Introduction

Robotic surgery, computer-assisted surgery, and robotically-assisted surgery are terms for technological developments that use robotic systems to aid in surgical procedures. Robotically-assisted surgery was developed to overcome the limitations of minimally-invasive surgery and to enhance the capabilities of surgeons performing open surgery.

In the case of robotically-assisted minimally-invasive surgery, instead of directly moving the instruments, the surgeon uses one of the methods to control the instruments; either a direct telemanipulator and through computer control. A telemanipulator is a remote manipulator that allows the surgeon to perform the normal movements associated with the surgery whilst the robotic arms carry out those movements using end-effectors and manipulators to perform the actual surgery on the patient.

The da Vinci Surgical System comprises three components: a surgeon’s console, a patient-side robotic cart with 4 arms manipulated by the surgeon (one to control the camera and three to manipulate instruments), and a high-definition 3D vision system. Articulating surgical instruments are mounted on the robotic arms which are introduced into the body through cannulas.

The da Vinci senses the surgeon’s hand movements and translates them electronically into scaled-down micro-movements to manipulate the tiny proprietary instruments. It also detects and filters out any tremors in the surgeon's hand movements, so that they are not duplicated robotically. The camera used in the system provides a true stereoscopic picture transmitted to a surgeon's console.

Application of Robotic in General Surgery

Foregut surgery Nissen fundoplication

Heller myotomy

Esophagectomy

Gastrectomy and subtotal gastrectomy Hepatobiliary Surgery Cholecystectomy

Hepatic lobectomy and segmentectomies Endocrine Surgery Adrenalectomy Bariatric Surgery Sleeve gastrectomy

Gastric bypass

Comparison of conventional laparoscopic surgery versus robot-assisted surgery

Conventional Laparoscopic Surgery Robot-assisted surgery Advantages Well-developed technology

Affordable and ubiquitous

Proven efficacy 3-D visualization

Improved dexterity

Seven degrees of freedom

Elimination of fulcrum effect

Elimination of physiologic tremors

Ability to scale motions

Micro-anastomoses possible

Tele-surgery

Ergonomic position Disadvantages Loss of touch sesnation

Loss of 3-D visualization

Compromized dexerity

Limited degrees of motion

The fulcrum effect

Amplication of physiologic tremors Absence of touch sensation

Very expensive

High start-up cost

May require extra staff to operate

New technology

Unproven benefit

Advantages and disadvantages of robot-assisted surgery versus conventional surgery

Human Strengths Human limitations Robot Strengths Robot Limitations Strong hand-eye coordination Limited dexterity outside natural scale Good geometric accuracy No judgement Dexterous Prone to tremor and fatigue Stable and untiring Unable to use qualitative information Flexible and adaptable Limited geometric accuracy Scale motion Absence of haptic sensation Can integrate extensive and diverse information Limited ability to use quantitative information Can use diverse sensors in control Expensive Rudimentary haptic abilities Limited sterility May be sterilized Technology in flux Able to use qualitative information Susceptible to radiation and infection Resistant to radiation and infection More studies needed Good judgment Easy to instruct and debrief

Conclusion

Although still in its infancy, robotic surgery has already proven itself to be of great value, particularly in areas inaccessible to conventional laparoscopic procedures. It remains to be seen, however, if robotic systems will replace conventional laparoscopic instruments in less technically demanding procedures. In any case, robotic technology is set to revolutionize surgery by improving and expanding laparoscopic procedures, advancing surgical technology, and bringing surgery into the digital age. Furthermore, it has the potential to expand surgical treatment modalities beyond the limits of human ability.