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Breakthroughs in Robotic Surgery

written by gwyneth campbell Apr 27, 2024

 Robotic surgery has emerged as a highly effective alternative to traditional surgery in various cases. It is now the preferred method for treating certain conditions due to its minimally invasive nature. Additionally, robotic surgical techniques can minimize patients' recovery time and improve their postoperative outcomes.

Uses of Robotic Surgery

Applications of robotic surgery in cardiology

Robot-assisted surgery is common in cardiology. One such procedure involves the mitral valve, which carries blood from the left atrium to the left ventricle. If the mitral valve is defective, blood may flow backwards into the left atrium, reducing the amount of blood that reaches the rest of the body. This can lead to symptoms like shortness of breath, edema (swelling), heart palpitations, and fatigue. In mitral valve repair and replacement, a surgeon operates directly to correct the narrowing or leakage of the mitral valve. This can be achieved in two ways: traditional surgery or robotic surgery.

Traditional surgery involves separating the rib cage in a procedure called sternotomy. This approach allows the surgeon to fully expose the heart valve and make necessary repairs without impediments. However, open-heart surgery results in cosmetic alterations, typically leaving the patient with an 8-to-10-inch scar and a long recovery time. This recovery phase requires supervised physical therapy and movement restrictions for 4-6 weeks.

According to a 2013 study, robotic mitral valve surgery is the most performed robotic operation in cardiology. It allows a surgeon to repair or replace the valve without causing substantial damage to the patient’s chest bones and muscles. Patients experience less pain, spend a shorter time in the hospital, and achieve a quicker return to physical fitness after robotic surgery.

However, robotic mitral valve surgery does have limitations. It requires the supervision of a team specially trained to operate robotic medical machinery. When a patient has undergone a previous sternotomy, moderate pulmonary dysfunction, or coronary artery disease requiring the placement of a stent, amongst other conditions, manual surgery is recommended.

Robotic surgery in neurology

Robotic devices can be used to perform high-stakes operations in neurology. In fact, the first robotic surgery was a neurosurgical biopsy conducted in the 1980s. Robotic tools can help surgeons reach areas of the brain that are hard to access with traditional tools and remove tumors through small incisions. Robotic surgery is mostly used for specific cases in neurology where the target region is small, deep, and localized. 

Robotic surgery in urology

Robot-assisted surgery has recently gained traction in urology. Robot-assisted radical prostatectomy (RARP) is the standard procedure for the removal of prostate cancer. Over the past couple of decades, RARP has emerged as the most common surgery for prostate removal in the U.S., which is used for 70-85% of radical prostatectomies in 2015. RARP’s popularity in this field is due to its non-invasiveness, as it can remove cancerous tissue without causing significant harm to the rest of the body. Post-surgery outcomes are better for patients who undergo RARP, including a decreased chance of urinary incontinence and an increased return to function. 

History of robotic surgery

Robot-assisted surgery was developed in the late 1960s but was not regularly employed until the late 1980s. In response to a lack of long-distance medical care available to soldiers stationed in remote areas, a series of distinguished researchers began to consider the possibility of remote-controlled robotic surgical tools. Remote surgical devices would allow surgeons to perform life-saving surgeries on wounded soldiers from miles away. They would also advance medical technology.

Scott Fisher, a researcher from NASA’s Ames Research Center, invented the first virtual reality 3D simulation, allowing the surgeon to observe their work through a head-mounted display. Furthermore, Stanford Research Institute biomedical engineer Philip S. Green and plastic surgeon Joseph Rosen patented the first robotic surgical device, the Green Telepresence System, in 1987. It included cameras, stereo displays, and a complex operating system. The Green Telepresence System allowed the surgeon to control the movements of the machine’s operating arms.

Today, the Green Telepresence System is known as the progenitor of the da Vinci® surgical system. The da Vinci® surgical system remains the premier robotic surgical system, with over 60,000 surgeons globally trained in its use. Currently, there are 5,500 models under the brand worldwide. The da Vinci® system is commonly employed in the fields of urology, cardiology, nephrology, and gynecology.

Created in 2000 in compliance with FDA regulations, the first version of the da Vinci® system was released in Europe in January 1999 for the field of cardiology. It comprises three components: the surgeon console, the patient trolley, and the imaging system. The patient trolley, often perceived as the “robot”, featured three arms, one housing the camera and two others executing incisions according to the surgeon’s directions from the console. Subsequent versions of the robot were equipped with three or four arms. The da Vinci® system grew in popularity as its practical applicability became apparent.

Although the Green Telepresence System led to the da Vinci® system, separate robotic models coexisted in the 90s. The AESOP® robotic surgical system, developed by Yulun Wang of California company Computer Motion, was approved by the FDA in 1994. The first version was manually operated with foot pedals, while the second version featured a remote voice control system, enabling the surgeon to operate the robotic arm by speaking. Subsequent developments allowed the surgeon to change the position of the operating table and room lighting through voice commands.

Future of robotic surgery

During the fourth quarter of 2023, the da Vinci® surgical system generated $1.93 billion for its American manufacturer, Intuitive Surgical. Its future appears secure, as its patent and marketing strategy facilitate its dominant position in the robotic surgery industry. The da Vinci® surgical system is widely used for prostate cancer surgeries, with the majority of urology residency programs equipped with one. Moreover, there is an increasing demand for the da Vinci® system in the fields of gynecology and neurology.

In the future, various robotic systems will enrich the market. These include the Asensus Surgical robots, which include the Luna platform. Luna robots have an integrated format comprising an operating surgical system and artificial intelligence. They are predicted to compete with the da Vinci® surgical system. The Luna system’s standout features include dexterity, a wide range of motion, and a cloud platform enabling the robot to provide information to the surgeon. The British medical device company CMR Surgical patented Versius, described on its website as a “uniquely small, modular & portable surgical robot”. Versius is unique in that it only has one arm, making it much smaller and cheaper than the da Vinci® system. For this reason, it may allow robotic surgery to become more accessible. The main competitor to the da Vinci® system in China is the Micro Hand S, which has already demonstrated results in surgery. Together, these systems will offer patients more options when deciding on the course of treatment.

 

Written by Gwyneth Campbell.

Edited by Mayasah Al-Nema.

 

References  

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