By: Zara Haider
Robotic surgery, as the name suggests, involves the use of advanced robotic systems controlled by surgeons to perform precise and minimally invasive procedures. Just as AI is revolutionizing industries, robotic surgery is redefining the future of healthcare, marking a turning point in society.
Robot surgery includes a robotic arm, to hold surgical tools; an HD camera, to give the surgeon a view of the surgical field; a console, the control center for the surgeon to maneuver the arm and camera.
This integrated electromechanical system can be applied over a wide range of procedures from appendectomy (removal of the appendix) to hysterectomy (removal of the uterus) to mitral valve repair (repairs/replaces the valve between the left ventricle and atrium of the heart) and more.
It works by making an incision, inserting a port (thin tubes) which the robotic device and camera are threaded into, and the surgeon performing the procedure. After the surgeon’s done, the port and instruments are taken out of the patient and the incision is sutured. This minimally invasive method makes it desirable for patients as it reduces the amount of scarring, possibility of infection and makes a quicker post-operative (post-op) recovery.
The robotic arm has a wider range of motion, thus using less space–and less disturbance to surrounding tissue and organs–to perform procedures including complex ones that require utmost precision.
The concept of robotic surgery has been around since the 70s, but it wasn’t until a decade after that the first two robots were created and successful in separate procedures: PUMA 560 with a brain biopsy; PROBOT with a prostatectomy (removal of prostate cancer).
In 2000 the first commercially available robotic surgical system, Da Vinci, made by Intuitive Surgical, was approved by the FDA and implemented widely. This marked the first time in the world that a robotic system was publicly used in healthcare, marking the beginning of actionable steps towards integrating technology and medicine.
Fast forward to today, the same company is set to release its latest model of the machine, Da Vinci 5, in 2025. Like its older models, Da Vinci 5 can be used in gynecologic, thoracic, general, cardiac and urologic surgeries along with lung biopsies.
The newest model features force feedback which measures how many newtons an instrument is applying, thus resulting in gentler surgeries with less unnecessary tissue damage.
The Da Vinci 5’s console center where the surgeon deploys the robotic arm’s movements will have a digital overlay that shows the instruments trajectory and landing point, making procedures less prone to human error. The control center’s newly added joints enhance ergonomics by allowing the view screen to be raised, lowered, and tilted. The curved armrests accommodate a wide range of arm sizes, and the controllers can be adjusted for height to suit the user. Additionally, the console integrates more control features for surgeons, such as managing the patient’s insufflation (filling body cavities with air/gas), pressure control, and adjustments to their workspace like camera angle and brightness. Ultimately, the model reduces the amount of staffing required for surgical procedures, aiding the persistent issue of understaffing.
A surgeon performing a surgery with two other staff members
A unique feature that the Da Vinci 5 has that hasn’t been publicly seen anywhere else is its multimedia capabilities. The model allows surgeons to record procedures and capture images to review or to confer with colleagues and mentors. Additionally, its virtual collaboration feature allows other surgeons, medical professionals and administrators to spectate and advise the surgeon live. Lastly, the mobile application portal, My Intuitive, provides an on-the-go option for surgeons to review their surgery data and performance which can also be accessed on the Da Vinci 5 console.
While the robotic system can impress even the most technically skilled surgeons, like all robots, it can succumb to malfunctions. However, the likelihood has significantly decreased from the initial 94% in 2003 to 16% in 2007 with 4.8% associated with patient injury. We can infer that the malfunction rate along with the rate of associated injury has only gone down.
Nerve damage is also a possibility as a post-op side effect. This was an area of concern in 2013 when a study conducted by UVA’s Department of Urology found that 6.6% of documented surgeries in their branch were reported positioning injuries resulting in nerve damage. More than half of the patients had the damage resolved within a month, but a little more than one-fifth sustained the injury for more than six months.
Despite the gained knowledge and elapsed time, surgeons still struggle with the issue and are advised by researchers to take extra caution with positioning patients on the table.
It may take some time–perhaps until our hair turns gray–before society views surgical robots with an easy smile. However, after enough research and trial-and-error, there’s a good chance that robots will be openly seen on the medical floor.
Citations:
Andonian, S., Okeke, Z., Okeke, D. A., Rastinehad, A., Vanderbrink, B. A., Richstone, L., & Lee, B. R. (2008). Device failures associated with patient injuries during robot-assisted laparoscopic surgeries: a comprehensive review of FDA MAUDE database. The Canadian Journal of Urology, 15(1), 3912–3916. https://pubmed.ncbi.nlm.nih.gov/18304403/
Cleveland Clinic. (2021). Robotic Surgery: Robot-Assisted Surgery, Advantages, Disadvantages. Cleveland Clinic. https://my.clevelandclinic.org/health/treatments/22178-robotic-surgery
Clinic, T. S. (n.d.). The History of Robot-Assisted Surgery | The Surgical Clinic. Https://Thesurgicalclinics.com/. https://thesurgicalclinics.com/history-of-robot-assisted-surgery/
Halpern, D. K., Liu, H. H., Howell, R. S., Halpern, R. A., Akerman, M., Conlon, J., & Weidler, C. (2020). Neural Monitoring for Robotic Abdominal Wall Reconstruction. JSLS : Journal of the Society of Laparoscopic & Robotic Surgeons, 24(2), e2020.00009. https://doi.org/10.4293/jsls.2020.00009
Intuitive Surgicial. (2023). Procedures. Intuitive.com. https://www.intuitive.com/en-us/patients/procedures
Intuitive Surgicial. (2024, March). Da Vinci 5. Intuitive.com; Intuitive Surgical. https://www.intuitive.com/en-us/products-and-services/da-vinci/5
Jackson, I. (2013, April 1). Robotic Surgery Side Effects Linked to Risk of Nerve Injury: Study. AboutLawsuits.com. https://www.aboutlawsuits.com/robotic-surgery-side-effects-nerve-injury-study-44252/#:~:text=Researchers%20found%20that%20nerve%20injuries
Mills, J. T., Burris, M. B., Warburton, D. J., Conaway, M. R., Schenkman, N. S., & Krupski, T. L. (2013). Positioning Injuries Associated with Robotic Assisted Urological Surgery. Journal of Urology, 190(2), 580–584. https://doi.org/10.1016/j.juro.2013.02.3185
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