Robot-Assisted Surgery

Robot-assisted surgery

Definition

Robot-assisted surgery involves the use of a robot under the direction and guidance of a surgeon.

Purpose

Robot-assisted surgery provides many benefits in the surgical care of patients. Computer-assisted robots provide exact motion and trajectories to minimize the side-effects of surgical intervention. Surgeon-guided robotics allow the surgeon to access patient anatomy with smaller incisions.

Demographics

Patients undergoing surgical procedures classified as neurosurgery , orthopedic surgery , radio surgery and radiotherapy, prostatectomy, endoscopy, laparoscopy , cardiac surgery and craniofacial surgery may experience robot-assisted surgical techniques.

Description

Neurosurgery

A high level of accuracy is required when operating on the brain to avoid damage to the sensitive brain tissue. Biopsies and minor interventions are best assisted by the robotic device. Interventions include drilling into the skull and making an incision through the dura mater to gain brain tissue samples, empty cysts, or eliminate hemorrhage.

Orthopedic surgery

Applications such as cementless hip-replacement, total knee arthroplasties, and pedicle screw placement can benefit for the more accurate cutting and drilling provided by a robot. Femur bone-cutting devices provide improved drilling to carve a cavity in the bone for prosthesis implant. Pins inserted into the bone before surgery are used as landmarks for computerized tomography (CT) imaging. The CT image provides the surgeon with the necessary information for choosing an implant. The surgeon removes the head from the femur bone, eliminating the joint. The leg is secured in position and the robot is brought into position. A high speed cutter is then applied to create the cavity, and then followed by a smoothing tool. The surgeon manually inserts the implant into the femur and completes the cap implant into the pelvic bone.

Radiosurgery and radiotherapy

Radiation treatment is provided by a robot. The CT image or magnetic resonance image (MRI) is used to determine where the radiation treatment should be delivered. The robot aligns with patient anatomy, delivering specific doses of radiation to the intended location.

Prostatectomy

Removal of all or part of the prostate is another robot-assisted procedure. The robot controls instruments inserted through the urethra to the prostate gland. A diathermic hot wire cutting loop is guided to remove tissue in an appropriate pattern around the urethra. Fastening the guiding frame to the upper legs of the patient secures the device for accurate guidance.

Endoscopy

Endoscopy is used to examine patient cavities for the presence of polyps, tumors, and other disease states. The endoscope can be better passed through cavities such as the colon or trachea. Three-dimensional images of the cavity are obtained and used to dictate the path that will be taken to pass the endoscope. Sedation and heavy analgesia can be avoided.

Laparoscopy

In laparoscopic surgeries, three to four small incisions are made in the abdominal or thoracic cavity to insert the instruments and video equipment. The surgeon performs the operation from a remote console that provides the human machine interface. The console provides video monitoring images that are three dimensional. Joysticks are used to manipulate the tools within the chest cavity to complete the surgical procedure.

Cardiac surgery

Robots are being used in the coronary artery bypass grafting surgeries and cardiac valve replacement and repair surgeries. The harvesting of artery and vein grafts can also be accomplished with the aid of laparoscopic techniques.

Craniofacial surgery

Difficult bone cuts and bone tumor removals are accomplished successfully using robotic instruments. Preplanned trajectories are programmed into the machine. Precision cuts are made in the manner desired to achieve an esthetical and satisfactory result. As the surgeon manipulates the saw, he or she is guided along the path by a predetermined trajectory determined during an initial run on a model of the surgical site.

Aftercare

The patient should expect a faster recovery then that achieved by traditional surgery procedures.

Risks

With some of these procedures, a longer surgical time is required to achieve the same desired outcome as the traditional surgical approach. There is an increased risk of anesthesia related complications as surgical times increase. Additionally, if the robotic procedure is not completed successfully, the surgeon may need to complete the procedure with a traditional technique.

Normal results

Results for each procedure are comparable to or better than the standard surgical procedure.

Morbidity and mortality rates

Complications should be comparable to the standard surgical procedure, and even reduced. Some complications may only be associated with the robot-assisted procedure.

Alternatives

Alternative treatment is to use a traditional surgical approach without the use of robot assistance.

Resources

periodicals

Rembold, Ulrich, and Catherina Burghart. "Surgical Robotics: An Introduction." Journal of Intelligent Robotic Systems 30 (2001): 1–28.

Allison Joan Spiwak, MSBME

WHO PERFORMS THE PROCEDURE AND WHERE IS IT PERFORMED?

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These procedures are performed by surgeons trained in the operative technique with robotic assisted surgery. The expense associated with the purchase of robot-assisted equipment can limit the number of institutions able to provide robot-assisted surgery.

QUESTIONS TO ASK THE DOCTOR

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• Is there an institution in the vicinity which uses robot-assisted surgery?
• Is the surgeon experienced in robot-assisted surgical techniques?
• What benefits would the robot-assisted surgery provide?
• What complications can be avoided and which may be encountered with robot-assisted surgery?