Surgical Robots in the Healthcare Industry

Robotic surgery is taking the surgical profession by storm.  The most widely used clinical robotic surgical system includes a camera arm and mechanical arms with surgical instruments attached to them.  It enhances precision, flexibility, and control during the operation and allows them to better see the site, compared with traditional techniques. But, Robotic surgery is still in its infancy and its niche has not yet been well defined.

 

Its current practical uses are mostly confined to smaller surgical procedures known as minimally invasive surgery. These are smaller incisions including fewer complications, such as surgical site infection, less pain and blood loss, shorter hospital stay and quicker recovery, and smaller, less noticeable scars.

The greatest dilemma about robotic surgery is if it is only the robot that performs the surgery. The fact is that a robot cannot operate without the surgeon's control and only responds to the instructions. The surgeon controls the arms while seated at a computer console near the operating table. To operate using the Robotic system, the surgeon makes tiny incisions in the human body and inserts miniaturized instruments and a high-definition three-dimensional camera. Enhanced near-infrared imaging is used during surgery to distinguish abnormal tissue from normal tissue and evaluate blood flow in real time. The scalability allows the surgeon to calibrate the robot’s arm to move a fraction of an inch for every inch of motion in the surgeon’s hand. This simplifies the most complex movements such as delicate removals, suturing, and knot-tying. Additionally, the mechanical wrist provides extra hold on an array of specialized surgical instruments with an even greater range of motion.

AESOP a system designed by Computer Motion Inc. of Goleta, CA, is a voice-controlled endoscope with 7 degrees of freedom. This increases the surgeon’s ability to control stable images. The Zeus system and the DA Vinci system are used in many laparoscopic procedures including, cholecystectomies, mitral valve repairs, radical prostatectomies, and reversal of tubal ligations, in addition to many gastrointestinal surgeries, nephrectomies, and kidney transplants. ROBODOC is used to precisely core out the femur in hip replacement surgery.

The most widely accepted application of robotic surgery is in coronary artery grafting. Studies suggest that robotic systems have not yet been developed enough to perform endoscopic closed-chest beating heart bypass grafting, despite 2-8 technical successes. 

Laparoscopic pediatric surgeries have benefits in treating various disorders in terms of preterm infants, including intestinal atresia, choledochal cysts, biliary atresia, and esophageal atresia.  

The da Vinci Si/Xi® monitor uses instant image referencing to let the surgeon display the diagnostic images such as ultrasound or CT scan images of the area, prior to the surgery.  

SOCRATES, a marker of the Zeus robotic surgical system allows the surgeons at remote sites to connect to an operating room and share video and audio, use a telestrator, to highlight anatomy, and control the AESOP endoscopic camera. 

Dario et al at the MiTech laboratory of Scuola Superiore Sant’Anna in Italy, have developed a prototype miniature robotic system that enables computer-enhanced colonoscopy. It has an inchworm-like locomotion that uses vacuum suction. It is believed to expand the applications of endoluminal diagnosis and surgery

The robotic systems enhance dexterity in several ways. They enhance the surgeon’s ability to manipulate instruments and thus the tissues. These systems are designed so that the surgeons’ tremor can be compensated on the end-effector motion through appropriate hardware and software filters. Additionally, these systems scale movements so that large movements of the control grips can be transformed into micro motions inside the patient. Still, these systems have yet to develop the full potential in instrumentation or to incorporate the full range of sensory input. 

The robotic systems eliminate the fulcrum effect, making instrument manipulation more intuitive. With the surgeon sitting at a remote, ergonomically designed workstation. Also, these systems eliminate the need to twist and turn in awkward positions to move the instruments and visualize the monitor.

The systems provide a 3-dimensional view with depth perception. Also, they increase the surgeon’s ability to directly control a stable visual field with increased magnification and maneuverability. This greatly enhances the surgeon’s ability to identify and dissect anatomic structures as well as to construct micro anastomoses.

Robotic surgery is a new technology and its uses and efficacy have not yet been well established. Mostly only feasibility studies have been conducted, and no long-term follow-up studies have been performed. Many procedures still need to be redesigned to optimize the use of robotic arms and increase efficiency. 

Costly

At present cost of these surgeries is nearly prohibitive and their future costs are a matter of conjecture. While some believe technological development will reduce the cost of these surgeries, others are of the view that improvements in technology, such as haptics, increased processor speeds, and more complex and capable software will increase the cost of these systems. Another issue is how much and how often will hospitals and healthcare organizations have to spend on system upgrades. 

These systems have relatively large footprints and cumbersome robotic arms. It may be difficult for both the surgical team and the robot to fit into the operating room. Some suggest that miniaturizing the robotic arms and instruments will address the problem. Others believe that larger operating suites with multiple booms and 

wall mountings will be needed to accommodate the extra space required by these systems. This would also considerably add up to the cost of technology.

Surgical robots have become the entry fee for centers wanting to be known for excellence in minimally invasive surgery despite the current lack of practical applications. Therefore, Whether or not robotic devices will grow into a more practical role remains to be seen.

Encapsulating, the practical role of robotic surgery is still hazy. At present, robotic devices seem to have more of a marketing role than a practical role. Many questions like malpractice liability, credentialing, training requirements, and interstate licensing for tele-surgeons, apart from finances are yet to be answered.