that undergo robot-assisted surgery usually have a shorter hospital stay, less pain and blood loss, a smaller chance of getting an infection, and a decreased likelihood of developing surgical complications. Because the incisions involved in robotic surgery are very small, the recovery rate is faster, which translates to a shorter hospital stay. Similarly, small incisions mean that less tissue is handled and exposed, so the infection rate decreases. Additionally, the patients are likely to feel less pain after the surgery because smaller incisions heal faster than larger ones.

Robotic surgery does have benefits for the surgeon. The main benefits are stabilization, scalability, and mobility. Since the robotic arms are calibrated by the surgeon before the surgery, unwanted movements can be filtered out. For example, the surgeon can adjust the settings so that even if the surgeon’s hands shake or slip by accident, the robotic arms inside the patient will remain steady.

Furthermore, the movements of the robot can be scaled at a ratio comfortable for the surgeon; they surgeon may adjust the settings so that a movement of four inches by the surgeon’s hand translates to a smaller and more delicate movement by the robotic arm. The robotic arms can do whatever the surgeon’s hands can do and more. The limit to a surgeon’s mobility is usually the wrist because it has a limited range of motion. The robotic arms have a much greater range of motion allowing for delicate movements and hard to reach angles.

What are the drawbacks of robotic surgery?

The primary drawbacks of robotic surgery include cost, lack of tactile senses, and training. Unlike other costs, medical costs vary directly with new technology. As medical technology advances, prices of procedures increase. That is the case with robotic surgery.

Take a hysterectomy for example. There are four ways of doing a hysterectomy, each with their own costs: robotically ($49,500), abdominally ($43,600), vaginally ($31,900), and laparoscopically ($28,300). It is evident that robotic surgery for a hysterectomy is the most expensive procedure. However, experts claim that the hidden costs associated with laparoscopy, abdominal, and vaginal surgery make robotic surgery cheaper in the long term.

Another drawback of robotic surgery is that it lacks the ability to feel. Sometimes, surgeries require surgeons to feel the area that they are operating on. Unfortunately, robotic surgery is unable to provide tactile information for surgeons.

Finally, training is an issue. As one can imagine, performing robot-assisted surgery requires tremendous skill and dexterity and learning the intricacies of the robotic surgical system takes time and intense training. A potential risk is that in the rush to increase the availability of robotic surgery, surgeons may not have a sufficiently strong command over the surgical system. Surgeons at Johns Hopkins believe that minor mistakes may be magnified in a robotic surgical system if the surgeon does not have the training needed to operate the machine.

What is the outlook for robotic surgery?

Robotic surgery has immense potential. The prospects of shortening a patient’s recovery time, lessening the pain and blood loss in the surgery, and scaling and stabilizing the robotic arms make robotic surgery a very appealing procedure for the future. The primary weaknesses of robot-assisted surgery can be improved over time.

As robotic surgery’s popularity grows, more and more teaching hospitals will offer fellowship programs for robotic surgery. These fellowship programs will make sure that the surgeons performing the procedures have a mastery over surgical system. Furthermore, the lack of tactile feedback will cease to be a problem if haptic feedback systems, which are mechanisms that display some sensory information, are coupled with the surgical arm. The idea is that the haptic system can tell the surgeon what a specific tissue feels like based on information gathered by the robotic arm.

All in all, we have reason to believe that robot-assisted will continue to improve the outcomes, and ultimately reduce the costs associated with many medical operations in the future.