What is robotic surgery?
In the last couple of decades Surgery has experienced a revolution. Established and tried surgical techniques transitioned smoothly from open to minimally invasive surgery, mainly laparoscopic surgery.
The laparoscopic surgeon handles the tissues, not in direct view, but through a screen and with the help of special tools. Modern technology has played a key role in the development of laparoscopic surgery and the outstanding results of the method have earned it recognition both within the medical community and in the consciousness of patients.
In the 21st century, however, the revolution is Robotic Surgery, i.e. the introduction of robotic systems, guided by computers.
The first generation of surgical robots is already used broadly around the world. Of course, these are not autonomous robots that can operate on their own, but mechanical aids of surgeons. These machines naturally require operation by human surgeons and accept orders from them. These surgical robots are navigated by remote control and voice activation.
Robotics is now used in Surgery because it enables unprecedented control and precision of surgical instruments in minimally invasive procedures.
In robotic surgery, the surgeon is seated in front of a surgical console – PC, where he is able to view the surgical field on a screen, and performs the operation by moving special levers, which look like joysticks. The computer is the interface between the patient and the surgeon, offering invaluable information to the doctor and greatly facilitating his work. The robotic system, through digital analysis, offers a perfectly accurate three-dimensional and magnified image to the surgeon, provides a detailed sense of the tissues, and essentially becomes the doctor’s assistant for the maximum benefit of the patient. The surgeon’s commands through the levers are transmitted digitally, simultaneously and with precision, to the modular robotic arms, which perform the movements in the surgical field. The movements of the robotic arms are controlled 100% by the surgeon, who must be specially trained in the use of the robotic system.
The birth of robotic surgery
Robotic surgery is a reality thanks to robotic technology and tele-surgery. Digital analysis has made it possible to transfer information over long distances, giving impetus to tele-surgery. Until recently, it was unthinkable to perform surgery from a distance, i.e. without the patient and the surgeon coexisting in the same place. This restriction led NASA and the US military to launch research to create a way for astronauts to be operated on by doctors on Earth, and soldiers who risked their lives on the battlefield by doctors at a remote and safe place!
Moreover, with its overwhelming acceptance by the surgical community, it exacerbated the need to overcome the limitations of laparoscopic surgery. Thus, robotic surgery was developed to offer more flexible tools with more freedom of movement, a more ergonomic position of the surgical team, and a three-dimensional and more accurate view of the surgical field.
Robotic surgery was finally developed to remove the limitations that existed in performing operations in microscopic and limited surgical fields, opening new horizons in surgery and pediatric surgery.
In 1985 the PUMA 560 robotic system was used to perform CT-guided brain biopsies.
In 1988, the PROBOT system, developed at Imperial College London, was used in prostate surgery.
The ROBODOC system of Integrated Surgical Systems was launched in 1992 to accurately sculpt hip surfaces during arthroplasty and hip replacement.
Further development of robotic systems was carried out by Intuitive Surgical with the construction of the da Vinci system and by Computer Motion with the robots AESOP and ZEUS.
Intuitive Surgical bought Computer Motion in 1994 and stopped developing ZEUS. The DaVinci system has been approved by the FDA for a wide range of surgical procedures including radical prostatectomy for prostate cancer, hysterectomy and mitral valve repair and is used in more than 800 hospitals in the United States and Europe.
The da Vinci system was used in 48,000 operation in 2007 and costs about $ 1.2 million.
In May 1998, Dr. Friedrich-Wilhelm Mohr performed the first robotically assisted coronary artery bypass grafting at the Leipzig Heart Center in Germany using the DaVinci system.
In 2001, J. Marescaux performed a cholecystectomy on a patient in Strasbourg, France while he was in New York (Lindberg operation).
In Greece, the first robotic surgery was performed by K. Konstantinidis and his scientific team (Athens Medical Center) in September 2006.
The first announcement of performed robotic operation from Greeks was made in February 2007 at the 2nd World Conference on Robotic Surgery (MIRA 2007) in New York, USA.
What are the advantages of robotic surgery?
Robotic Surgery is a minimally invasive and traumatic method, due to the precision of surgical maneuvers. Also, robotic surgery:
- Ensures minimal blood loss and less pain
- Minimizes the possibility of intraoperative and postoperative complications
- Significantly reduces hospital stay
- Ensures faster recovery
- Provides better cosmetic outcome
- Overcomes the limitations of the laparoscopic method (two-dimensional image or unstable image, loss of degrees of freedom and sensation, ergonomic problems for the surgical team)
- Allows the surgeon to have a three-dimensional (3D) image of the surgical field, at an exceptionally large magnification
- Ensures greater accuracy in surgical movements. As the surgeon’s handlings on the console are converted into movement of the surgical arms, the normal trembling of the hands is almost eliminated, resulting in an unprecedented surgical skill.
- Enables the surgeon to perform difficult surgical procedures. The surgical tools of the robotic arms can carry out all the movements performed by the human hand (7 degrees of freedom in movement), with greater skill and precision, while rotating almost 360o in the surgical field.
- Provides the surgeon with greater comfort during the operation. Unlike conventional surgery, robotic surgery allows the surgeon to perform the operations while sitting, in a carefully designed and ergonomically excellent environment. In this way the surgeon’s strain is reduced, with particularly important advantages, especially in cases of difficult and long operations.
- Enables the surgeon to prepare the operation on the computer, using the images of the internal organs of the patients that result from their examinations. The surgeon can also recall on his screen during the operation and consult useful images.
Applications of robotic surgery
Robotic surgery can be applied in many specialties of surgery, such as general surgery, surgery for morbid obesity, cardiac surgery and thoracic surgery, vascular surgery, pediatric surgery, urology, gynecological surgery, gynecology, and endocrine gland surgery.
The most common laparoscopic procedures that are performed today are robotic, thus multiplying the important advantages that laparoscopic surgery provides for the patient: surgery for morbid obesity, cholecystectomy, treatment of obstructive pulmonary disease, the surgical treatment of gynecological diseases, prostate surgery, nephrectomy, endocrine surgery, and plenty more.
What is the da Vinci surgical system
The da Vinci surgical system is the first robotic surgery system approved by the US Food and Drug Administration (FDA) for surgery. It is a product of Intuitive Surgical, which combines the surgeon’s fine skills with computer-aided robotic technology.
It is divided into three parts: The robot with the special arms, the endoscopic tower, and the surgical console.
The surgeon directs and coordinates the whole system through the surgical console, having in front of him an enlarged and three-dimensional image of the surgical field. The surgical console has handles, where the surgeon places his fingers and moves the special levers as if using his hands.
Every movement of the surgeon is reproduced with absolute accuracy and stability in the surgical field by the surgical arms of the robot, which is usually placed to the left of the patient. The surgeon’s team is also there. The surgeon through special lenses perceives the surgical field and communicates and cooperates with the robot and the rest of the surgical team.
The endoscopic tower includes two video cameras, automatic image adjustment system, high-definition video monitor and other useful devices.
The design of the da Vinci surgical system began in 1995 and from 2000 until today it is used in more than 350 hospitals worldwide, while its use is spreading rapidly in recent years, due to its significant advantages.