Robotic Assisted Surgery (RAS ) - Paradigm shift in surgery
Robotic surgery or more appropriately- Robotic assisted surgery is the new buzzword in the surgical specialities.
Patients are now increasingly being offered this method for all types of surgery including removal of gallbladder for gallstone disease (Robotic assisted Cholecystectomy), hernia repairs of all types, surgery for prostate cancer, surgery for uterus removal, surgery for benign and cancerous condition of bowel etc.
This explosion in robotic surgery has occurred particularly in the last 5-6 years in India although robotic assisted surgery was being done by enthusiastic and expert surgeons for last 10-12 years in India.
Patients naturally have few questions and doubts about this new type of surgery. In this blog , I will try to answer these questions and doubts and explain the advantages of Robotic assisted surgery.
(Q1) Can the robot operate independently or partially independently on the patient.
(A1) No the robotic instruments and arms that are used to operate on the patient are totally under control of the surgeon.As such , it is a master - slave relationship. The robotic instruments and arms will move only when prompted by a movement of the surgeon’s fingers and hands.
(Q1) Is Robotic surgery similar to Laparoscopic surgery ?
In certain aspects robotic surgery is similar to laparoscopic surgery and in some aspects it is different resulting in enhancement of the advantages of Laparoscopic surgery.
Like laparoscopic surgery, robotic surgery is carried out through very small cuts to approach the area of surgery - Minimally Invasive Surgery. This results in early recovery and better cosmetic outcome.
However, RAS has additional advantages when operating on same conditions when compared to laparoscopic surgery:
The surgeon gets a 3 dimensional view of the operative area in RAS. This results in a clear identification of the internal organs including small blood vessels . I laparoscopic surgery the vision is mostly 2 dimensional which at times can be a disadvantage.
The movements of the robotic instruments in the operative area are what is described as wristed movements. It is as if the human hand is inside the body and able to move with the same degree of freedom. In contrast the degree of freedom of movements of laparoscopic instruments is more limited.The increased freedom of movement results in very precise dissection during RAS.It also results in better operating in areas of narrow or difficult access.
Both robotic and laparoscopic instruments enter inside the human body through skin and muscle via hollow cylinders ( ports) . However in RAS most movement occurs inside the body due to wristed movement. In laparoscopic surgery ; due to less degrees of freedom the instruments need to be manoeuvred more from outside by the surgeon resulting in increased movement and friction at the area where the ports enter the body thru skin and muscle. This the results in more pain in the post- operative period ( fulcrum effect )
In RAS the surgeon performs the procedure in sitting position with movements occurring mainly at wrist and finger levels. In laparoscopic surgery , the surgeo operates in standing position and movements occur at hand , shoulder and also over torso region to manipulate the laparoscopic instruments. In longer surgeries especially , this results in surgeon getting tired with possible less efficiency
The energy levels that are needed to coagulate and cut blood vessels during RAS are much less as compared to that in laparoscopic surgery. This results in less spread of heat and less possibility of damage to internal organs during RAS.
The above factors result is certain advantages in RAS:
Less pain
Less tissue damage
Less blood loss
Early recovery
Less hospital stay
Less complication
Commonly performed robotic assisted surgeries in General Surgery are :
Robotic assisted Cholecystectomy (removal of gallbladder)
Robotic assisted inguinal hernia repair
Robotic assisted Umbilical Hernia Repair
Robotic fundoplication
Robotic surgery is also widely used in other specialities like Urology, Gynaecology, Oncology, Endocrine surgery, etc.
I have myself completed a Fellowship in robotic surgery ( FARIS ) conducted by ARIS ( Association of Robotic and Innovative Surgeons ) . I am performing Robotc Assisted Surgeries ( RA Cholecystectomy , RA Inguinal and Umbilical Hernia Repairs ) at Venkateshwar Hospital , Dwarka
The amalgamation of AI with Robotic surgery is further advancing this field leading t rapid expansion of its use in all types of surgery. In a few years it will be commonplace and will help patients immensely.
