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Robotic Surgery

Surgery Before Robots


Traditional surgery may still be the stereotype of surgeries for most people. It involves cutting open layers of large areas of the body to expose the region that needs to be operated on, often accompanied by considerate amounts of blood loss and immense pain. Traditionally, procedures that treat injuries and illnesses like bone fractures, tumours, torn meniscus, and abdominal pain looked like many surgeons and related staff standing around a table. Some of the said surgeons cutting open layers of different tissues and clipping them to reveal raw organs and bones while cleaning up blood from nearby. Coming this far, it's not hard to imagine how painful surgery may be and how long it will take for a patient to recover from so many openings. Here's the problem, what current healthcare professionals can do to improve upon this invasive surgical procedure. From the 1980s, laparoscopic surgeries are a recent advance in surgical procedures, a giant leap from traditional surgeries. It involved making small incisions on the body's surface near the region that needs to be operated on, inserting a laparoscope (a long thin stick attached to a high-intensity light) and a camera to see inside the body. The laparoscopic camera sends real-time images to a monitor, and the surgeons will operate inside the body based on the pictures they see on the monitor. The laparoscopic camera is a minimally invasive surgical technique mainly done on areas in the lower abdomen. Laparoscopic surgeries seem like the solution to the invasive surgery problem; however, it has drawbacks and limitations. For one, due to a pivot point where the laparoscope and the abdominal wall touch, the instrument's endpoint will move in the opposite direction as a surgeon's hand, which is called the fulcrum effect; surgeons need to counter their intuition when working. This counter-intuition is a challenging skill to manage completely, which makes training for laparoscopic procedures more difficult. Another big issue was that hand tremors of the surgeon from long hours of surgery could be translated or even amplified through the instruments, decreasing the procedure's accuracy. Given these limitations, it is clear the laparoscopic surgeries are not the final stop of the train to find the best minimally invasive surgery (MIS).

Image is courtesy of ResearchGate


Minimally Invasive Robotic Surgery (MIRS)


Minimally invasive surgeries that involve robotic systems are the next step up. Here is a table that compares MIRS with the two types of surgeries mentioned above.

One type of robotic system commonly used in knee and hip replacement surgery is the Supervisory Controlled System(SCS). SCS is entirely automated, and surgeons will not need to perform the surgical steps. It requires a lot of prep-work done by the surgeon before the actual surgery to input a detailed set of instructions for the robot to follow and programs the robot to complete the surgery independently. Inputting these instructions involves mapping out the entire body and the region to be operated on, then connecting key points on corresponding points on the mapped body images. Another type of MIRS is the telesurgical system; this concept is easy to grasp. It involves the surgeon at a monitor controlling the movement of the robot's arms that is doing the surgery. The last general category of MIRS is the Shared Control System. Mostly used in neurosurgery and orthopedic surgery where the surgeon is very involved in the procedure, and the robot is like an assistant for the surgeon. The robot can help the surgeon filter out tremors to make manipulations of the instruments more steady and control operating table environments like lighting to make conditions the most ideal for operation. There are many surgical robotic systems on the market. They come in various designs, but mostly the idea is there is a robot with arm(s) at the operating table. The surgeon controls them from a device some distance away from the operating table. Here are two pictures that show some of the well-known systems.

Image is courtesy of RoboHub


There will be cons for MIRS; the biggest drawback of this technology is that it is costly, each system costing from 0.5 to 1.5 million dollars. But despite this, since these robots are so beneficial for both surgeons and patients, they are currently the best solution to the invasive surgery problem.


Robots in Action


The first robotic system used in Canada was when Dr. Kazuhiro Yasufuku and Dr. Tom Waddell removed an early-stage tumour from the lungs of a 78-year-old man at Toronto General Hospital (TGH) in 2012. Robotic surgical systems offered the best non-invasive treatment, requiring only a few small incisions instead of a big opening. They provided many different imaging modalities that can make surgeries safer and more precise. The team decided that a robotic assistant would be worth a try in this surgery. They employed the Da Vinci System, whose arms were able to successfully take out the tumour under surgeons' control from several meters away. No patients reported issues while recovering from robotic surgery; the patient was able to get out of his bed just a while after his surgery, walk around two days later, and go home on the fifth day after surgery. Traditional surgical procedures of removing a lung tumour include spreading apart the ribs and surrounding muscles to reach the chest. With robots, surgeons can manage robotic arms almost the same as their arms and get the chest through a few small incisions. After this case, surgeons used the Da Vinci System at TGH in six more procedures, and the feedback it received was unanimously positive. Robots not only did their jobs but also led to patients experiencing less blood loss, shorter hospital stays, less pain, and faster recovery. Doctors at TGH see robotic surgical systems in the future of thoracic procedures and surgery in general. This cutting-edge technology that many large companies are keen on developing gives surgeons the tools to make surgeries faster, better, and safer for patients.


References


2012. Canadian first: Early-stage lung cancer gets new surgical treatment with robot. University Health Network. Retrieved January 11, 2021 from https://www.uhn.ca/corporate/News/PressReleases/Pages/lung_cancer_surgical_robot.aspx

Dwivedi, Jyotsna & Mahgoub, Imadeldin. (2012). Robotic Surgery -A Review on Recent advances in Surgical Robotic Systems. ResearchGate. Retrieved January 11, 2021 from https://www.researchgate.net/publication/268408467_Robotic_Surgery_-A_Review_on_Recent_advances_in_Surgical_Robotic_Systems

Giorgi, Anna. (2018). Laparoscopy. Healthline. Retrieved January 11, 2021 from https://www.healthline.com/health/laparoscopy

Sherwinter, Danny A.. (2020). What are the disadvantages of laparoscopic inguinal hernia repair? Medscape. Retrieved January 11, 2021 from https://www.medscape.com/answers/1534321-104549/what-are-the-disadvantages-of-laparoscopic-inguinal-hernia-repair

Palep, Jaydeep. (2009). Robotic assisted minimally invasive surgery. Journal of minimal access surgery. ResearchGate. Retrieved January 11, 2021 from https://www.researchgate.net/figure/Fulcrum-effect-in-laparoscopic-surgery_fig1_26312188

Fursov, A.B.;Ismailov, A.S.; Kuspaev, E.N.. (2015). Disadvantages and complications of laparoscopic operations. The FASEB Journal. Retrieved January 11, 2021 from https://faseb.onlinelibrary.wiley.com/doi/abs/10.1096/fasebj.29.1_supplement.lb685


Cover image is courtesy of Wix



Article Author: Ivy Sun

Article Editors: Maria Giroux, Stephanie Sahadeo

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