Robotics Assisted Research
Updated: Oct 23, 2018
Author: Su Kim
Today, robotics-assisted surgery allows surgeons to reduce incision sizes and conduct more accurate and precise procedures. In the future, robotics may be the answer to long distance surgeries, with doctors operating the console at a separate location from the patient. Currently, however, robotics-assisted surgery remains an underdeveloped field. Financial costs and lack of training pose challenges, and case samples are limited for the range of surgeries that exists today. To understand the risks, benefits, and future directions of robotics-assisted surgery, this paper will examine notable types of surgeries performed in the fields of pediatrics, gynecology, and cardiology, followed by training program recommendations and cost evaluation.
Robotics-assisted surgery was first developed in 1983 by an orthopedic surgeon in Canada. The surgeon and his team named the robot “Arthrobot,” which paved the way for advanced robots in other fields like ophthalmology, urology, and gynecology. Arthrobot was followed by PUMA560, the first robotic arm to assist a surgeon; PROBOT, the first robot built for prostate surgery; ROBODOC, the first robot used for hip replacement; and ZEUS, the first robot used for gynecological surgery .
In 2003, a company named Intuitive Surgical, Inc. purchased the company that created ZEUS, and developed the da Vinci surgical robot, which was approved for gynecological surgery by the Food and Drug Administration in 2005 . Since then, a large multi-institutional study on the usage of the da Vinci robotic surgical system in gynecologic oncology has been published, and robotics-assisted surgeries in other fields have quickly followed. Based on a report by Intuitive Surgical, Inc., the number of robotic surgical systems doubled between 2007 and 2013 in the United States and Europe. By 2014, approximately 570,000 da Vinci procedures were performed worldwide, 79% of which were performed in the United States . Table 1 below shows the decline in the rate of growth of robotic surgeries performed in various fields from 2007 to 2011.
Robotic-Assisted Surgery in Pediatrics
In pediatrics, the robotic pyeloplasty treatment (kidney reconstruction) of ureteropelvic junction (UPJ) obstruction, a condition in which urine flow from the kidney is blocked, has experienced moderate success with robotics-assisted surgery. Studies have found that robotic pyeloplasty, in comparison to open pyeloplasty, were associated with shorter hospital stays and reduced pain medication usage, but longer operation times. In the long run, robotic pyeloplasty showed about a 17% greater chance of complete cure of hydronephrosis, a condition characterized by excess fluid in a kidney due to a backup of urine, and about 17.6 months shorter recovery time when compared to open pyeloplasty .
Robotic-Assisted Surgery in Gynecology
Robotic systems have also assisted gynecological surgeons perform hysterectomies (uterus removal), salpingectomies (fallopian tube removal), oophorectomies (ovary removal), myomectomies (uterine fibroid removal), and lymph node biopsies. Robotic surgery has been found to reduce morbidity and mortality rates of those who have gynecologic cancer. Similar to the robotic pyeloplasty treatment of UPJ, there has been less blood loss, faster recovery, less pain and scarring, and reduced risk of infection in gynecological surgeries .
Robotic-Assisted Surgery in Cardiology
The Ministry of Health and Welfare in South Korea examined the national data of robotic operations provided by the National Evidence-Based Healthcare Collaborating Agency to determine the overall trends of robotic cardiovascular and thoracic surgery. Valvular heart disease was the most common case suitable for robotic cardiac surgery in this study, followed by atrial septal defect repairs. There were no occurrences of serious surgical complications and mortality of the 50 patients involved . For cases of robotic lobectomies, robotic esophagectomies, and robotic surgery for mediastinal disease, there was a decrease in length of hospitalization and reduced complications .
The current studies on robotic-assisted surgeries have for the most part shown positive results. The learning curve of the technology is still being determined as leaders in the field work to devise an effective curriculum to train the next generation of medical professionals.
In 2010, Bowen et. al demonstrated that an experienced open surgeon and fellowship-trained surgeon can quickly gain expertise in performing pediatric RALP when trained through an established robotic-surgery program . Proctoring was an essential part of the training program that significantly shortened the learning curve. In the study, after five proctored RALPs, an experienced open surgeon was able to operate robotic surgeries independently with a 96% success rate .
The Cost of Robotic Surgery
There are ongoing debates on whether or not robotic surgery has more advantages than other minimally invasive surgical methods. Although the cost of the robotic-assisted surgeries exceeds those of alternative choices, it is usually counterbalanced by reduced post-operative expenses and the ability for patients to return to work more quickly . Some still argue that robotics surgery is not worth its cost: in such cases like hysterectomies, reports have shown that robotics surgery had barely, if any, better outcomes than open or minimally invasive surgery . Other cases, like robotic prostatectomies, demonstrated greater benefits over laparoscopic surgery .
On average, a robotic surgery requires $2000 more than an open surgery . Because the technology is so new, there is no guarantee that paying these higher costs will provide better results. More importantly, it will take time for robotic surgeries to become available to the public since unlike regular surgeries, they are not covered by medical insurance companies. Patients should consider their financial situation before choosing robotic surgery as a viable option.
In an era of technological advancements, robotics-assisted surgery will soon become the norm as more da Vinci Surgical Systems are purchased and utilized. Currently, robotics-assisted surgery has proven to be functionally effective in pediatrics, gynecology, and cardiology, yielding equal or better postoperative results for patients compared to traditional surgical methods. If more physicians undergo established robotic-surgery training programs and the cost of these procedures is lowered, robotic-assisted surgery may play an important role in the future world of medicine.
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