Surgical robotics has made significant strides in changing patient care. The birth of robotic surgery took place at a time where there was an increasing demand for greater surgical precision and safer operations, and in an era where surgeons were increasingly adopting minimal invasive surgical (MIS) technologies to enhance their outcomes. The clinical introduction of the Puma 560 in 1985 led to the first surgical robot being applied to perform selective brain biopsies. It was designed to outperform hand biopsies in terms of accuracy and surgical precision.
The benefits of these minimally invasive approaches (such as laparoscopy and thoracoscopy) included:
- reduced wound access trauma,
- shorter hospital stay,
- improved visualisation,
- less postoperative wound complications (ranging from wound infections to incisional hernias),
- Less disfigurement. As such they were designed to offer an equivalence to open surgery with less tissue trauma and speedier discharge that in turn was anticipated to offer
- Increased cost-efficacy.
The healthcare industry has witnessed paradigm shift from open surgeries to minimally invasive surgeries (MIS). Minimal invasive surgeries are witnessing high demand across all disease areas due to the advantages offered such as smaller incisions, minimum blood loss, shorter hospitalization period, quick recovery, minimal post-operative side-effects and reduced costs. Surgical robots are widely used in minimally invasive surgeries that enable surgeons to perform procedures with higher precision, flexibility, and control.
Advantages and disadvantages of humans and surgical robotic systems
- Good judgement
- Adaptable and able to improvise
- Able to use qualitative information
- Easy to train
- Easy communication with humans
- Limited mechanical precision
- Prone to fatigue, tremor, inattention
- Cannot work in hazardous environments
- Limited quantitative abilities
- Good mechanical precision
- Untiring and stable
- Can work in hazardous environments
- Multimodal sensory integration
- No judgement
- No qualitative abilities
- Limited in haptic sensation
There is a large spectrum of autonomous behaviors that can be observed in surgical procedures: some are far easier to implement and encourage the use of (such as tremor reduction), while others are much more forward-looking, such as autonomous cardiac ablation in the beating heart, where a clinician must rely on the robot entirely to creating continuous lesions in the heart. The technologies associated with these works are often a combination of multiple areas of research and technology: robot design and control, medical image integration and real-time signal processing, and artificial intelligence and machine learning.
Challenges for Surgical Robot
Though current robotic systems are able to address the manipulation requirements for a very large set of surgical applications, the adoption of robot-assisted MIS over open surgery or manual laparoscopic surgery has not gained wide acceptance across all surgical disciplines. Beyond the socioeconomic reasons and difficulties in carrying out cost-benefit analysis in light of post-operative outcomes, there are key technical hurdles that explain this low rate of adoption. The challenges of limited visualization and the sensory deficiency associated with use of current robotic systems can impact the surgeon’s ability to carry out surgical tasks as easily as in open surgery. These challenges present situational awareness barriers that limit the surgeon’s ability to interpret the surgical scene, to associate the scene with preoperative imaging information and to safely complete surgical interventions.