Robotic surgery has only been around since the early 2000s, but in certain surgical fields it's already overtaken traditional open surgery.

And now it's poised to change the nature of surgery forever.

In the past, surgeons had to make large incisions in order to reach the organs they needed to operate on. This often meant big, ugly scars and long recovery times. Then, in the '70s laproscopic surgery emerged and completely upended the whole surgical field as the first minimally-invasive type of surgery. But even that had limitations, as it was difficult to perform certain complex procedures, like removing complex tumors.

Now, the new high-tech robot, called the da Vinci Surgical System, is poised to completely revolutionize surgery once again. In some ways, it already has.

Robotic surgery allows surgeons to perform complex surgical procedures using a minimally invasive approach. It's also much more precise than even the most skilled doctor with the steadiest hand. Doctors say that patients are requesting robotic surgery because it leaves small scars and allows for a quicker recovery time.

How It Works



The da Vinci Surgical System almost resembles a video game, with its futuristic controls, interactive robotic arms, and 3-D screen.

The da Vinci Surgical robot Wikimedia Commons There are two components of this system: The robot itself (which operates on the patient) and the separate control console (which is controlled by a surgeon).

The robot has three small, nimble robotic arms that attach to various instruments such as a scalpel, scissors or electrocautery instruments. each instrument can easily swapped out for different functions. The last arm holds an endoscopic camera that gives the surgeon 3-D vision from the control console.

The robot and its many arms are controlled by the surgeon, who sits in a separate console. (Usually the console is in the same room as the patient, but in the future that may not be the case; see "The Future of Robotic Surgery" below). While operating, the surgeon looks through eye holes in the machine to see a 3-D image of the procedure while simultaneously maneuvering the robotic arms. The doctor controls the robotic arms via two foot pedals and two hand controllers.

The robot translates the doctor's movements and carries them out through the robotic arms, which operate on the patient. The robotic arms enter the patient through tiny incisions. The robot takes the doctor's movements and makes them much more precise and efficient.

What It's Used For

Robotic surgery is not ideal for all surgeries, but it has replaced traditional open surgery in many fields, including, most notably, urology and gynecology. Today, it's commonly used for prostatectomies, nephrectomies, and hysterectomies, but it's also increasingly used for cardiac valve repair and other complex surgeries.

Mt. Sinai Hospital is a urological surgeon and the Director of Minimally Invasive Urology at Mount Sinai Hospital in New York City who specializes in robotic, laparoscopic and endoscopic surgery. He established the robot surgery program for the Department of Urology at Mt. Sinai and performs over 800 surgical procedures each year--many of which he uses the robot for.

"Robotic surgery is great for prostate and kidney surgery," Palese said. "With kidney surgery, you used to have to make larger incision and maybe even remove part of the rib cage. With the robot, that's no longer the case. It's also great for prostate surgery because you can see really well while operating because of the magnification."

The Drawbacks



Palese explained that today the majority of urological surgical procedures are performed via the da Vinci robot. While that's an amazing phenomenon — especially considering that the technology is only about ten years old — there are drawbacks.

"Robotic surgery is ingrained in urology and gynecology and it's not going anywhere," Palese said. "So you need to have a skill set to learn how to use this thing. We train the residents in robotic surgery because we're doing everything robotically or laproscopically. But that means that the residents aren't doing as much open surgery."

That means that younger doctors are not necessarily being trained to perform traditional open surgeries, still a crucial skill. In most other countries, which have not yet embraced robotics, surgeons are still performing traditional open surgery.

"We've talked about doing open-surgery fellowships where we can go back and teach younger surgeons how to do open surgery," Palese said. "This technology is great but we still need to keep the traditional skills."

As robotic surgery has taken over these surgical fields, there's also been an interesting shift in age dynamics.



"We’ve found that younger surgeons who have experience with video games picked it up quicker than older surgeons," Palese said. "Today it's so commonplace. Most patients request this surgery, even if traditional open surgery is preferable. It all happened so fast. Some amazing surgeons almost lost their practices overnight because they weren't able to transition fast enough and adapt to the new technology."



The Future of Robotic Surgery



What's most remarkable about robotic surgery is what the future might hold.

Doctors are anticipating the growth of tele-medicine and long-distance operations, where a doctor could conceivably operate on a patient in another city, state, or even a different continent. Practically, this would mean that surgical centers would be set up in different parts of the world and a doctor could go to a surgical center and sit in a control console while a patient in a different surgical center would be operated on by a robot controlled by that doctor.

Already a long-distance operation was performed via robotic surgery between New York and Strasbourg, France, in 2001. The surgery, which was dubbed "Operation Lindbergh" for its pioneering qualities, was performed successfully, but there was a delayed lag time that made this long-distance surgery impractical. However, as the internet becomes faster and bandwidth becomes cheaper, this will undoubtedly change.

"In the future there will be tele-medicine, where you can operate on someone somewhere else in the world," Palese said. "I don't think that's far-fetched science fiction anymore. I think that I’ll see that in my lifetime."

Palese added that the growth of tele-medicine will also mean a higher level of competition between doctors who are vying for surgical bids. This would raise the bar and push surgeons to be the very best in the field.

The other possibility that we could see in the future is the single-incision port, where a doctor could make a tiny incision, perhaps through a patient's bellybutton, and then insert the snake-like arms of the robot through that incision. Currently, the robot makes a few small incisions, through which its arms are inserted.

"The next generation of this technology will mean that you put one little hole in the patient and then put snake-like arms through that hole," Palese said. "That will be a real technology buster. That would change the nature of surgery forever."

Watch our exclusive video about the robotic surgery below.