Robotic Surgery
Robotic Surgery is the latest technology in the surgical field to increase the precision of surgery while reducing its problems.
Robotic Surgery is a type of minimally invasive surgery. "Minimally invasive" means that instead of operating on patients through large incisions, we use miniaturized surgical instruments that fit through a series of quarter-inch incisions. When performing surgery with the da Vinci Xi—the world’s most advanced surgical robot—these miniaturized instruments are mounted on three separate robotic arms, allowing the surgeon maximum range of motion and precision. The da Vinci’s fourth arm contains a magnified high-definition 3-D camera that guides the surgeon during the procedure.
How Robotic Surgery Works :
The surgeon controls these instruments and the camera from a console located in the operating room. Placing his fingers into the master controls, he is able to operate all four arms of the da Vinci simultaneously while looking through a stereoscopic high-definition monitor that literally places him inside the patient, giving him a better, more detailed 3-D view of the operating site than the human eye can provide. Every movement he makes with the master controls is replicated precisely by the robot. When necessary, the surgeon can even change the scale of the robot’s movements: If he selects a three-to-one scale, the tip of the robot’s arm will move just one inch for every three inches the surgeon’s hand moves. And because of the console’s design, the surgeon’s eyes and hands are always perfectly aligned with his view of the surgical site, minimizing surgeon fatigue.
The ultimate effect is to give the surgeon unprecedented control in a minimally invasive environment. As one of our surgeons notes, “It’s as if I’ve miniaturized my body and gone inside the patient.” Utilizing this advanced technology, our surgeons are able to perform a growing number of complex urological, gynecological, cardiothoracic and general surgical procedures. Since these procedures can now be performed through very small incisions, our patients experience a number of benefits compared to open surgery.
Advantages of Robotic Surgery:
Other benefits :
- In Prostate Cancer – early return of continence
- In Kidney Cancer – better cancer control and functional recovery of kidney
- In penile cancer – less wound complications
- In Bladder Cancer - Better preservation of sexual function
- Less Blood Loss
- Lower Risk of Adverse Side Effects
- Minimal Blood Transfusion
- Quicker Return to Normal Activity
Robotic Surgery MYTHs
Majority of surgeries in uro oncology – Radical Prostatectomy , Partial Nephrectomy , Radical Cystectomy , Nephro uretrectomy – are done robotically worldwide. However there are many MYTHs prevalent regarding robotic surgery. We are highlighting some of them here:
It is the surgeon who does the surgery by operating the robot to perform precise surgical steps. The robot does not and cannot independently perform any surgical step. The surgeon’s finger movements on the console are transmitted to the robotic arms to the patient. In fact the robot filters a surgeons tremors in the fingers during surgery to make the surgery more precise.
The surgeons training and experience in laparoscopic and open surgery , along with the understanding of the anatomy are vitally important in the success of robotic surgery . A robotic surgeon has to undergo rigorous , supervised and extensive training before he starts operating. An inexperienced surgeon cannot make the surgery better just because he has the robot. It is always prudent to select the right surgeon and the right technology.
Robotic surgery is expensive as compared to open or laparoscopy in the short term . However the long term costs are not that different if we consider the cost of prolonged recovery, delayed return to work , requirement in terms of manpower and finances during this recovery period.
The surgical robot is controlled by a human hand. It is as prone to complications as any other technique , however the incidence and magnitude of these complications appear to be lower with robotic surgery . Patients recover faster after the operation in robotic surgery as compared to open surgery.
Depending on the stage of the disease, the patient may require radiation , chemotherapy or hormonal therapy after robotic surgery is done . This additional treatment can be given faster after robotic surgery because the patients recovery in terms of urinary control and wound healing is faster.
While cancer control might be similar in prostate, kidney and bladder cancer surgeries , the functional outcomes in terms of urinary control , wound healing and kidney function recovery are far superior in the peri operative period for robotic surgery.
The main advantages of robotic surgery are – less blood loss , less pain , early discharge , early urinary control. Improved cosmesis is the least important of all advantages
All surgeons are used to operating with a feel of the tissues by tactile or haptic feedback during open or laparoscopic surgeries. This tactile feedback is not possible in robotic surgery. However the visual cues of offered in robotic surgery by superior 3D vision , and upto ten times magnification of the operative field, makes the surgery much easier. The surgeon operates sitting on a console in a relaxed ergonomic fashion which reduces surgeon fatigue in long surgeries.
Robotics has the advantage of ease of ergonomic motion , easy suturing , better optics including 3D vision and camera controlled by surgeon , 7 degrees of freedom of movements for the instruments and shorter learning curve as compared to laparoscopy. Since it is easier to learn than laparoscopy , large volumes of surgery are not needed to achieve good outcomes.
In case of such malfunctions, there is a fool proof and recoverable system where each fault can be rectified safely.