Robotic surgery: Future is already here

The minimally invasive surgery, also known as keyhole surgery, is a surgical technique designed to minimize the trauma inflicted on a patient during major surgeries. Laparoscopy is the most used form of minimally invasive surgery, especially for gall bladder removal, and has been practiced worldwide for the last 90 years. However, laparoscopic surgery has some limitations, such as a lack of 3-dimensional vision and limited movement of the surgical instruments. To improve upon these limitations, robotic technology evolved.

Surgical robots were first approved by the FDA in the early 2000s to assist in minimally invasive surgery. The “da Vinci robot” by Intuitive Surgical was the first of its kind, and it provides surgeons with enhanced visualization, dexterity, and precision during the procedure. The da Vinci robot is made up of four main components: the surgeon console, patient-side cart, Endo Wrist Instruments, and Vision System. It allows the surgeon to sit at a console and get a magnified three-dimensional view of the surgical field with real-time progression of the instruments.

While robots have replaced humans in some industries, in the medical industry, it is still the human being, i.e., the surgeon, who operates the robot to perform a particular surgery. The robot can filter out hand tremors and control unnecessary movements, but it cannot replace human skills. Several robotic machines are being evaluated for clinical use in various specialties, with four already available in the Indian market. One of them, called Mantra, has been developed by an Indian company called SS Surgical Innovation and is available at one-third of the cost of the da Vinci Robot. The other two are Versius by CMR Cambridge and Hugo system by Medtronic.

In India, the first robotic radical prostatectomy was performed at Aiims, New Delhi in July 2006, and since then, there have been over 100 installations in India, with most of the high-end work in urology surgery being done by robot assistance. The real indications for robot assistance are radical prostatectomy for prostate cancer, radical cystectomy for bladder cancer (in some patients), partial nephrectomy for renal cell cancer, reconstructive surgery for defects in the kidney and ureters, etc.

For kidney cancers, the robot offers advantages over laparoscopy by providing better magnification, suturing of the defect created by the removal of the tumor, and better vision to have a safe and complete removal of the tumor. It is particularly useful for obese patients. The use of the robot for a kidney transplant is an evolving indication, mainly in obese recipients, but superior outcomes in terms of kidney graft function have not yet been established.

While the surgical robot is an excellent tool for minimally invasive surgery, it is important to consider the cost and real advantages of the technology for patients. Acquiring a surgical robot is a capital-intensive venture, and healthcare budgets are already skyrocketing. The robot has its limitations, and the propaganda by the industry to promote it is killing the laparoscopic skills by creating a belief that robot is better than laparoscopy for most of the surgeries. One of the examples is removal of the gall bladder, which could easily be done with laparoscopy but is being promoted for robotic way.  Patients should discuss the real advantages of robot in terms of overall gains as laparoscopic surgery is a proven method for performing many types of surgeries, such as gallbladder removal, kidney removal, large kidney stone removal and hernia repair etc.,  and should not be overlooked.



Views expressed above are the author’s own.


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