Robotics In Surgery- The Less Invasive Approach
Introduction
The term robot is from Czech word “robota” meaning forced labor. Presently there are extremely many definitions of robot. The commonly used definition of the word robot is “a reprogrammable, multifunctional manipulator which is designed for moving tools, parts, materials, or specialized devices through programmed motions for the purpose of performing a range of tasks.” Less invasive procedure avoids open invasive surgery in support of local or closed surgery with fewer traumas. These types of procedures involve the use of laparoscopic instruments. Laparoscopy allow the observation of them surgical area through the endoscope, and this is usually done through the use of a small opening. This allows access to pelvis.
Patients prefer less invasive surgery because it normally results to small scars there is less pain and fast recovery. In 1938, a short story title runaround was written by Isaac Asimov which described the, way robots were coming in conflict with the human beings (Gong, M & Box, N 2007). The term robotics was used to describe three laws which are governing, the behavior of robots. The first law is that a robot can not cause harm to a human being. The second law is that a robot should obey to the orders that human being gives it except if when it is doing so it is coming into conflict with the first law. The third law is a robot should protect its existence as long as if when doing so does not interfere with the first and the second law.
In the first days, applications of robotics were in mathematics, industry, and computers, but today robotics technologies are being used in exploration of ocean and space, police and military tasks. Medicine is one very important application of robotics mostly in surgery. Robotic systems have the ability to influence the many fields of medicine, and it can improve various processes in surgery, medicine, and diagnosis. The applicability of robotics in medicine is used in surgical training, medical training, diagnostic processes, rehabilitation therapy, and surgery (Gong, M & Box, N 2007).
The first applicability of robotic technology in surgery was in 1985. This is when a robot was used in guiding a needle for brain biopsy with accuracy of 0.05mm. This robot served as an example for the Neuromate, and it received approval in 1999 for use in guidance of image stereo tactic brain surgery. Later, development of robotic systems was done by intuitive surgical through the introduction of da Vinci surgical system. The da Vinci surgical system consists of three components, high definition 3D visions system, patient side robotic cart, and surgeon console (Hemal, A 2011). In this system, the surgeon wears the 3D glasses and seat right in front of the video monitor so that he can view the projected image. The surgeon does not have to be directly in front of the patient.
The da Vinci senses the all the hand movements of the surgeon and then electronically translates them to scaled down micro movements so as to maneuver the tiny instruments (Faust, R 2007). The da Vinci received approval from FDA, and it has since been used in hysterectomy, Nissen fundoplication, uterine myomectomy, mitral valve repair, and gastric bypass surgery. Currently The da Vinci is in the trial so as to find out if it can be used in grafting coronary artery bypass. Intuitive surgical, Inc bought computer motion, Inc in 2003, and this ended the legal battle that was between these two companies about patent rights. Intuitive surgical, Inc own and markets the da Vinci robot (Faust, R 2007).
Robotics in surgery
Robotics and surgery have come together as one to create a new surgical operating room. In robotic surgery, the robotic technologies assisted by computers are being used to enhance the ability of the surgeon to perform surgical procedures. Robotic surgical systems boost the agility of the surgeon in different ways. Those instruments that have an increased DOF enhance the ability of them surgeon to manipulate the organs and tissues. The tremor of the surgeon can be compensated in the effectors movement at the end by suitable filter of the software and hardware. With robotic technologies surgeons are provided with comfortable optimal operating positions (Hemal, A 2011).
Surgeons do not have to stand up for long thus ending up being tired as in open surgeries. Surgical robots are classified into different ways. The common robotic surgical classification include by level of autonomy like image guided, teleoperated, preprogrammed, and synergetic. By manipulator design like, DOF, actuation, and kinematics. By targeted anatomy like intravascular, cardiac, microsurgical, percutaneous, and laparoscopic and by intended operating environment like hospital floor, imaging scanner, and operating room (Hemal, A 2011).
Advantages of robotic surgery
Robotic surgery has some advantages which include precision, less blood loss, quick recovery, small incisions, efficiency, and less pain. Robotic procedures are associated with decreased stay in the hospitals, less blood loss, reduced use of pain medication, and reduced transfusion. With robotic in surgery, there is less incision, and the patient does not take long before recovering. Because the patient takes less time to recover after a surgery, the stay in the hospital is also reduced (Hemal, A 2011).
Patients with robotic surgery do not stay long like those patients who had traditional surgery. The number of staff required during surgery is reduced with the use of robot. Nursing care and the overall cost is also reduced after surgery because the stay in the hospital is less. When robots are used in surgery, the surgeon has a better control over the instruments used in surgery. The surgeon also has a good view of the site of surgery. With robotic assistance during surgery, surgeons do not have to stand for long all through the surgery, and they do not get tired. There is reduced risk of complications. During surgical treatment, risk such as infection can happen at the incision site.
Infections are the cause of complication which affects quick recovery of the patient (Ost, M 2011). The da Vinci system alleviates risk in different ways. The ways in which it tries to mitigate this risk is that the number of incision is smaller, where a large and open incision increased the susceptibility of the patient to bacterial infection after and at the time of surgery. Robotic assisted surgery minimizes scarring. The size of incision in the traditional method of surgery produces a scarring on the abdomen of the patient. Robotic incisions have small incisions which leave invisible scarring.
Disadvantages of robotic surgery
Robotic surgical system help in transforming the surgery procedures but they have disadvantages. The disadvantages of robotic surgical systems include cost, time, compatibility with existing systems, and efficiency. The first disadvantaged of robotic surgery systems is its usage and efficiency. Robotic surgery being a novel technology, its efficiency and usages has not been established well. There have been no long term studies that have been performed. It is significant to redesign many procedures on robotic surgery so that to optimize the usage of the arms of the robots, and increase efficiency. High cost is a second disadvantage of robotic surgical systems (Ost, M 2011). Robotic surgery systems cost is nearly unaffordable. Robotic systems are very expensive in this early stage of technology.
However it is possible that when there is an improvement in technology and when surgeons gain more experience, the cost of buying robotic systems and using them will reduce. It is also possible that with the high rate of improvement in technology, the robotic systems will be more complicated hence increase the cost. The cost of upgrading the system is also a disadvantage because this systems need to be upgraded as they improve. There is also increase in cost needed for providing training that is needed so as to operate the system. It is only when they gain a wide spread multidisciplinary that their cost will be justified (Najarian, S & Afshari, E 2010).
Compatibility and efficiency is a disadvantage of these systems. The large size of this system is a disadvantage to the overcrowded operating room. The arms of the robot are very bulky and many instruments are needed in this small space. In beating heart surgery that needs assistance from the robots, the space is small because stabilizes will also be needed. This overcrowded area interferes with the agility of the surgeons. It is hard for the robot and the surgery team to fit in the operating room. Another disadvantage is that the current instrument and equipments in the operating room are not compatible with the new surgery robotic systems (Najarian, S & Afshari, E 2010).
If the correct instruments are not there, assistance will be required to help in performing the surgery. Accurate insertion points are a disadvantage of the system. The large arms of the robot are likely to obstruct each other on the outside if there is incorrect placement of the incision. If there is incorrect incision, collision of tools can happen or there can be regions in the abdomen that might not be accessible.
Conclusion
Robots have a number of application including education, industrial production, entertainment, sports, and exploration. The advancement in the past ten years has helped surgeons to perform surgery without touching the organs that they are operating on. Minimally invasive operations in medicine has a great advantage in less trauma, lower health risk, reduced loss of blood, and fast recovery from the surgery. Robots in surgery have many advantages including accuracy during surgery, being able to process data from multiple sensory systems simultaneously, less tiresome, easier to sterilize, fewer tremors, and stability. Robotics in surgery is being targeted and much preferred because they can collaborate with human operators. Therefore, future research is aiming to develop robotic systems that have human senses such as hearing, taste, touch, and sight. Robotic systems are at infancy therefore, more research is needed for their improvement and elaboration.
Reference
Faust, R (2007). Robotics in surgery Nova Publishers
Gong, M & Box, N (2007). Multispeciality application of robotic technology Robotic Urologic Surgery
Hemal, A (2011). Robotics in Genitourinary surgery Springer Publishers
Najarian, S & Afshari, E (2010). Advances in medical robotic systems with specific application Journal of medical engineering & technology 35 (1)
Ost, M (2011). Robotic and laparoscopic reconstructive surgery in adults and childrenSpringer Publishers
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