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Robotics - The Future of surgery

"Would robot do my homework appa?" - asked my six year old as I sat in my study discussing about robotic surgery over the phone with my friend. When I returned back to my homeland after working as a Consultant Urologist and Uro Oncologist (Robotics) in UK, many of friends and relatives asked similar questions. It is also intriguing for many as what a robot does? Does it operate on its own? Will the surgeons become obsolete? How about patient care? To some who are slightly more informed-robotic surgery is a costly affair and patients can't afford it...

A surgical robot is a simple master-slave device which helps the surgeons to overcome many of the difficulties faced during an operation. Traditionally many operations were and are still performed by a large cut on the abdomen (for e.g. Cystectomy to remove the urinary bladder). Usually, the recovery and complete healing from these operations takes a while, in case of abdominal operations, up to 3 months. In addition, accessing certain parts of the abdomen would be difficult with an open operation, blood loss in these situations is inevitably higher and patients have a lot of post-operative pain etc. Many of these problems were overcome with introduction of Laparoscopy. In the last 25 years, Laparoscopy has become the standard method fora majority of abdominal operations.

Laparoscopy provides a magnified view, results in small cuts in the abdomen, quicker recovery, reduced post operative pain and less blood loss. But, Laparoscopy has limitations; 2D vision, limited range of movements of the instruments, long period of learning for the surgeons. In order to overcome the limitations of Laparoscopy and open operations, but take into good aspects of this technique, surgical robotics was introduced.

In the last 10 years, the uptake of these machines throughout the world especially in US, Europe including UK and Australia is extensive. In India, these machines are becoming popular with the hospitals in major cities investing in these machines. In Chennai, Apollo Hospitals has surgical robotics and the usage is progressively increasing.

The surgical robot has three components; console (where surgeon sits and operates with magnified 3D vision and can control the instruments with great precision), patient cart (the robotic arms along with their instruments are attached to the patients) and vision cart (with a 2D vision and other essentials). The operation is performed by the surgeon through the robot (and not by the machine itself!).

Robotic surgery has distinct advantages. It gives the surgeon a magnified 3D vision of the part requiring the operation and allows surgeons to do the procedure with great precision. This advantage is gained by the fact that the robotic instruments has great freedom of movements like, or even more than a human wrist (laparoscopic instruments lack this advantage). Though the instruments are much smaller than a wrist but have the advantage of a great amount of movement, highly precise operations become feasible. And for the same reason, blood loss in robotic surgery is far less, recovery of patients' bodily function is much quicker and the post operative pain is much less. Overall, robotic surgery allows the surgeon to perform a high quality operation for their patients.

Initially introduced for Cardiac surgery, surgical robots became popular in Urology. In particular, performing complex, yet high quality Cancer operations along with preservation of vital structures became feasible with the surgical robot. Eventually, this machine has now become a standard instrument in an Urology theatre, particularly in the developed countries. In addition to Urology other surgical specialities have now taken up robotic surgery. Gynaecology, General surgery (including Bowel, Liver, Pancreatic surgery), Head and Neck surgery are progressively adopting this approach.

Disadvantage of the surgical robot is the cost. Currently, there is only one provider for this machine and hence the costs are reasonably high and therefore the cost of a robotic operation is high as well. However, this higher cost is offset by quicker recovery of the patient from the operation, reduced hospital stay, reduced need for medications, quicker recovery of bodily functions (for e.g. urinary continence and sexual functions) and quicker return back to work. Hence the overall expenditure for and after a robotic surgery is balanced compared to the traditional open or laparoscopic operation. In addition, surgeons need training to use the machine and its instruments safely.

Robotic surgery with its distinct advantages allows surgeons to perform high quality operations for both cancers and non-cancerous conditions. Laparoscopy, when introduced initially, was criticised by the professionals and public as a non-starter and costly affair. Today, almost every hospital has laparoscopic facilities and numerous operations are performed every day. Robotic surgery, with its advantages beyond laparoscopy and traditional open operations, no doubt is the future of surgery. However, I am not sure whether it can help my daughter do her home work!!

Dr Narasimhan Ragavan
MS, FRCSEd, MD(UroOncology), FRCS(Urol), Fellow in Robotics and Laparoscopy (Germany)
Consultant Urological Surgeon and Uro Oncologist, Apollo Hospitals, Chennai

 
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