Advantages and Disadvantages of Robotic Surgery

Robotic Surgery is a surgical technology in the world of healthcare that doctors are opting to use for many surgical procedures on humans today. Robotic surgery is a procedure that involves a surgeon manipulating the hands of a robot. Many people don’t know enough about robotic surgery. It is very important for everyone to familiarize themselves with this technology because in the near future this equipment has the potential to take over the operating rooms of many hospitals.

The goal of this paper is to give some basic information about how Robotic surgical procedures has evolved and to bring to light some of the ways robotic surgical procedures might affect you one day. When I was faced with the choice of having robotic surgery two months ago I felt like I didn’t know enough about the technology. I had no knowledge of how this type of surgery would affect me. I would like people to be able to understand how this technology will affect their lives.

For this assignment, I decided to research the advantages and drawbacks of robotic surgery to inform everyone about this technology so that if faced with this choice you won’t be in the dark like I was.

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Introduction

On television, in shows such as Grey’s Anatomy, the process of the conventional surgical procedure are acted out on screen for the world to watch. In the near future, many scenes in such shows will have to be altered to feature the surgeries being done by physicians with robotic surgical devices (if they haven’t already done so already). Robotic surgeries are becoming very common in our society.

It is very important for everyone to know and understand what this practice entails so that if presented with the choice of human or machine one can make the right choice. I was living my life from day to day like many people. I exercise when I can and I eat right. For a period of a little over a year, I was experiencing abdominal pains so my doctors put me through many series of exams. One of the test results came back abnormal showing that I had a tumor. Being a young woman that is recently married I was scared so I decided to have my tumor removed right away.

When my husband and I sat down to discuss my options with my physician I was given a choice between a conventional procedure that is performed solely by a human doctor or robot-assisted surgical procedure that involves an actual surgeon manipulating the hands of a robotic machine. I was very frightened about the thought of having a machine working on my body because the idea was foreign to me. I heard about robots working on cars and I heard of the surgical procedure but I never actually thought about being the subject of one of these devices.

I wasn’t confident enough about this type of surgery so I opted to go with the conventional type of procedure. Robotic surgery is performed everyday around the world and it has the potential to dominate the world of surgery, however, it has advantages and disadvantages. Discussion Many people might think that this is a topic of no interest to them because right now they don’t need a surgical procedure done or they have no plans of having a surgical procedure. To those people, I would like to say neither did I!

To make light of this subject the first thing I would like to do is provide a timeline that show a brief history on the development stage of robotic surgical machines.

1921 a Czechoslovakian play writer named Karel Capez introduced and coined the term robot in a play called Rossom’s Universal Robots”. The play writer based the term off of the Czech meaning of the word "forced labor” (Long, 2007).

1923 The term robots entered the English language (Long, 2007). In the begging of the robots career, they started relatively as “dumb machines” that did only slavish repetitive tasks.

1985 Robotic Surgeries began with a robotic machine called the Puma 560. The user of the robot was a surgeon named Kwoh et al who perform neurosurgical biopsies with the machine. He wanted to be as accurate as possible and felt the machine would be able to perform a greater precision.

The next person to use the Puma 560 was Davies et al three years later during a transurethral resection of the prostate Lippincott, W (2004). The next system that was later developed was PROBOT. This was a robot designed especially to assist with transurethral resection a man’s prostate.

During the same time period that PROBOT was being developed, another machine called the ROBODOC was being developed. This robotic was designed to assist with the precision of hip replacements. ROBODOC was the first surgical robot approved by the FDA.

Researchers from the National Air and Space Administration (NASA) Ames became interested in using the information that was present from the previous robots to develop a technology called telepresence surgery. The technology of telepresence became the major driving force behind the development of surgical robotic robots as we know them today. Lippincott, W (2004)

990’s Scientists from the National Air Space Administration teamed up with the Stanford Research Institute (SRI) to develop a dexterous telemanipulator for hand surgery with a design goal of giving the surgeon the sense of literally operating on the patient in front of them somewhat, instead of from across the room.  The US Army recognized the work being done at the Stanford Research Institute and became interested of treating wounded soldiers remotely instead of putting the surgeons in arms way the idea was to be able to treat soldiers and decrease mortality by “bringing the surgeon to the wounded soldier—through telepresence.

Many of the surgeons and engineers working on surgical robotic systems for the Army eventually formed commercial ventures. These ventures lead to the introduction of robotics to civilian surgical communities.

Computer Motion, Inc. of Santa Barbara, CA. This company used funding provided by the US Army to develop the Automated Endoscopic System for Optimal Positioning (AESOP), a robotic arm controlled by the surgeon's voice commands to manipulate an endoscopic camera.

Shortly after AESOP was marketed, Integrated Surgical Systems (now Intuitive Surgical) of Mountain View, CA, licensed the SRI Green Telepresence Surgery system. This system underwent extensive redesign and was reintroduced as the Da Vinci (one of the world's most used surgical assisted device today.

One year later Computer Motion put the Zeus system into production  Robotic surgery today has certainly come a long way. The surgical procedure is similar to when it was first developed but more advanced in terms of the many procedures that robots can assist with.

The device as we know it today is equipped with cameras and enhanced visual effects, to allow doctors the option of getting inside the body through tiny incisions and repairing whatever is necessary to be prepared. The surgical procedure that I underwent conventionally is done by a surgeon making an eight to ten inch cut at the bottom of my stomach (very similar to the cut a woman gets when delivering a baby). I was hospitalized for three days and was given pain medication around the clock. Dr.

Thad Denehy, MD (my surgeon) advised me that Robots in the field of surgery have dramatically changed the procedure and that my greatest benefit to having Robotic Surgery was less pain, less bleeding and less scaring. Since the machine uses cameras and enhanced visual effects, doctors make smaller incisions. The Da Vinci and Zeus system each use “arms” to operate. In order for these arms to get inside the body and operate, the robot only requires a one-centimeter incision to fit each arm. For my procedure, it would have required three tiny incisions on my abdomen.

The cut would have been about one centimeter in length (a little less than a half of an inch) to fit the arms of the robot instead of a 20 inch cut (about 8 inches) at the bottom of my stomach. According to Dr. Denehy, the advantage to having the robot assist surgical procedure would have been that I would get smaller cuts the smaller cuts. He explained that smaller cuts are better because a large incision would require more time to heal. Another potential great advantage from getting the robot assist surgery Dr. Denhey explained would be less blood loss.

This would be good for patients who are anemic (low blood count) or for people with medical conditions that cause them to bleed easily. In my case I'm anemic so I would benefit from this procedure. With less blood loss and smaller incisions, the Dr. went on to advise me that would be less than half the recovery time of conventional surgery. Two weeks to full recovery instead of eight weeks to full recovery. This could be a determining factor for many people. a person who doesn’t have the luxury of staying out of work for more than eight weeks would be back to work in some cases as early as one week.

According to Dr. Denehy the larger the cut the more trauma, it causes to a person's body and the risk of getting an infection is high. Though Dr. Denehyy had such wonderful things to say about Robotic surgery I still was convinced. One major disadvantage for me was the amount of experience he had with using the Robot assist device. He had only performed 32 surgeries using this machine while with the conventional surgery he had performed over 2000. I was very concerned about his experience level with this machine. This surgeon was recommended to me by two other doctors.

According to Dr. Wai (One of my regular gynecologists) during my exam (before going to see Dr. Denhey) Dr. Denhey was the best surgeon in her opinion to remove my tumor. I was very frightened that the best-qualified doctor for the job only did this procedure 32 times with the robot that offered so many promises. In my research, I learned that since the robotic surgical procedure is a new technology its uses and efficacy have not yet been well established (Anthony R. Lanfranco, BAS, Andres E. Castellanos, MD, Jaydev P. Desai, PhD,*†  William C. Meyers, MD  (2011).

I spoke with two surgeons new in the field (Dr. Steven Choe, MD and Dr. Poovendran, Saththasivam, MD. to see if maybe Dr. Denehy's experience level was due to him being an older surgeon. I was very surprised to learn that both new doctors had never used this equipment. I was told by both physicians that it wasn’t mandatory to learn how to use the machine but since the hospital had just purchased the machine they were both going to get training for using this machine. Surgeons start out their careers without learning about robots initially. It is not mandatory for them to learn how to use the machine. This made me think of another disadvantage.

What would happen if the surgeon performing the surgery become ill and need assistance. Who would jump in and assist him with the procedure? If all surgeons aren't on the same page with knowing how to use the machine Im not sure if this surgery is a benefit at all. As a patient, I would be most confident knowing that if something should go wrong during the procedure with the health of my doctor another physician in the vicinity of the hospital is ready and capable of jumping in and completing the procedure. According to Dr. many surgeons still lack the skills of working with the surgical robot.

Another disadvantage was that to date, most of the studies that have been done for surgical robots have been on the practicality of the equipment. The researchers of the technology haven’t done any follow-up studies to date on a long-term period. At least that was what my surgeon advised me during my consultation. I also learned that many procedures performed with the robotic surgical device will also soon be redesigned to optimize the use of robotic arms and increase efficiency. This is great for a patient looking to have a procedure done in the future but not so great for a patient waiting to have a procedure done today.

Many of the disadvantages seem to project that can all go away with time and experience it see very likely that many disadvantages be remedied in the future( Anthony R. Lanfranco, BAS, Andres E. Castellanos, MD, Jaydev P. Desai, Ph.D.,*†  William C. Meyers, MD 2011) It became clear to me that though this technology offers many advantages there are some disadvantages that really concerns me. One of them being that because this equipment requires a surgeon to move the instruments while watching a video monitor potentially a lot could go wrong.

Robot assist surgeries require the surgeon to move in the opposite direction from the target on the monitor. If the surgeon becomes tired and forgets that he is to be moving in the opposite direction he or she can cause major damages. In order for this to work correctly, it requires a lot of hand-eye coordination and great hand and finger dexterity. The idea that this procedure is done through the eyes and fingers of a human being, leads me to believe that this type of procedure is not safety proof.

Perhaps even more important than the probability of a fault is the ability to detect that a fault has indeed occurred and prevent hazards resulting from it, that is, allow the robot to "fail safely". This usually involves shutting the robot down and removing it from the patient and having the operation manually completed by a surgeon. As the task which the robot undertakes becomes more and more complicated, there is an increasing need for more complex hardware and software components (faster response, better accuracy, more degrees of freedom).

This increases the probability of error exponentially. Software is notoriously difficult to reason about, while hardware reliability never ceases to be of prime importance.

Conclusions

Robotic surgery is rapidly making its way into the progression of surgical procedures as we know it today. Though the technology is fairly new it’s becoming the choice for surgery for both surgeons and patients. Many individuals still feel that they need time to completely trust these machines and would probably consider it in a few more years.

With the further use of this machine, the pros will more than likely outweigh the cons. The more surgeons use this machine they will become more familiar with the different capabilities of Robotic Surgical devices. They will also figure out ways getter better trained and getting a lot of practice using the equipment. More studies will be done on the feasibility of the technology. Conventional Surgical techniques took thousands of years to develop to where it is today adding this new dimension to it will further expand and make better the many practices.

People such as myself will take a second look at having the robot assist in with surgical procedures that involve me and will probably be more excited about having to get smaller incisions and reduced recovery time after surgery.

References

1. Brown University. (1999). Robotic surgery. Retrieved from http://biomed. brown. edu/Courses/BI108/BI108_2005_Groups/04/  Long, T. (2007, January 25). The robot cometh. Retrieved from http://www. wired. com/science/discoveries/news/2007/01/72500 Parmar, A. (2001). STRESS-FREE SURGERY. Siliconindia, 5(10), 44. Interview with Dr. Denehy
2. Interview with First year surgical resident at saint peters University Hospital Steven Choe Interview with first year sergical resident Povendran, saththasivam at saint peters university hospital Websites http://biomed. brown. edu/Courses/BI108/BI108_2008_Groups/group12/Roboticsurgery. html http://www. ncbi. nlm. nih. gov/pmc/articles/PMC1356187/ http://www. onlineschools. org/robotic-surgical-technology/ http://library. thinkquest. org/03oct/00760/ http://www. medscape. com/viewarticle/466691_5 Anthony R. Lanfranco, BAS, Andres E. Castellanos, MD, Jaydev P. Desai, PhD,*†  William C. Meyers, MD SUMMARY

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