Kudrat Ghotra – McMaster University
When we think of “robot arms”, the first image that comes to many resembles science fiction. But these aren’t fantasy; they exist in medicine today. It is a prime example of how technology combined with biology has revolutionized the field of medicine.
Robot-assisted surgery has been utilized since the 1990s, although its roots began earlier. In the 1980s, researchers began exploring the use of robotic technology to enhance surgical procedures. The first documented robot-assisted surgery took place in 1985 when the PUMA 560 robotic surgical arm was used for neurosurgical biopsies.5 In the late 1990s, the da Vinci Surgical System was introduced, which turned out to be a milestone in invasive surgeries as it was the first FDA-approved robot for medical procedures.2
Today, robots are far from autonomous and do not perform surgeries independently. Instead, robots are used as tools, much like scalpels used in surgery by a surgeon. In robot-assisted surgeries, surgeons control robotic arms to perform precise, intricate surgeries, which are often minimally invasive, but robot assistance may also extend to open surgeries.
A typical clinical robotic surgical system includes a camera arm offering a 3D high-resolution view of the surgical site. Mechanical arms with surgical tools are connected to the system. Surgeons sit at a console and look through a lens which allows views of the area. They perform movements at the console which translate to movements of the robotic arms, allowing for delicate maneuvers in the body.
The goal of robot-assisted surgery is to minimize incisions and trauma to the patient. This approach is minimally invasive and aims to decrease complications like infections, reduce pain, minimize blood loss, shorten hospital stays, expedite recovery, and result in fewer scars for patients.3,4 Using robots as tools enhances a surgeon’s abilities during complex procedures, making hard-to-reach areas more accessible. This is because robotic arms surpass the range of motion of a human wrist, making procedures more efficient. Additionally, this technology enhances safety for surgeons, preventing injuries and extending their careers.5
Today, these surgeries can be performed for various procedures such as appendicitis, bladder cancer, gastrointestinal cancer, cardiothoracic surgery, kidney disease, weight-loss surgery, and lung masses.4
While these surgeries have provided great advantages, several challenges and concerns exist. The high cost of acquiring and maintaining these machines, typically around 2 million USD for a standard setup, restricts their availability in certain healthcare settings.6 Moreover, experienced surgeons must learn to use these devices effectively, requiring an investment of time and effort. Additionally, as with any machinery, ensuring patient safety in the event of technical glitches during surgery remains an ongoing area of advancement in this field.7
Although this technique may be safer, is it better? Studies have shown that robot-mediated surgeries take longer and mostly show the same results compared to other, more common, techniques. For example, up to 9 percent of laparoscopies led to further surgical intervention, but so did 8 percent of robot surgeries. In gastrointestinal surgery, life-threatening complications ranged from 0 to 2 percent in robot surgeries, but 0 to 3 in laparoscopies and 1 to 4 percent in open surgeries. Further, 12 percent of laparoscopies result in a surgeon having to take over and do an open operation. That number is only down to 8 percent with robot surgeries. The difference may be in the surgeons and their expertise, which may outweigh any technique used to perform these surgeries.6
As technology continues to advance, perhaps performing intricate surgeries will become easier with higher efficacy, and robotic interventions will show enhanced outcomes relative to more widespread surgical procedures. While it is unlikely that surgeons will be replaced by machinery in the immediate future, these technological assistants can revolutionize medicine in ways yet to be fully recognized. Only time will reveal the extent of these transformative possibilities.
Works Cited
1. Shah J, Vyas A, Vyas D. The History of Robotics in Surgical Specialties. Am J Robot Surg. 2014 Jun 1;1(1):12–20.
2. Felilx E. General Surgery News . 2021 [cited 2023 Dec 11]. The History of Robotic-Assisted Surgery. Available from: https://www.generalsurgerynews.com/Opinion/Article/09-21/The-History-of-Robotic-Assisted-Surgery/64651.
3. The Mayo Clinic [Internet]. 2022 [cited 2023 Dec 11]. Robotic Surgery . Available from: https://www.mayoclinic.org/tests-procedures/robotic-surgery/about/pac-20394974.
4. Partridge J. Mayo Clinic Health System. 2022 [cited 2023 Dec 11]. Robotic surgery increases precision, shortens recovery. Available from: https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/robotic-surgery-precision-and-recovery.
5. Cleveland Clinic [Internet]. 2021 [cited 2023 Dec 11]. Robotic Surgery. Available from: https://my.clevelandclinic.org/health/treatments/22178-robotic-surgery.
6. Bakalar N. The New York Times. 2021 [cited 2023 Dec 11]. Are robot surgeries really better? Available from: https://www.nytimes.com/2021/08/16/well/live/robotic-surgery-benefits.html.
7. Hayward J. Outpatient Surgery . 2018 [cited 2023 Dec 11]. When the Robot Malfunctions. Available from: https://www.aorn.org/outpatient-surgery/article/2018-December-when-the-robot-malfunctions.
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