Robots in Surgery
Issue 4, Volume 113
By Ryan Lin
Robot dogs, Roombas, self-driving cars—the world around us is slowly becoming automated with even the most simple, everyday tasks being taken over by robots. The same situation can be observed in the workplace. Many common jobs are being automated for higher efficiency and profits, contributing to an increase in unemployment rates. Yet, at the same time, lives are being saved with these same innovations that allow surgeries to utilize robots.
Robotic surgery, also known as robot-assisted surgery, uses a robotic system to surgically operate on patients, either independently or alongside a human surgeon. Robotic surgery has been around since the 1980s, beginning with the PUMA 560. This machine was first used in 1985 as a stereotactic surgery, one that is minimally invasive and removes lesions within tissues and organs. In this surgery, a brain biopsy, a procedure where a small piece of tissue is extracted, was performed.
The development of several new robotic surgery machines has occurred since. This includes the PROBOT in 1988, which was used to conduct a transurethral prostate surgery, and the ROBODOC in 1992 used for femur cavity preparation. In the 1990s, minimally invasive surgery was introduced along with three new robotic surgery systems: the Da Vinci, the AESOP, and Zeus. The Da Vinci robotic system is still used worldwide today. However, the AESOP and Zeus systems were discontinued just a few years after their creation. The Da Vinci X, Da Vinci Xi, and Da Vinci SP were designed for different robotic surgeries. Da Vinci X and Xi feature the same general parts, the only difference being Da Vinci X being less costly and possible to upgrade. The Da Vinci SP is more geared toward operations where narrow areas need to be treated.
There are three parts to the Da Vinci system: the surgeon’s console, the patient cart, and the vision cart. The surgeon’s console is where the surgeon sits, views the surgery itself, and controls how the instruments need to move. The high-definition real-time 3-D images of the area are viewed there. The patient cart holds the camera and instruments required for surgery, which are attached to the mechanical arms. The cart is located next to the patient’s bed where they are operated on. The vision cart is in charge of enabling communication between all parts of the robotic surgical system. However, the characteristics of these parts may vary depending on the particular robotic surgery system, such as varying sizes of mechanical arms. These arms may also utilize different specialized surgical instruments. Some systems allow the surgeon to control the scale movements. For instance, a surgeon may move their hand by one inch to move the mechanical arm by two inches for a one-to-two scale. The system has since evolved to have better handling and an increased range of motion.
Robotic surgeries tend to be minimally invasive, meaning that only tiny incisions are created in a procedure. Other benefits of robotic surgeries include more precision, stability, and flexibility than traditional surgical procedures. For instance, these machines allow for a clear and detailed view of the operation site in contrast to the naked eye, which may miss important details. With a better examination of the area, a surgeon can operate with higher precision. There can also be areas that are hard for a surgeon’s hands to reach, but with the assistance of a robot, it is much easier to operate. Surgeon fatigue can also be minimized because surgeons are sitting down compared to traditional surgery where they have to stand for hours on end. Most importantly, the complexity of certain surgical procedures make robotic systems necessary to utilize. Procedures that have been aided by robotic surgery include heart surgery, urologic surgery, endometriosis, and general surgery.
The advantages of robotic surgery are endless for both the operation itself as well as the people involved. There is a faster recovery for the patient because of less tissue damage during the operation. The smaller incisions also correspond with a lower chance of the development of an infection, less pain, and fewer visible scars. Moreover, less blood loss results in fewer blood transfusions needed. Overall, these benefits lead to a faster return to daily life for the patient.
There has also been new research and ideas for robotic non-invasive procedures, compared to the minimally invasive system currently used. Microbots, for instance, wouldn’t require any incisions at all. These robots would rely on the body’s circulation to deliver it to a specific part of the body. Capsule robots act as a camera traveling inside the human body to run diagnostic tests, conduct surgeries, or deliver drugs. This type of robot follows the non-invasive nature of the microbot, utilizing magnetic interactions to move with freedom.
While the current robotic surgery system uses instruments controlled by surgeons to operate, researchers are working toward further advancements to transition the robots into mostly automated systems, where the robots move without the need for a surgeon. Recent tests at the University of California, Berkeley, demonstrate that these new robots have matching or greater levels of performance compared to humans operating them. Though the entire surgery can’t be automated, scientists hope to reduce the risks that come with fatigued surgeons. More importantly, surgeons are unlikely to lose their jobs to the application of robots since patients are likely to be reluctant to be operated on by the robot alone. These robotic systems are limited to following a set procedure, meaning they can’t account for any unexpected mistakes or variables during an operation.
The introduction of robots into the medical world has impacted both surgeons and patients alike. Though robotic surgery is past its infancy stage, there is much more development to come in the foreseeable future. These incredible developments are potential innovations that may grow past the surgical world. Many industries such as agriculture, manufacturing, and the military are beginning to adopt the same robots that are used in the medical society. New jobs may form from the adoption of these technologies. The development of robotic surgery is only the beginning of the shift from human to automated labor.