Medical technology in the operating theater has come on leaps and bounds, but it still needs a helping hand from human.
Robotic surgery allows for control and precision previously unknown to surgeons. Contrary to popular belief, the robot does not operate on the patient alone. It is a ‘slave’ to a human ‘master’, meaning it is not a true robot (these can work and react automatically). The surgeon sits at a console next to the operating table and the robot is placed around the anaesthetised patient. The surgeon looks at a high-deﬁnition 3D image provided by the robot’s cameras, and special joysticks are used to control the ultra-ﬁne movements of the robotic arms.
This brings many exciting advantages. The camera, previously held by a human being, is now held perfectly still by the robot. The movements and angles that the arms of the machine provide allow for ﬁ ne precision and less damage to adjacent tissues when cutting, leading to reduced pain and a faster recovery. This has led to very rapid uptake by some specialists, including urologists (who operate on the bladder and kidney), gynaecologists (who operate on the uterus and ovaries) and heart surgeons. As with most technologies, there are downsides to using robots in operations. They are expensive, large, cumbersome to move into place, and remove the important tactile feeling of real tissue between the surgeon’s ﬁngers.
Robotic surgery is considered a step forward from standard keyhole surgery, where the surgeon holds the camera and operating arms. However, early results have shown that there are practically no outcome differences between the two techniques. Combined with higher costs, some surgeons think this means robots are actually inferior to current techniques. This has led to the development of on-going trials, comparing robotic to standard keyhole surgery.
Surgeons around the world are working as a single, giant team to deliver these, and the results will determine the future of medical robots for generations to come.
The evolution of robotic surgery
The current robots in use, like the da Vinci Surgical System, are second generation. The ﬁrst generation, like the Unimation PUMA developed in the Eighties, had very limited movements and could only carry out speciﬁc tasks. The second generation brought a range of ﬁ ne and varied actions, which surgeons rapidly adapted to.
These new-and-improved robots were pioneered and driven forward by North American health systems. Uptake has been slower in Britain due to health budgets, at a time when other treatments have an even bigger impact on patient outcome. There is excitement over development of the third generation of robot, which promises to be more compact, faster and to be packing in even more cutting-edge technology. The future may see telesurgery, where the surgeon in one place (eg a hospital) performs robotic surgery on a patient elsewhere (eg an injured soldier on a battleﬁeld).