Dr. Karthik Chandra Vallam, MBBS, M.Ch., DNB, Surgical Oncologist, Robotic and Laparoscopic Surgeon
Surgery has evolved from the era of invasive “open” model to the minimally invasive model especially when dealing with “cavity” surgery (abdominal/chest cavities). The advantages of MIS are pretty obvious with smaller incisions, lesser pain, earlier return to normal activities, lesser wound-related complications. However, there are significant challenges with traditional laparoscopic surgery – counter-intuitive movements, rigid non-articulating instruments, limitation with 2D vision and ergonomic discomfort for the operating surgeon to name a few. Newer platforms like Robotic Surgery work to overcome these limitations and make it easier for the surgeons to do a better job and thereby improve outcomes for the patient.
How does the Robotic Surgery work?
The current Robotic Surgical System consists of four components: 1) a SURGEON CONSOLE where the surgeon sits, views the screen, and controls the robotic instruments and camera via finger graspers and foot pedals; 2) a ROBOTIC CART with four interactive arms that hold instruments through trocars attached to the patient; 3) a VISION CART WITH CAMERA that allows for a three-dimensional image of the surgical field using image synchronizers and illuminators; and 4) WRISTED INSTRUMENTS that translate the mechanical movements of the surgeon’s hands into computer algorithms that direct the instruments’ movements
During Robotic Surgery, small incisions are made on the patient’s abdomen/chest through which three to four trocars are introduced into the patient. Through these trocars, a few instruments and an endoscope (camera) are placed. These ports are “docked” (connected) to the robot which enables the surgeon to operate from the console which is connected to the robotic cart. The primary surgeon sits unscrubbed at the console in the operating room at some distance from the patient, using finger graspers and foot pedals to control the instruments (just like in a video game). The console provides 3D imaging with improved depth perception, and the surgeon has independent control of the camera and instruments. Finally, the robotic arm, with its wristed joint and six degrees of freedom, allows for greater dexterity than unassisted surgery and decreases normal hand tremors.
What are the advantages of Robotic Surgery?
Robotic surgery presents a spectrum of advantages over traditional laparoscopic techniques. Robotics allows the surgeon to see 3D images with 10x magnification, obtain better angles with the increased degrees of freedom provided by the EndoWrist instruments, and control three different instruments and the camera simultaneously. These advantages make it easier to execute complex laparoscopic procedures like identifying important neurovascular structures and intracorporeal suturing in deep and narrow places like the pelvis. Greater surgical precision and improved ability to spare healthy tissue not impacted by cancer are added benefits. The surgeon is able to operate from an ergonomically comfortable, seated position at a console, with eyes and hands in line with the instruments and is not dependent /minimally dependent on assistant surgeons. This is specifically advantageous for long-duration surgeries like certain cancer surgeries. With the robot, the surgeon does the job of 3 people simultaneously (camera assistant, operating surgeon, assistant surgeon) with ease.
Is the Robot “programmed” to do the surgery independently? / Is it safe?
Throughout the procedure, the surgeon controls every surgical maneuver. THE ROBOT CANNOT OPERATE INDEPENDENTLY. It is a master-slave system operated by a specially trained and highly skilled surgeon.
What are the surgeries which can be performed with the robot?
FDA has approved a long list of surgeries that can be safely performed with the da Vinci robotic surgical system. Surgeries, where robotic technology has a significant edge, are – prostatectomy, partial nephrectomy, colorectal cancer surgery, esophagectomy, radical hysterectomy (uterus removal for cancer) and certain (bariatric) weight reduction procedures.
Dr. Karthik Chandra Vallam,
Surgical Oncologist, Robotic and Laparoscopic Surgeon,
Mahatma Gandhi Cancer Hospital and Research Institute, Visakhapatnam