In the last few years, robotic surgery has emerged as a safe (arguably safest), almost painless method for surgery. Therobotically-assisted surgery which essentially uses high-end computer systems to perform surgical procedures is now being used for critical surgeries including gynae procedures, bypass surgery, cancer treatment and even in the case of transplants. Manipal Hospitals is among the first in the country to create special set-ups for robotic surgery in view of increasing public demand.

Robotic Surgery

Overview

Robotically-assisted surgery (RAS) or robotic surgery was developed to overcome the limitations of minimally-invasive surgery and to enhance the capabilities of surgeons performing open surgery. Not just for patients but also for surgeons, the RAS has come as a boon. It has been shown that surgery performed with the help of robot helps in early recovery of the patient, involves less bleeding or incision and leaves lesser scars. For surgeons, the procedures can be less tiring. They don’t have to bend over an operating table—they can sit in front of a screen with a magnified, color 3-D view of the surgical field.

The Process

In a robotic surgery, one arm of the robot controls the camera and the other three hands manipulate the surgical instruments. The entire process is observed via a high-definition 3D vision system. The robotic arm is designed in such a way that it can reach the interiors of the organ curvature, which is not possible in traditional or microscopic surgery without damaging normal tissues.

The RAS can be used to perform both minimally-invasive surgery and open surgery.

In the case of robotically-assisted minimally-invasive surgery, instead of directly moving the instruments, the surgeon has various options to control the instruments. One of the methods is to use a direct telemanipulator. This is essentially a remote manipulator that allows the surgeon to perform the normal movements associated with the surgerywhilst the robotic arms carry out those to perform the actual surgery on the patient.

Another option is to use a computer-controlled system. Here, the surgeon uses a computer to control the robotic arms and its end-effectors. The advantage of using the computerized method is that the surgeon does not have to be present at the point of surgery, but can be anywhere in the world, leading to the possibility for remote surgery.

In the case of enhanced open surgery, autonomous instruments replace traditional surgical tools to performing certain actions such as rib spreading. This is much smoother than what could be achieved by a human hand, reducing or eliminating the tissue trauma traditionally associated with open surgery. Moreover, this requires just a few minutes’ training on the part of surgeons, thus improving open surgeries, especially cardio-thoracic, that have so far not benefited from minimally-invasive techniques.

Challenges

The biggest challenge for this technology is that people may find it a bit scary that it’s not the human operating on them. However, practically it’s the surgeon who is performing the operation using the robot, which is not yet been made 100% autonomous. Still, the final decision vests with the patient.  So, before you jump to a conclusion on what kind of procedure to elect, here are some things to consider –

Back in 2000, there were only 1,000 robotic surgeries world-wide. That number surged to 360,000 in 2011 and 450,000 last year. Experts say the practice is on the rise because of its strong benefits. For the patient, there’s usually less blood loss, a shorter hospital stay and less reliance on post-operative pain medication. There’s also the cosmetic benefit of no big scars.

Due to robotic use, the surgery is done with precision, smaller incisions, decreased blood loss and quicker healing time. Articulation beyond normal manipulation and three-dimensional magnification helps resulting in improved ergonomics. Due to these techniques there has been a drastic reduction in the duration of hospital stays, transfusions and use of pain medication.

Compared with other minimally invasive surgery approaches, robot-assisted surgery gives the surgeon better control over the surgical instruments and a better view of the surgical site. In addition, surgeons no longer have to stand throughout the surgery and do not tire as quickly. Naturally occurring hand tremors are filtered out by the robot’s computer software. Finally, the surgical robot can continuously be used by rotating surgery teams.

At the rate at which leading health providers of the world are adopting this technology, it will soon be made available in all countries and regions. In India, you can already benefit from the unique advantages offered by robotically-assisted technology at Manipal Hospitals.

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