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Robotic surgery is one of the most compelling medical trends of the 2000s and 2010s. Doctors and patients alike are eager to take advantage of the superior precision and minimally invasive surgical protocols that robot-assisted or wholly robotic surgery is known for.
Many people may have heard of robotic surgery, but most people are probably unfamiliar with the details.
On this page, we’ll explain the different types of robotic surgery, standard robotic surgery procedures, and the costs of robotic surgery for patients and hospitals.
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What Are The Types Of Robotic Surgery?
Robotic surgeries are distinct from each other on the basis of their intended application. For instance, surgery robots for general surgical use have different capabilities than surgery robots for specific purposes like neurosurgery or spinal surgery.
When most people think of robotic surgery, however, they’re thinking of the general use of surgical robots which are capable of performing a wide range of operations as well as a handful of specialty surgeries, provided that the appropriate surgeon is operating the robot.
At present, all robotic surgeries are conducted under the direct and total control of the human surgeon. Thus, while robotic surgery uses robotic arms and manipulators and is very technology-intensive, it’s still fundamentally a manual process in which careful human attention is required at every part of every step.
Automated surgeries are not yet approved by regulatory authorities, though there are a number of compelling surgical automation suites that may help the surgeons of the near future reduce the number of errors during repetitive and sensitive surgical techniques.
All types of robotic surgery share a few things in common.
Specifically, robotic surgery utilizes laparoscopic cameras on thin filaments such that the surgeon can see exactly what is going on inside of the patient’s body throughout the operation. Similarly, robotic surgery suites have a handful of different instruments that are mounted on robotic arms or long robotic filaments.
When the surgeon makes an incision using the robotic filament, the robotic arms are then adjusted to hold the keyhole open to allow for unobstructed access for the other instruments. Next, surgical tools enter into the patient, and the surgeon can make subsequent cuts or manipulations.
Regardless of the type of robotic surgery in question, it’s clear that the majority of robotic surgeries are minimally invasive.
Taking cues from the successes of laparoscopic surgery, robotic surgical suites aim to provide surgeons with keyhole access to the patient’s interior. Compared to traditional laparoscopic surgery, robotic surgery can sometimes make fewer keyhole incisions in the patient, though this is not always the case.
In situations where a large incision is required, robotic surgery can also be used. However, in cases where operations are intended to be laparoscopic, and there is a significant complication requiring conversion to open surgery, surgeons may have a more difficult time when they use robotic methods.
Transplant medicine is one area where robotic surgery is unlikely to become established as quickly as in other areas. While robotic surgery suites are effective at breaking down organs and exfiltrating them safely through a tiny space, there is little hope for being able to remove an intact and healthy organ using robotic surgery alone.
Nonetheless, robotic surgery may have a role to play at the edges of transplant surgery, preparing organs for removal or preparing a recipient for their transplant in the operating room.
Different surgical systems have varying capabilities as far as the types of procedures they can perform. Some systems qualify as “robot-assisted” surgery systems rather than fully robotic surgery systems. In contrast, others, like the ZEUS and the Da Vinci robotic surgery systems, eliminate nearly all manual human effort during surgery except that which is required to operate the surgeon’s console.
The Da Vinci Robotic Surgery System
Many people have heard of Da Vinci robotic surgery. Since its debut in the early 2000s, people have been fascinated by the Da Vinci system’s high-tech approach to the operating room. The Da Vinci robotic surgery system is comprised of a handful of different surgical tools mounted on robotic arms as well as a console for the surgeon.
Much as with other robotic surgery systems, the Da Vinci requires a human operator as well as a nurse support staff. However, the support staff may not intervene until the robotic phase of the surgery is completed if things are going well.
The Da Vinci system is currently used for a handful of different procedures ranging from urology to gastrology. In the surgeon’s console on the Da Vinci, the surgeon has a set of widescreen displays that they sit in the middle of. The console displays the view from the laparoscopic camera as well as information about the physical state of the robotic equipment. From this nerve center, the surgeon prompts the unit’s robotic arms to undertake the actions that they desire.
In the years since the Da Vinci’s debut, advanced data has been integrated into the surgical process. Surgeons can create 3D images of the patient’s tissues so that they can better understand how to proceed with the surgery.
Likewise, surgeons can create digital simulations of the intended movements of the robotic arms, which are overlaid onto the 3D image of the patient’s tissue. Thus, before the surgeon proceeds with the next step of the surgery, they can know precisely what is going to happen, much like how they’d visualize the following action of their hands and fingers during a manual surgery.
The Da Vinci system costs around $2 million per suite, though newer systems are more expensive. While the Da Vinci surgical suite has been faulted for its high costs on numerous occasions, it isn’t particularly more expensive than other robotic surgical suites.
Is Remote Surgery Possible?
Given that surgeons remotely control the robots necessary for robotic surgery, many people have questioned whether it might be possible to set up a robotic surgery unit with no surgeons on-site.
This was a particularly compelling possibility for the military, who funded the majority of the early investigation into the prospect of robotic surgery and helped to develop many robotic surgery prototypes.
In a hypothetical remote robotic surgery situation, the surgeon could be controlling the robot from across the world, with only nursing and other staff on-site to support the patient after the surgery has concluded. This would be advantageous if there were local support staff but no specialized surgeon for a particular type of operation required for a patient.
In other words, fully remote surgery could help to even out healthcare disparities caused by brain drain or extreme remoteness. Unfortunately, a fully remote operation remains a dream that has yet to be realized. Sophisticated robotic surgery suites like the Da Vinci still require the surgeon to be in the same room as their patient.
Furthermore, getting regulatory approval for fully remote robotic surgery will likely be difficult, as there aren’t any direct comparisons which could prove to regulators that remote operation would be as safe and as effective as in-person robotic surgery.
While there aren’t any fully remote robotic surgery systems in operation today, implementing the idea in the future will likely require a lot of testing first.
What Are Common Robotic Surgery Procedures?
A plethora of different surgeries can be performed robotically, but some surgeries are more common to perform robotically than others.
Prostate cancer surgery is the most common way that robotic surgery is utilized. In 2010, 86% of prostate cancer surgeries in America were performed robotically. Prostate cancer surgery is considered to be uniquely well-suited for robotic surgery, as the tight working area of the prostate and the surrounding region makes standard laparoscopic surgery or open-air surgery far more difficult.
Importantly, it seems that robotic surgery for prostate cancer is preferred among surgeons for the added convenience rather than as a result of superior outcomes for patients, however. Patient outcomes are no better via robotic surgery than awkward laparoscopic interventions. Both laparoscopic surgery and robotic surgery are preferable to open-air surgery.
In robotic hernia surgery or robotic umbilical hernia repair, surgeons can repair the bulging associated with hernias without making large incisions which cause patients to lose more blood, have more pain, and experience longer recovery times -- a critical set of concerns for injuries like hernias which may not be operated on if the risks are too high.
Thus, robotic surgery can extend the envelope of possibility concerning the types of hernias that are worth operating on in a way that laparoscopic surgery might not be able to.
Robotic gallbladder surgery, robotic cholecystectomy, and even colon resection surgery are also increasingly common. A robotic approach to these surgeries is highly preferable to an open-air manual approach, though most surgeons require extensive training with the robot before they are ready for action.
Because these surgeries are among the most common, transitioning a more significant proportion of surgeons to using robot surgeries will likely require a massive retraining effort over the next decades.
In robotic colon resection surgery, the surgeon’s robotic filament makes an incision inside the patient’s colon, which is subsequently folded over problematic areas, all without opening the patient’s abdominal cavity.
In robotic splenectomy, robotic adrenalectomy, and robotic colectomy, surgeons are even able to remove patients’ spleens and other organs without making a large incision. As the surgeon can’t remove the target organs in one piece, the robotic filament slowly cuts the organ into tiny pieces, which are stored in a small surgical bag inside of the patient.
The bag can then be removed through the keyhole opening in the patient once it is full. Thus, the patient’s problematic organs or cysts can be transferred bit by bit until the operation is complete. Colon removal surgery can be performed in a similar way.
The most significant difference between robotic keyhole ectomies and traditional ectomies is that the patient loses a lot less blood. The operation takes significantly longer as a result of the need to chop the organ into small pieces using the robotic filament’s very small scissors or cutting surfaces. The only bleeding occurs from the keyhole incision site, meaning that it is easily controlled and typically not extensive enough to require a transfusion.
If medical systems transition to robotic keyhole surgery for their ectomy needs, they’ll also find that they have a lower demand for blood from donors, leaving the blood for use in emergency situations.
Robotic neurosurgery is also becoming more familiar with the advent of tools like the NeuroArm, which can perform neurosurgery inside of an MRI machine.
What Are The Costs Associated With Robotic Surgery?
Robotic surgery costs are at the forefront of the discussion about robotic surgery. In most cases, robotic surgeries are more expensive than their laparoscopic or manual equivalents.
For a patient, a robot-assisted prostate surgery costs roughly $2000 more than a manual or laparoscopic procedure.
Robotic hysterectomy surgery costs as much as 33% more than standard laparoscopic surgery. Robotic hernia surgery costs appear to follow a similar rule. Less conservative estimates hold that robotic surgeries can be up to ten times more expensive than traditional laparoscopic surgery.
Hospitals may not necessarily make more money using robotic surgery, either. Robotic surgery suites like the Da Vinci have expensive servicing contracts, which can cost as much as $120,000 per year even before taking the cost of surgical disposables into account. Furthermore, some insurance plans may not cover robotic surgery when traditional laparoscopic surgery is available. This means that robotic surgery is out of reach for many people, at least for the moment.
However, as more surgeons opt for robotic methods, the cost of robotic surgery is likely to drop accordingly. Likewise, too many people in the medical community, the future is clearly one where robotic surgery will be the norm.
Is Robotic Surgery Better Than Other Types Of Surgery?
While there are some advantages associated with robotic surgery over conventional laparoscopic surgery and open-cavity manual surgery, it isn’t clear that robotic surgery is always superior to less technological methods.
The high costs of robotic surgery have consistently been cited as problematic from a resource distribution perspective of healthcare. Likewise, surgeons require extensive training to operate robotic surgery units.
Critically, when surgeons use a robot to perform surgery, they can’t always get the tactile feedback of their surgical instruments as they use them on the patient. Some of the newer robot surgical suites include tactile feedback features, but many of the most popular systems like the Da Vinci do not.
Robotic surgery can’t make use of the surgeon’s muscle memory or tactile intuition about how surgery should proceed on the basis of the surgical tools probing patient tissues. While the lack of tactile feedback is a significant difference between normal surgery and robotic surgery, it isn’t clear how big of an impact the difference actually causes for patients.
Robotic surgery recovery time may be shorter than other surgery modalities in some cases. However, the time that patients spend in the operating room is frequently significantly longer with robotic surgery.
For a typical prostate cancer operation, robotic surgeries can take around four hours, whereas they take only an hour and a half on average when performed manually.
Furthermore, patient outcomes are frequently very similar between laparoscopic surgery and robotic or robot-assisted surgery.
Nonetheless, many surgeons swear by robotic surgery systems, with few choosing to return to manual methods after investing the time in learning how to operate the robotic surgery systems.
Importantly, robotic surgery is superior to non-laparoscopic open-cavity manual surgery. The reason behind this is that as with laparoscopic surgery, robotic surgery can enter the patient in a small incision rather than a large one.
The patient will lose less blood and have a shorter recovery time. Less exposure to the open air during an operation also means that patients are less likely to have complications or contract infections as a result of getting the surgery.
Is Robotic Surgery Better than Standard Laparoscopic Surgery?
There’s some evidence that suggests that fully robotic surgery is superior to non-robotic laparoscopic surgery for certain types of procedures. This evidence frequently states that robotic surgery is prone to fewer complications than traditional laparoscopic surgery.
However, there is also evidence that the added costs of robotic surgery do not necessarily come with additional benefits for patients. This evidence sometimes suggests that the primary benefits of robotic surgery are actually for the surgical staff rather than the patients themselves, meaning that robotic surgery would still be preferable for most operating rooms to have as an option in the long run.
There are a few definite benefits of robotic surgery which have yet to be fully exploited by surgeons, however. In short, surgeons who use robots rather than traditional laparoscopic tools can perform more complex surgeries in smaller spaces.
This means that they can treat issues that wouldn’t be treatable with a standard laparoscopic set. Because the alternative to complex surgeries in tight spaces might be an open-air surgery if laparoscopic methods are unsuitable, the advantage of robotic surgery might be huge in comparison.
Robotic surgery itself could be classified as a subset of laparoscopic surgery in many cases. In many robotic surgeries, laparoscopic techniques are used, as the inflation of the patient’s body cavities with carbon dioxide to provide internal space for the surgeon’s tools to work. Similarly, the cameras, manipulators, and lights on robotic surgery units are comparable to those of the standard laparoscopic surgery set.
Perhaps the most significant advantage of robotic surgery over traditional laparoscopic surgery is that the surgeon doesn’t get fatigued during extended operations. While robotic surgeries tend to last longer than laparoscopic surgeries, in both laparoscopic surgeries and traditional open-air surgeries, surgeons are at a higher risk of their hands tremoring the longer the surgery goes on.
When surgeons have tremors due to fatigue, there is a significantly higher chance of them making an error during the execution of their surgical protocol. Thus, when using a robotic surgery system, the total number of errors caused by fatigue is close to zero, as the robotic manipulators do not get fatigued or less able to make precise movements over time.
There’s also a high chance that surgeons are less fatigued in other parts of their bodies when they use robotic surgery systems rather than traditional laparoscopic systems. In a standard laparoscopic surgery setup, the surgeon stands over the patient on the operating table while manipulating their surgical tools with the help of video displays and their support staff. This means that over the course of an hours-long surgery, the surgeon can get tired.
With a robotic surgery system, the surgeon is seated on a stool, peering into their surgical console, meaning that all of their energy can be directed to the task at hand. For marathon-length surgeries, this is a substantial advantage, and it also explains why surgeons who start to perform robotic surgeries are unlikely to return to older methods.
Like all medical procedures, however, surgeons with robotic tools are limited by the quality of the information that they have before the operation begins. Thus, for everything from gallbladder surgery to prostate cancer interventions, doctors and surgeons still need to run non-robotic medical tests and take careful patient histories.
Robotic Surgery Reviews
While patients generally report that they feel positive about robotic surgery, it is dubious whether or not patients could tell the difference between robotic surgery and traditional laparoscopic surgery. Given that robotic surgery results in slightly less time spent in recovery, it may be preferable for patients who are extremely time-sensitive.
Picking the right robotic surgery-enabled surgeon is critical in getting the best outcome for patients. This means that if you’re considering getting robotic surgery, you’ll need to find a surgeon who specializes in it rather than a surgeon who is trained in robotic surgery methods but does not actively use them in their practice all of the time.