Surgical Robot and Advantages of Robotic Surgery

What is a surgical robot? 

A surgical robot is a computer-controlled device that can be programmed to aid the positioning and manipulation of surgical instruments.

The goal of robotic surgery is to use a minimally invasive approach to perform procedures which are generally performed by laparotomy or are too complex for conventional laparoscopy or surgeons who are novices in laparoscopic surgery.

Advantages of robotic surgery: The major advantages of robot-assisted over conventional laparoscopy are:
 

1. Superior visualization: Conventional laparoscopy provides two-dimensional (2D) imaging of the operative field. A robotic system affords a 3D vision while allowing rapid zooming and panning of the camera. The newer systems have enhanced visualization with automatic white balancing, calibration, and focus.

    

2. Mechanical improvements: A fulcrum effect is created when rigid conventional instruments pass through the incision, thereby leading to inversion of movement from the surgeon’s hand to the working end of the instrument. When an instrument is introduced into a trocar, the abdominal wall is the fulcrum. When a surgeon’s hand moves in one direction, the instrument moves in the opposite direction. If a patient is obese, there is more torque placed on an instrument and the rigid smaller caliber instruments, such as laparoscopes, may fracture. Robotic instruments are less likely to break, thus, many surgeons prefer robot-assisted laparoscopy in patients with obesity. This is because all robotic instruments are 8 mm wide and attached to the robotic arms, which in turn are attached to the robotic cannulas (trocars). The force that the abdominal wall places on each instrument is sustained by the trocar and mechanical robotic arm. The robotic laparoscope is 8 or 11 mm in diameter and is also introduced through a trocar, which is docked to the robotic scope arm. In contrast, conventional laparoscopy is performed with 3 or 5 mm instruments that are introduced through smaller trocars. Also, similar to the human arm and hand, robotic instruments have seven degrees of freedom, which allow wrist-like or “EndoWrist” movement that facilitates suturing, especially for trainees. Conventional rigid laparoscopic instruments only have four degrees of freedom. While flexible laparoscopic instruments (eg, Autonomy Laparo-Angle) can also move with seven degrees of freedom, their use requires additional training because the movements are not intuitive. For comparison, all electrosurgical robotic instruments are available and wristed except the harmonic scalpel, which is not wristed.
    
3. Stabilization of instruments within the surgical field: In conventional laparoscopy, small movements by the surgeon are amplified (including errors or hand tremor). Robot-assisted surgery minimizes surgeon tremor.

    

4. Improved ergonomics for the operating surgeon: Having the surgeon be seated while using telerobotic systems provides significant ergonomic benefits, particularly when compared with conventional laparoscopy and open abdominal surgery. While being seated appears to improve ergonomics for all surgeons, not having to stand for long periods may be of particular benefit for surgeons who are pregnant, those with orthopedic or mobility limitations, or those who are operating on patients with an elevated body mass index.

REFERENCES:

1)     Herron DM, Marohn M; SAGES-MIRA Robotic Surgery Consensus Group. A consensus document on robotic surgery. Surg Endosc. 2008 Feb;22(2):313-25; discussion 311-2.

2)     Oppenheimer P, Weghorst S, MacFarlane M, Sinanan M. Immersive surgical robotic interfaces. Stud Health Technol Inform. 1999;62:242-8.

3)     Moss EL, Sarhanis P, Ind T, Smith M, Davies Q, Zecca M. Impact of Obesity on Surgeon Ergonomics in Robotic and Straight-Stick Laparoscopic Surgery. J Minim Invasive Gynecol. 2020 Jul-Aug;27(5):1063-1069.

4)     Wee IJY, Kuo LJ, Ngu JC. A systematic review of the true benefit of robotic surgery: Ergonomics. Int J Med Robot. 2020 Aug;16(4):e2113.