Robotic Surgery

written by Dr Loh Chit Sin on 19 June 2013
Robotic surgery is a form of minimally invasive keyhole surgery. In robotic surgery, the instruments are not held in the surgeon’s hands but attached to a robot which is fully under the surgeon’s control.
This procedure is done under general anaesthesia (you are asleep and pain-free). The surgeon sits at a computer station nearby and directs the movements of a robot. A second surgeon is often involved at the side of the patient being operated to assist in the surgery.
The surgeon first makes several small puncture holes in the body to insert the required operating instruments. A stereoscopic telescope is inserted through one of the punctures to give a magnified 3-dimensional view of the operative field inside the body. The movement of the telescope is directly under the surgeon’s control. Similarly, operating instruments inserted are actuated under the surgeon's direction. The computerised control system is designed to be intuitive with the movement of the operating instrument exactly matching the movement of the surgeon’s hands holding and rocking the controlling levels.
What are the advantages of robotic surgery?
The advantages of this surgery are similar to those of conventional keyhole surgery. Compared to open surgery done through an incision, robotic surgery is significantly less invasive, associated with minimal blood loss. Post-operative pain is minimal and speedier recovery. However, in addition to conventional keyhole surgery, robotic surgery affords the surgeon added dexterity, enabling him/her to perform complex surgical manoeuvre with precision and control deep inside the body where space is limited. In special situation such as in prostate cancer surgery, this unique ability of the robot can result in improved functional outcome and reduced complications. The movement of the surgical instrument can also scaled down in proportion to the controlling level to add precision when operating on small structures as in coronary bypass.
During robotic surgery, the surgeon can easily see the area being operated on. The surgeon is also in a much more comfortable position and can move in a more natural way than during endoscopy. However, robotic surgery can take longer to perform, due to the amount of time needed to set up the robot. Also, the robot is expensive to use and may not be available in many hospitals.
Robotic surgery may be used for a number of different procedures, including:
• Coronary artery bypass
• Cutting away cancer tissue from sensitive parts of the body such as blood vessels, nerves, or important body
• Gallbladder removal
• Hysterectomy
• Kidney removal
• Kidney transplant
• Mitral valve repair
• Pyeloplasty (surgery to correct ureteropelvic junction obstruction)
• Pyloroplasty
• Radical prostatectomy
Currently, the most common use of the operating robot is in surgical removal of the cancerous prostate where it offers clear advantages over conventional methods. Robotic operations on the ureterus and cardiac surgery are also fast gaining popularity.