Robotic surgery represents one of the cutting-edge advances in the medical field. It does not mean a robot will perform surgery on us. The more appropriate term is robot-assisted surgery, a procedure where a human surgeon uses robotic machinery to operate. The surgeon will still be conducting the surgery; the only difference is that a robotic arm will go into the patient instead of the surgeon’s human hands.

The surgery landscape has positively changed with specialized robotic systems available to aid surgeons. Linking human experience with the skill of a mechanical system allows for a far higher level of accuracy and control than was previously possible with traditional techniques. That is not to say traditional procedures are obsolete.

Robotic surgery is used for many different operations, including colorectal, head-neck, gallbladder, prostate, bladder, kidney, lung biopsy, hip replacement, hernia repair, and gynecological surgeries. The National Institute of Cardiovascular Diseases (NICVD) has launched robotic angioplasty in our country.

How did robotic surgery come into being?

It was back in the middle of the last century when the US military looked into systems to help their surgeons perform surgery over long distances. They partnered with the Defense Advanced Research Projects Agency (DARPA). Then, Stanford Research Institute (SRI) developed a prototype of a robotic system that surgeons could control from a long distance. Soon, DARPA and SRI joined hands to work on this tool. Other institutes started working to develop similar systems. This is where robotic surgery began.

A breakthrough was achieved in 1985 when a robotic mechanism called PUMA 560 successfully conducted neurosurgical biopsies. This accelerated the development process, and in early 2000, the advanced robotic system we use today, the da Vinci Surgical System, was launched. This system became popular quickly, significantly increasing the number of robot-assisted surgeries.

The system’s maker is Intuitive Surgical, a leading manufacturer in this field. Competitors include Versius by CMR Surgical, Senhance Surgical System by Asensus, Dexter by Distalmotion, etc. In addition, US company Stryker developed the Mako robotic arm system for joint replacement surgery.

Breakdown of components

There are three main parts of a robotic system. A mechanical or robotic arm with surgical instruments. This arm can replicate the surgeon’s hand movements and is designed to operate within tight spaces.
The surgeon needs to see the field they are operating on. High-resolution cameras provide this visual. The camera offers a very detailed, live feed from inside the body.

The surgeon is also part of the system. They occupy a command center called the console. This is where the control system for the arm and camera are installed for the surgeon to operate. The console is placed close to the patient.

For the actual surgery, the arm and camera are generally inserted through a small incision—sometimes, no incision is required. The camera visualizes the operating field with a very high magnification, often better than what the surgeon sees. The surgeon then starts manipulating the instruments to complete the surgery. It is not the robot making the decision, it is the surgeon. The robot only offers greater precision and range of motion than human hands.

Manifold benefits

Robotic surgery provides more flexibility, precision, and dexterity than conventional methods. The introduction of the robotic system has made many delicate operations easier.

The robotic arm also has a wider range of motion than the human hand. It can rotate 360 degrees within limited space while imitating the movements of human hands. The problem of tremors with human hands is also absent with robotic hands, thus enhancing efficiency.

The visual quality of the robotic system is often better than that of human eyes. There are many intricate and critical details inside the body that our eyes may find difficult to identify. With the robotic system’s magnification and high-resolution images, this is no longer a problem for surgeons.

The comfort of a surgeon is important, too. If surgeons have to stand for a long period, they are bound to feel fatigued. This hampers their performance and negatively affects the outcome of the surgery. With robotic surgery, surgeons do everything from a seated position, minimizing the risk of tiredness and allowing them to operate at peak level for longer. However, some surgeons complain of back pain after a prolonged console stay.

Robotic surgery generally has fewer complications than conventional ones. Blood loss is minimal. Post-operative pain is less, reducing the requirement for pain medication. The risk of infection is also low. Patients can recover fast and go back to their normal daily lives. As a result, healthcare costs are lowered, and the quality of life is increased.

Risks and necessities

Robotic surgery is not free of risk. The possibility of infection is not completely avoided. That is why proper sterilization must be done before the procedure. There is also a chance that the robotic system may experience technical issues during the surgery. There might be times when the system completely shuts down due to hardware problems or software glitches. In either case, this causes an interruption of the surgery, leading to an increased risk of complications. During those situations, the surgeon must come out of the console and operate using conventional methods.

Can any doctor perform robotic surgery? No. They must be appropriately trained. A simple one—to two-day workshop is not sufficient, and any doctor wishing to be a specialist in robotic surgery must undergo extensive training and experience before performing it on a patient.

Being preferred globally

For the patients, robotic surgery reduces complications, hospital stays, and overall costs. For surgeons, it allows them to perform at a higher level. There are ergonomic advantages, too, as they can do things from a seated position. According to Dr. Worrell from the University of Arizona, robotic systems may help decrease joint problems in the shoulder and back, enhancing the longevity of the surgeons. For hospitals, robotic surgery can decrease expenditure over a period of time. For hospitals suffering from human resource shortages, it can be a solution.

According to Strategic Market Research (SMR), a US-based global market research company, between 2012 and 2022, the proportion of surgeries leveraging robotic technology rose from 0% to 22%. The most common applications were in thyroid cancer (38%) and prostate cancer (27.8%) surgeries. Surgical robots commanded a market share of around USD5 billion in 2021. By 2030, it should be close to USD 21billion. The market share will grow further with the advent of AI. SMR estimates it will increase from 43.8% to 46.9% by 2029.

In many developed countries, robotic surgery is already integrated into the mainstream of healthcare. This offers a convenient alternative to traditional techniques. More and more surgical procedures are being adapted to the robotic system, and patients are also enjoying the benefits of this. So, the future looks brighter for robots!

Dr. Imtiaz Ahmed graduated from Dhaka Medical College and currently resides in Canada. He has over seven years of experience in healthcare compliance. At present, he is working with patient support programs, as well as supporting auditors and external regulators to ensure alignment with applicable laws and procedures. He was part of the internal team that investigated opioid crisis-related issues at the company and coordinated with external stakeholders. He is also a published writer of historical non-fiction and fiction books. His most recent works include a two-book series on England and France’s Hundred Years War and a biography of a book series on renowned admirals, both published in Ekushey Book Fair 2024.
imtiazdmc@gmail.com