Robotic surgery is a developing field that utilizes the precision of machines to assist surgeons. Several studies demonstrate that robotic surgery is superior to human executed surgery for certain procedures, and there are currently a number of different applications of robotic surgery in medicine. Overall, robotic surgery is typically used to increase control over surgical tools, reduce the invasiveness of a procedure, and incorporate helpful visualizations.
Groysman et al. studied a cohort of patients who underwent surgery for oropharyngeal squamous cell carcinoma to compare patient outcomes from non-robotic surgery with those from transoral robotic surgery (TORS). The results showed that non-robotic surgery was more likely to leave residual tumor when compared to TORS. The success rate of TORS is driven by its use of articulating arms which enhances tumor extraction and a high-definition endoscope which enhances visibility. Because of residual tumor, patients who underwent non-robotic surgery were more likely to receive chemotherapy to treat residual tumor.1 These possibilities make tumor removal one of the applications of robotic surgery.
There are many benefits of robotic surgery, which Gauci et al. categorize in their assessment of implementing robotic techniques to treat advanced colorectal cancer. The minimally invasive approach features smaller incisions, reduced postoperative pain, reduced blood loss and thus faster recovery times. Enhanced visualization reduces complications because it enhances identification and thus dissection. Supportive technologies like indocyanine green integrates with robotic systems for superior anatomical assessments. Surgeons who use robotic technologies report improved comfort and reduced physical demand since these procedures can last up to 8 hours. Dual console surgery allows two surgeons to work on tumor removal simultaneously. The wristed components of robotic systems increase precision which is critical to preserve adjacent organs and blood vessels. Overall clinical outcomes are better; shorter hospital stays, reduced ICU visits and faster recovery have been reported.2
Other applications of robotic surgery can improve results in complicated procedures. Gul’s study does an in-depth comparison of complex gynecological procedures that benefit from robotic techniques. Patients with obesity and endometrial cancer, high BMI and fibroid masses, rectovaginal disease, frozen pelvis, or retroperitoneal masses, and those needing neuropelveology procedures (surgeries targeting sacral pudendal nerves), posterior myomectomies, , abdominal mesh vault suspensions and mesh removals are complex pelvic cases that have better suited for robotic surgeries. Like Gauci et al., Gul explains that the enhanced precision and visualization of robotic surgery improve surgical outcomes. In addition to the benefits listed by Gauci et al., robotic systems in gynecology have a 57 Newton grip force, 7 degrees of freedom during wrist like motions, virtual reality, a computer interface, and no hand tremors due to scaling and filtration. Patient benefits can include complete disease removal, early recovery and return to normal activities as well as reduced pain.
Ballet et al.’s study reports positive findings for treating pelvic cancers with robotic surgical techniques. The Da Vinci Xi robotic system was selected to replace the typical laparoscopic method which has ergonomic limitations. Purported benefits of this system include that fewer incisions are needed to achieve triangulation of surgical zone, switching to laparotomy is not required when laparoscopy cannot perform complex surgical techniques, and visualization is fully optimized. While patients are usually left with four scars from the standard laparoscopic method, one scar is the outcome when the Da Vinci Xi robotic system is applied.
IIn many cases, applications of robotic surgery are improving surgical results across various parameters. These parameters include patient recovery, disease complexity, workplace stress for physicians, scarring and most importantly, disease treatment.4 However, it is important to note that robotic surgery is not currently appropriate or applicable to all cases.
References
1. Groysman M, Gleadhill C, Baker A, Wang SJ, Bearelly S. Comparison of margins and survival between transoral robotic surgery (TORS) and non-robotic endoscopic surgery for oropharyngeal cancer. Am J Otolaryngol. 2023 Nov-Dec;44(6):103982. doi: 10.1016/j.amjoto.2023.103982. Epub 2023 Jul 6. PMID: 37531886.
2. Chahaya Gauci, Praveen Ravindran, Stephen Pillinger, Andrew Craig Lynch, Robotic surgery for multi-visceral resection in locally advanced colorectal cancer: Techniques, benefits and future directions, Laparoscopic, Endoscopic and Robotic Surgery, 2023,ISSN 2468-9009,
3. Nahid Gul. Robotic surgery in gynaecology. Obstetrics, Gynaecology & Reproductive Medicine, Volume 32, Issue 12, 2022, Pages 267-271, ISSN 1751-7214.
4. Elodie Ballet, Clement Rousseau, Tiphaine Raia Barjat, Céline Chauleur, Robotic retroperitoneal para-aortic lymphadenectomy via single-site port, Journal of Gynecology Obstetrics and Human Reproduction, Volume 52, Issue 10, 2023, 102675, ISSN 2468-7847.