Robotic-Assisted Surgery in General Practice: Innovations and Applications

In the not-so-distant past, surgery was a daunting and often risky procedure to treat medical conditions.

Today, surgeries are safer and more effective, thanks to groundbreaking advancements in surgical technology. These breakthroughs offer new hope not only to those undergoing complex surgical procedures such as craniotomy but also to doctors who ensure comprehensive care for their patients. 

The techniques have undergone a long process of development, from minimally invasive surgeries to more sophisticated surgical systems. 

Robotic-assisted surgery, in particular, stands out as a critical innovation in the area of medical excellence. 

With advanced 3D visualisation systems and enhanced precision, Robotic-assisted surgery emerges as a promising approach to surgical treatment.

Robotic Surgery: An Overview

Robotic surgery or robotic-assisted surgery is a minimally invasive surgical approach in which surgeons guide robotic systems through the entire surgical procedure. 

This clarifies one of the most asked questions: Does the robot itself perform the robotic surgery?

The answer is no.

During the procedure, the surgeon, who is experienced in robotic surgery, controls robotic arms instead of directly operating patients with their hands. The surgeon's movement is reflected by the robotic arms. They hold the instruments and make precise incisions. Once the surgery is done, arms fix the incisions by making sutures.

Components of Robotic Surgical System

The robotic surgical system is equipped with several tools to assist surgeons in controlling the surgical procedure. To understand robotic surgery in detail, let's bifurcate the components of a robotic surgical system.

Robotic arms 

• These are the core components of the robotic surgical system, which mimics a surgeon's arm by replicating its proficiency and range of motion.
• Robotic arms, which are controlled by the surgeon from the console and designed to hold and operate surgical tools, enable the surgeon to execute complex tasks with enhanced accuracy. 
• The arms not only allow for fine-tuned adjustments but also minimise the risk of human error.

Surgical Console

• The surgical console is the cabinet where the surgeon sits to control the robotic system.
• It includes joysticks or control handles with arm control and foot pedals that translate the surgeon's hand movements into precise actions performed by the robotic arms. 

3D Visualisation System

• This system is composed of advanced cameras and imaging technology that capture detailed visuals of the internal organs and project them onto screens within the surgical console. 
• It offers a high-definition, three-dimensional view of the surgical area so that the surgeon can easily see and navigate the patient's intricate anatomy.
• The 3D perspective provides depth perception and a clearer view of the surgical field, which is essential for performing delicate procedures with accuracy.

The precision and control provided by robotic surgery are unmatchable. Hence, surgeons from every department, such as cardiology, urology, neurology, oncology, and many more, have welcomed robotic surgery.

Several robotic surgical systems have gained significance in recent years, such as the Da-Vinci surgical system, the Zeus system, the AESOP robotic surgical system, and SurgiBot, thus enhancing the surgical landscape.

Applications of Robotic Surgery

The precise nature of robotic surgery enables surgeons to carry out critical surgical procedures with ease that were earlier not compatible with laparoscopic and minimally invasive techniques. Robotic surgery is becoming widely accepted in different areas of medicine.

Some of the common robot-assisted surgical procedures include:

• Appendectomy for removal of the appendix
• Hernia repair for repairing abdominal or inguinal hernias
• Gallbladder removal for removing the gallbladder
• Hysterectomy for removal of the uterus
• Myomectomy for removal of uterine fibroids
• Endometriosis surgery
• Prostatectomy for removal of the prostate gland
• Renal surgery for removing tumours or renal stones
• Brain tumour removal surgery
• Stereotactic radiosurgery for radiation therapy to brain tumours
• Orthopaedic surgery such as knee and hip replacement, spine replacement etc.
• Gastric bypass surgery for weight loss

Surgeons, with the help of robotic surgery, now have the freedom to perform surgical procedures delivering micro-movements with seven degrees of motion. This was actually beyond their capabilities even after years of experience.

Benefits of Using Robotic Surgery

The reason behind the unprecedented explosion in surgeons' use of robotics is the advantages it provides over conventional open and laparoscopic surgical techniques.

Some of the reasons why surgeons in India are opting for robotic surgery:

• High precision
• High-quality 3D visualisation
• Reduced surgeon's fatigue
• Improved patient outcomes

From the patients' perspective, robotic surgery ensures smaller incisions, decreased bleeding, and quicker healing time, This consequently reduces the number of hospital stay as well.

Challenges in Using Robotic Surgery

Although robotic surgery provides remarkable benefits, it's crucial to understand that it's not a universal approach. Not every patient is a suitable candidate, and not all medical conditions can be addressed with this approach.

Enhanced surgical skills

Surgical teams must have sufficient training to perform these sophisticated interventions proficiently with optimum patient care. 

High initial set-up cost

The system may require specialised operating rooms, sterilisation and ventilation zones, and other infrastructure to carry out the robotic surgery procedure smoothly. 

Additionally, investing in training for surgeons, nurses, and other staff to operate and maintain the system becomes crucial.

Technical issues and safety concerns

Robotic systems, like any complex technology, may experience malfunctions or failures both during and post-surgery. The surgeon should be prepared to address any anticipated complication.

Ethical Challenges Governing Robotic Surgery

Whenever any new technology is introduced, guarding patients' safety is of foremost importance. There is no doubt that robotic surgery provides enhanced precision, which is nearly impossible with our precious methods, but this won't undermine the ethical challenges that may arise during robotic surgery.

Informed consent to the patients

• Before implementing robotic surgery in patients, they must have a clear understanding of the robotic surgery process, its potential benefits, risks, and limitations.
• Additionally, patients should be informed about available alternatives to robotic surgery and their potential implications so that they can make informed decisions.

Surgeon Training and Skill

• The medical governance body should ensure that surgeons are adequately trained and skilled in performing robotic surgery systems.
• To ensure consistent quality of care, regular training and education to keep surgeons updated on the latest advancements and best practices should be promoted.

Manufacturer's Responsibility

• Since, there are various generations of robotic surgery machines available in the market, the accountability of the manufacturer company should be established to make the robotic surgery more promising.
• There should be clear guidelines for the liability of surgeons, hospitals, and other healthcare providers involved in robotic surgeries.

Current Status of Robotic Surgery in India

In 2000, AIIMS New Delhi became the first medical institute in India to have its surgical robot system. Since then, there has been a gradual increase in utilisation of robotic surgery in the medical field. In the year 2023, AIIMS, Delhi partnered with Medtronic to launch surgical robotics training centre.

The da-vinci robotic surgical system is available in top hospitals in India including Max hospital, Gurgaon , Fortis, Gurgaon for treatment for various forms of diseases.

As per data of 2021, there are over 75 robotic systems across India for medical treatment, and over 500 surgeons trained in robotic surgery.

The increasing availability of robotic surgical systems in India presents a significant opportunity to enhance healthcare access and quality. However, further investments in training, infrastructure, and research are essential to fully realise the potential of this technology.

Conclusion

Robotic surgery, the advanced form of surgery, can be differentiated from traditional open surgery and conventional laparoscopy, as it combines the surgeon's skills with robotic technology to enhance the quality and safety of surgical procedures.

In coming years, it's being expected that under assigned guidelines, robotic surgery can be adapted to a wide range of specialties, demonstrating its versatility and potential to revolutionise the field of medicine.