Robotic Surgery: Uses, Advantages, and Risks

What is robotic surgery?

Robotic surgery is a form of minimally invasive surgery that utilizes robotic systems to enhance the precision, dexterity, and control of surgical procedures (Rivero-Moreno et. al., 2023). This advanced technology allows surgeons to perform complex operations more accurately than traditional surgery, often resulting in fewer complications and reduced recovery times.

In robotic-assisted surgery, the surgeon does not operate directly on the patient but instead controls robotic arms from a specialized surgeon console. The console provides a magnified, high-definition, 3D view of the surgical site, allowing for meticulous maneuvering of surgical instruments through small incisions (Biswas et. al., 2023). To ensure extreme precision, these robotic movements are scaled, filtered, and translated from the surgeon’s hand motions.

One of the most widely used robotic surgical systems is the da Vinci Surgical System, developed by Intuitive Surgical in 2001. The da Vinci system is designed to improve surgical accuracy across various specialties, including robotic cardiac surgery, transoral robotic surgery, urology, gynecology, and general surgery (Probst, 2023). It features multiple robotic arms with specialized surgical instruments and a high-resolution camera. These robotic-assisted tools provide enhanced dexterity, enabling procedures that would be challenging with conventional laparoscopic techniques.

Integrating robotic surgical procedures into modern medicine has significantly expanded the scope of minimally invasive approaches. Unlike traditional surgery, which requires large incisions and direct manual manipulation, robotic procedures reduce tissue trauma, improve visualization, and allow for precise dissection. Additionally, surgical robotics helps minimize surgeon fatigue by providing stable, tremor-free movements throughout the procedure.

When to use robotic surgery?

Robotic surgery is used in various surgical specialties due to its ability to enhance precision, minimize invasiveness, and improve patient outcomes. Below are the key situations where robotic-assisted surgery is preferred over traditional techniques.

Minimally invasive procedures

Robotic technology is widely used for laparoscopic surgery and other minimally invasive procedures, offering advantages over conventional methods (Williamson & Song, 2022). Surgical robots allow surgeons to operate through small incisions using robotic instruments, reducing trauma to surrounding tissues. This approach is commonly employed in hernia repairs, gallbladder removal, and hysterectomies. By minimizing tissue damage, robotic procedures often lead to shorter hospital stays, reduced need for pain medication, and faster recovery.

Complex surgical tasks

Robotic-assisted surgery is a preferred approach for procedures requiring extreme precision. Robotic systems enable surgeons to perform complex procedures with greater accuracy, reducing the risk of complications. Specialties such as cardiac surgery, cancer resections, and spinal surgeries benefit from robotic surgery services due to improved visualization and dexterity. The system’s ability to perform procedures in confined spaces makes it an essential tool for treating intricate anatomy, such as mitral valve repair and prostatectomy.

Specific conditions

Robotic surgery systems are used to treat various medical conditions requiring enhanced surgical control. In gastrointestinal surgeries, robotic techniques are employed for colon, rectal, liver, and pancreatic procedures. Genitourinary surgeries, such as pelvic prolapse repair and fibroid removal, also benefit from robotic precision. Additionally, robotic-assisted techniques are applied in orthopedic surgeries for conditions like degenerative disk disease and scoliosis. Obesity-related procedures, such as gastric bypass and sleeve gastrectomy, also utilize robotic instruments to enhance surgical precision.

Benefits and advantages of robot-assisted surgery

Robotic-assisted surgery offers significant benefits for patients and surgeons, making it a preferred approach for many complex surgeries. Robotic systems' advanced capabilities improve surgical precision, reduce complications, and enhance patient recovery.

For patients, robotic-assisted surgery typically results in less blood loss, reduced tissue trauma, and lower surgical site infection risks. The minimally invasive nature of these procedures allows for smaller incisions, leading to shorter hospital stays and faster healing times. Patients undergoing surgeries such as neck surgery or robotic thoracic surgery often experience less post-operative pain and require fewer pain medications, improving their overall recovery experience. Additionally, smaller incisions result in minimal scarring, which is an important consideration for many individuals.

Risks and disadvantages of using robots in surgery

While robotic surgical systems provide enhanced precision and control, they also pose several risks and disadvantages that must be carefully considered. These challenges impact both the technical aspects of the procedure and the outcomes for patients.

One major concern is the potential for mechanical failure. Robotic surgical systems can experience malfunctions. Issues such as malfunctioning robotic arms, camera errors, and instrument breakage can disrupt procedures and necessitate conversion to traditional surgical methods. Additionally, robotic systems lack haptic feedback, making it difficult for surgeons to gauge the force applied during tissue manipulation, increasing the risk of unintentional tissue damage.

Another concern is surgical complications, including nerve injuries from prolonged patient positioning and an increased risk of errors due to incorrect system inputs. Mistakes in robotic surgery can lead to wrong-site surgeries, unintended retained foreign objects, and other serious complications. Furthermore, robotic-assisted procedures often take longer than traditional surgeries, leading to extended anesthesia times and an increased risk of anesthesia-related complications.

Qualifications needed to perform robotic surgery

Surgeons must meet several educational and training requirements to perform robotic surgery safely and effectively. This involves obtaining a strong medical background, completing specialized training in robotic surgical systems, and gaining extensive hands-on experience. Below are the key qualifications needed to become a robotic surgeon.

Medical degree

A medical degree (MD or DO) is the foundational requirement for performing robotic surgery. Surgeons must complete medical school and a residency program in a relevant surgical specialty, such as general surgery, urology, gynecology, or cardiothoracic surgery. A strong background in laparoscopic and minimally invasive techniques is essential before advancing to robotic-assisted procedures.

Completion of a robotic surgery curriculum

Aspiring robotic surgeons must complete a structured robotic surgery curriculum, often required by hospitals and surgical training programs. Many institutions mandate the completion of courses like the da Vinci Surgical System training, which provides fundamental knowledge of robotic surgical systems, patient positioning, safety protocols, and procedural techniques.

Simulation training

Before performing live robotic surgery, surgeons must engage in simulation training. This involves dry lab (non-patient) and wet lab (cadaver or animal tissue) exercises that help develop proficiency in robotic-assisted techniques. Simulation-based training allows surgeons to refine their skills in controlling robotic surgical systems without compromising patient safety.

Docking and instrumentation training

Surgeons must undergo specialized training in robot docking and instrumentation handling. This involves learning how to correctly position the robotic surgical system, attach robotic instruments, and troubleshoot potential mechanical issues. Proper docking is crucial for optimizing surgical precision and minimizing complications during robotic procedures.

Hands-on experience

Gaining practical experience is essential before independently performing robotic surgery. Surgeons typically start as bedside assistants, observing and assisting in multiple robotic procedures before transitioning to the console surgeon role. Under the supervision of experienced robotic surgeons, they perform basic robotic-assisted surgeries before advancing to more complex procedures.

Main takeaways

Robotic surgery has transformed modern surgical practices by enhancing precision, improving patient outcomes, and expanding the scope of minimally invasive procedures. While robotic-assisted surgery offers numerous benefits, such as reduced blood loss, fewer complications, and shorter recovery times, it also presents challenges, including technical risks, longer operating times, and the need for extensive surgical training.

To perform robotic procedures, surgeons must meet strict qualifications, including obtaining a medical degree, completing a robotic surgery curriculum, undergoing simulation training, and gaining hands-on experience. As robotic surgical systems evolve, education and skill refinement remain essential for robotic surgeons to ensure safe and effective procedures.

Despite its complexities, robotic technology continues to shape the future of surgery, offering advanced capabilities that improve surgeon precision and patient care.

References

Biswas, P., Sikander, S., & Kulkarni, P. (2023). Recent advances in robot-assisted surgical systems. Biomedical Engineering Advances, 6, Article 100109. https://doi.org/10.1016/j.bea.2023.100109

Probst, P. (2023). A review of the role of robotics in surgery: To DaVinci and beyond! Missouri Medicine, 120(5), 389. https://pmc.ncbi.nlm.nih.gov/articles/PMC10569391/

Rivero-Moreno, Y., Echevarria, S., Vidal-Valderrama, C., Pianetti, L., Cordova-Guilarte, J., Navarro-Gonzalez, J., Acevedo-Rodríguez, J., Dorado-Avila, G., Osorio-Romero, L., Chavez-Campos, C., Acero-Alvarracín, K., Rivero, Y., Echevarria, S., Vidal-Valderrama, C., Pianetti, L., Guilarte, J. C., Navarro-Gonzalez, J., Acevedo-Rodríguez, J., Avila, G. L. D., & Osorio-Romero, L. (2023). Robotic surgery: A comprehensive review of the literature and current trends. Cureus, 15(7), Article e42370. https://doi.org/10.7759/cureus.42370

Williamson, T., & Song, S.-E. (2022). Robotic surgery techniques to improve traditional laparoscopy. JSLS: Journal of the Society of Laparoscopic & Robotic Surgeons, 26(2), Article e2022.00002. https://doi.org/10.4293/JSLS.2022.00002