The evolution of Surgical Systems – robotics applied to medicine

Robotic surgery has already become a successful option in neurological, urological, gynaecological, cardiothoracic, and numerous general surgical procedures. And all would agree that the future of robotic surgery is nearly as promising as the human will to invent better ways of accomplishing delicate medical procedures. We take stock of the current scene in robotic surgical intervention.

Healthcare Practice, Frost & Sullivan

Since the onset of the 21st Century, medicine has been witnessing a considerable revolution, especially in the bounds of the surgical rooms.

Technological developments have been continually introduced with increasing use of new capabilities, which promise to provide better outcomes and more cost-effective processes.

Innovative algorithms, robotic devices, telepresence, imaging systems, sensors and human-machine interfaces are likely to work cooperatively with surgeons in the planning and ution of surgical procedures.

The motivation behind this trend is the minimal invasiveness of such procedures, which results in less surgical injury and reduced pain and morbidity associated to the surgery; it also reduces the period of hospitalisation, thus costs of procedures, although initial investments are considerably high.

During the 1990s, the so-called laparoscopic revolution brought about a paradigm shift from traditional open surgery to minimal access technique. Favorable results triggered surgeons to adopt such technique for most surgical procedures. Nonetheless, laparoscopy faced its limitations. For example, the video camera held by the assistant was unstable and gave a limited 2-dimensional vision of the field, and the primary surgeon was forced to adopt awkward positions to operate with straight laparoscopic instruments, limiting maneuvering.

Therefore, the growth of the laparoscopic field reached its ostensible plateau, and it seemed that only a new technological leap could spur further development. Robotic devices effectively addressed such limitations, thus revolutionising the potential of minimal access procedures.

A surgical robot is a self-powered, computer-controlled device that can be programmed to aid in the positioning and manipulation of surgical instruments, enabling the surgeon to carry out more complex tasks. Robots are not intended to act independently from human surgeons or to replace them. Instead, these machines act as remote extensions completely governed by the surgeon, only acting as manipulators.

Table 1 highlights advantages of robots when compared to laparoscopic systems.

Instead of the flat, 2-dimensional image that is obtained through the regular laparoscopic camera, the surgeon receives a 3-dimensional view that enhances depth perception. The camera motion is steady and conveniently controlled by the operating surgeon via voice-activated or manual master controls, allowing solo surgery. Also, manipulation of robotic arm instruments improves the range of motion compared with traditional laparoscopic instruments, thus allowing the surgeon to perform more complex surgical movements. Moreover, robotic procedures present shorter learning curve as compared to laparoscopic technique.

Although rapidly developing, robotic surgical technology has not achieved its full potential. The cost of this innovation is also rather high. The absolute cost of a robotic system is significantly higher than a laparoscopic one. Major part of the increased cost is due to the initial cost of purchasing the robot itself (estimated at USD 1,800,000) and yearly maintenance (USD 100,000).

At present, Da Vinci, a device made by Intuitive Surgical, is the only product of its kind approved for clinical use by the FDA available on the market. The company’s system has been used for noncardiac thorascopic procedures, prostatectomy procedures, cardiotomy procedures, cardiac revasculariation procedures, urologic surgical procedures, gynecologic surgical procedures, and pediatric surgical procedures. With over 10,000 procedures performed, it has the most supporting clinical evidence of any medical robotics system. The company’s market success has spurred a great deal of interest in the industry, and is likely to spur market entry from other larger medical device and robotics companies. Once several technologies start to compete, the cost of surgical robotic systems will fall considerably, thus leading to more widespread use.

Currently, there are more than 850 medical institutions and hospitals using Da Vinci around the world. United States is the country where the technology is most widespread, although Germany, Australia, Japan, and less developed countries like Brazil have been adopting such technology.

Despite the fact that robotic technology is not of widespread use and is still in its infancy, it is expected to play an increasingly important role in the future of surgery and this cutting-edge development in surgery will have far-reaching implications. High costs are prohibitive to the proliferation of such technology, thus, it needs to be brought down before robotic procedures can become mainstream, everyday surgical procedures.

Visionaries go further in the domains of surgical revolution, expecting robots to be less of a mechanical device than an information system – one that should be fused with other information systems. One proposed example of this kind of fusion is image-guided surgery, also called surgical navigation. Robot-assisted surgeons will be able to see real-time, three-dimensional scanner images electronically superimposed over the operative field that is displayed on the monitor. In other words, on the screen, human anatomy will be rendered translucent, and the surgeon will be able to determine the exact location of a tumor and more readily avoid damaging vital structures. In fact, with preoperative scanner images, surgeons could robotically practice their patients’ surgery the night before, and the robot’s computer could be programmed not to allow any mistake, or even correct those occurred. The evolution is a matter of time.

 Table 1: Laparoscopic limitations as compared to robotic solutions


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