Robotics in Medical Surgeries

The last twenty years was a time of revolutionary changes in technologies surgery. There became a new category of surgery - minimally invasive surgery, which gave an oppotunity to minimize surgical trauma and likelihood of complications, shorten hospital stay, and postoperative rehabilitation. Further development of the working methods of minimally invasive surgery was the use of special robotic systems in the wide surgical practice, greatly improving the accuracy of surgical procedures. Robotic execution of operations is new and extremely promising direction in various branches of surgery. There is a clear trend towards robotic devices used in medicine, robotic surgery is evolving. Field of its application is not fully defined, and the number of studies which are aimed at identifying advantages and disadvantages of this method of operations, are negligible, but they are (Anthony et al., 2004).

A surgical robot is a device that is controlled by computer and programmed to assist in manipulation and positioning of surgical tools, letting the doctor to perform more difficult tasks. The systems at present were not designed to act without human surgeons or to swap them. Rather, these extensions acting as remote machines completely directed by the surgeon, and therefore can be uttered as Master-Slave manipulators. FDA (U.S. Food and Drug Administration) has approved two master-slave systems and are in use. It includes the “ZEUS system” (Computer Motion, CA) and the “Da Vinci Surgical System” (Intuitive Surgical, California). 

In the mid 1980s, robots started performing medical surgeries. The first medical surgeries by robot “PUMA 560” was carried out in 1985 and used for brain biopsy. Later on, robots used for hip replacements and prostate surgery. The da Vinci Surgical System was introduced in the late 1990s for mitral valve repair, prostate cancer surgery and hysterectomies. This system has three components namely, high definition three dimensional system, four arms that can be controlled remotely, and a console for the surgeon. 

There are several advantages and drawbacks associated with performing medical surgeries by Robots. These surgeries can be carried out remotely that is helpful when human (doctors/ surgeons) experience lack of skilled professionals in a certain area. Robots performing medical surgeries have the advantages of making use of tinier incisions leads to decreasing the time of healing for patients. In comparison to surgeons, surgical robot arm has much greater articulation that provides surgeons more flexibility. In addition, the system of 3D offers the surgeon an improved visibility (Latifi, 2010).   

The foremost advantages of robots performing medical surgeries are quicker healing time, less pain, decreased blood loss, smaller incisions, miniaturization and precision. Additional benefits are articulation of three-dimensional magnification and ahead of normal manipulation. In the same way, robotic surgery facilitates in shorter hospital stay, decreased blood loss, decreased use of anesthesia, decreased risk of infection, decreased post-operative pain, more complete and faster recovery, as well as helps patient in quicker return to daily routine.

  When using robots appears minimal number of complications: less than 1% of wound infection or hernia formation, disruption of bowel, bowel injury, bladder and urethra, which require additional operations, less than 1% of bleeding, bruising, and needed a blood transfusion(Cadierre, 2001).

The “Robot Institute of America” (RIA) describes a robot as a programmable Multipurpose handling device for moving material, work pieces, tools or special equipment. The freely programmable motion makes available for a wide variety of tasks. This makes it possible to use in the medical environment, in which the robot involves in surgical operations. The use of robots in medicine is a very young field. Several Robotic systems have been or are used, and assist physicians in surgery. Robot may have several advantages over a surgeon (e.g. higher accuracy and better sensors) and support him in his work or parts of the work. However recently, there are negative reports about robots, showing that it can have some disadvantages for the patient. In this paper we are explaining what a robot is, how it is constructed and how it works. At the end, we will discuss its pros and cons.

Telepresence Surgery and distance teaching in robotics (Telementoring) are two innovative applications, linking a robot to a telecommunications system i.e. SOCRATES (Computer Motion). In telerobotic measures, the remote surgeon controls the from a console that is amazingly far from the slave robot arm operating the patient. The first major surgery of transatlantic telerobotic cholecystectomy was carried out by surgeons in New York (USA), to a patient is Strasbourg (France) in 2001. This technology was initially developed by the US military to remotely operate the wounded soldiers from their own country. This is not a matter of joke as the remote surgery of a patient is now a reality and one expert surgeon can easily operate anytime and anywhere  supported that the this equipment is available or not.

There are a number of pros of performing medical surgeries such as incisions are small. In traditional surgery of open-heart, the surgeon has to cut 10 to 12 inches in order to get access to the heart by spreading open the rib cage and splitting the breast bone (sternum). Then, the patient is positioned on a machine of heart-lung and the patient’s heart stopped for a while for the operation. This method possibly leads the patients towards postoperative pain and infection, along with longer time for complete healing. Since, after robot-assisted heart surgery the recovery of patient is faster and the stay at hospital is shorter and patient possibly leaves the hospital earlier, 2 to 3 days before the patient have undergone conventional surgery of open-heart, as well as the efficiency will also be increased and about 50 percent more quicker to return to work. The reduction in the recovery time not only benefit patients but also to hospital and its staff because less number of people required during surgery, the overall cost of hospital stays, and lessens nursing care required after surgery.  

In comparison to approaches of minimally invasive surgery, the surgery performed by robots provides the surgeon a better view of the surgical site, along with an improved and enhanced control over the surgical instruments. Furthermore, Robots performing medical surgeries reduced the pressure from surgeons as now they do not need to stand throughout the surgery. As expected, hand tremors are monitored by the computer software of robots. Lastly, the robot performing surgery may constantly be used through rotating teams of surgery (Faust, 2007).

Besides its effectiveness, it possesses some serious threats and concerns. Everybody can easily understand the fact, that robotics involves the efficient control of steeper motor by complex programming. This programming is done, in order to effectively operate the motor and ultimately the robotic arms as a result. If there is any flaw or a problem in the programming, then the consequences can be very bad. Moreover, any problem in remote connectivity at delicate stages in operation can produce very serious results. So this technology has huge amount of concerns than positive impacts.

More of its disadvantages include its size, time and cost. Because of its huge size, it is not easily portable and cannot be used for emergency treatments. Robotic technology occupies much space in the operating rooms, where must be nurses and surgeons, because its has a very bulky equipment. Surgeons can not confidently cope with robotic arms because they hold down their movements in a small operating rooms. The cost factor is also a big hurdle in this issue, as this technology requires a huge amount of money for installation and maintenance. BrownUniversity reported that an average cost on the heart surgery had increased because of the use of robotic equipment. The cost became higher ($2,000) than those performed by surgeons. It takes much more time for the robotic arms to complete the operation than it is done by the professional surgeons.This factor also makes this equipment, a thing with more concerns than positive points. We can only wait to see, what results will come when this technology gets a bit more advanced and more improvements will be made to the existing system.

Thus , the use of robotics in surgery is a logical continuation and development of the new level trends in minimally invasive surgery, but every technology has many  pros and cons in the way of development. Certainly, all patients can not be operated with the use of robotics. Therefore, it is necessary to develop the technology and the definition of  indications for its use. So, there are two options to resolve the problem of cost and size, but they are very expensive: to make the equipment smaller or to expand the operatin rooms to accommodate staff and robotic technology.