Robotic surgery is a concept that incorporates robotic units to help doctors in their surgeries. This procedure was brought into use to remove the hurdles of surgeries that are minimally-invasive and to improve the outcomes of open surgery [1].

The idea tells us that the doctors work through the hands of the robot by changing its hand movements as per requirements [2].

HISTORY:

Year - Event
• 1985 - PUMA 560 surgical arm in neurosurgical biopsy.
• 1987 - First laparoscopy done, with the help of a robot [3].
• 1992 - First surgery (prostatic) performed entirely by a robot (PROBOT). ROBODOC- exact fittings in the femur for replacing the hip [1].
• 1993 - AESOP: a robotic unit activated by voice, utilized in endoscopic operations [4].
• 1998 - Reconnecting the fallopian tube.
• 1999 - Coronary artery bypass graft of a beating heart. Cardiac hybrid revascularization of a closed-chest beating heart [1]. These two operations carried out using the ZEUS robotic unit.
• 2001 - Trans-Atlantic tele-surgery (cholecystectomy) done by Prof. Jacques Marescaux and team: from New York to Eastern France [1].
• 2007 - Microsurgery through a robotic unit for removing the nerve of the spermatic cord responsible for chronic testicular pain.
• 2008 - Reconstructing the neurogenic bladder in small children using a robotic unit
• 2009 - First kidney transplant using the da Vinci Si unit.
• 2010 - First surgery at the femoral vasculature using a robotic unit [1].

ADVANTAGES OF ROBOTIC SURGERY:

For patients-

1. Amount of anesthesia given is less [6].

2. Decrease in hospital stays.

3. Level of discomfort and pain is brought down.

4. Quicker time of recovery, to Activities of Daily Living (ADL).

5. Minimal cuts given, hence the rate of contracting infections is also low.

6. Lesser amounts of loss of blood along with transfusions.

7. Scarring of skin is almost not seen.

For surgeons-

1. Visualization area is bigger i.e. the surgeons can see a bigger area of the operation site on the screen.

2. Range of movements of robots in small places in the body is much higher. Hence, open surgery can be avoided.

3. If the surgeon is operating in very small places in the body, the robotic units provide a high degree of precision as all the operations are controlled by a computer [7].

4. The efficiency of the surgeons can also reduce after a hard day's work. Hence, the robotic units minimize this risk [8].

DISADVANTAGES OF ROBOTIC SURGERY:

1. Heart operations performed with robotic units can consume a lot of time when compared to normal heart operations. But all this changes quickly according to the surgeon's skill & experience.

2. The robotic units are quite costly in their initial stages of use; over time one could also see an increase or decrease in their costs. To balance it out, they would have to be used in a wide range of disciplines [9].


3. The surgeon has to be in close contact with the robotic unit to reduce the time lapse between the instructions given out and the response of the robotic unit with its movements [8].

4. Extra training is required to use the system; surgeons will have to make some time for this as well [10].

Here, the advantages clearly outweigh the disadvantages. Hence, more and more people should try to incorporate this technology into their already established system.

APPLICATIONS:

1. Cardiac surgery: Robotic units were initially developed to aid surgeons performing cardiac operations. Surgeons have been able to go ahead with minimally invasive endoscopic coronary artery bypass grafting & valve procedures, by visualizing the parts to be operated in 3D and using instruments that are miniaturized and multiarticulated. There is an alternative for surgeons: either to use the Zeus or the da Vinci robotic unit in carrying out the above mentioned procedures.

2. Ophthalmology: Precision in micro-suturing is the necessity of many eye surgeries. This task is fulfilled by the "Steady Hand" robotic unit which mandates the surgeon to be in close contact with the tool along with the robot.

3. Neurosurgery: Clinically, the first task that the robotic unit was made to do was stereotactic neurosurgery. The robotic units that were used for this purpose were PUMA 560, Minerva, Neuromate etc. Currently, in this field the attention has shifted from neurosurgery to radiosurgery.

4. Orthopedics: For the process of total knee replacement to have a positive outcome, the limb & the prosthesis should be in a straight line. To aid this process, the ROBODOC unit drills an exact hole in the cavity of the femur through CT guidance. Another robotic unit has been made that can help the surgeons in placing needles, especially in cases such as nerve blocks.

5. Urology: In this field, the uses of robotic units range from transurethral prostate resections to accessing the kidney percutaneously. Very late surgical additions in this field include renal transplants, robotic vasovasotomy etc.

6. Gastrointestinal operations: The specific cases that have been done include pyloroplasty, gastric bypass, excising the duodenal polyp, gastric banding, rectopexy etc.

THE FUTURE:

1. Reducing the overall size of the robotic unit by incorporating motors that are miniature in size.

2. Raising the number of points by which one can reach the patient- done through fixing the robotic unit to the wall.

3. Incorporating the images on the console which can be seen endoscopically.

4. Carrying out telementoring by using robotic units will encourage a flow of ideas and give uniformity to the process of surgical training (11).

5. A single incision-port could be a reality through which the robot could enter inside a patient. This would be a change from the number of entry points that is made use of currently [12].








REFERENCES:

1. http://en.wikipedia.org/wiki/Robotic_surgery

2. http://library.thinkquest.org/03oct/00760/

3. http://www.vcuhealth.org/?id=1088&sid=1

4. Basnett G. History of Robotic surgery. Website:
http://www.uclh.org/aboutus/FT/MembersMeet%20Past/History%20of%20robotic%20surgery%20-%20Gillian%20Basnett.pdf

5. http://en.wikipedia.org/wiki/Lindbergh_Operation

6. http://www.pennmedicine.org/robotics/benefits.html

7. http://uchealth.com/services/robotic-surgery/patient-information/benefits/

8. http://www.futuretechnology500.com/index.php/future-medical-technology/robotic-surgery-advantages-and-disadvantages/

9. http://biomed.brown.edu/Courses/BI108/BI108_2004_Groups/Group02/Group%2002%20Website/robodisadvan.htm

10. http://linni101.weebly.com/advantages-and-disadvantages.html

11. Dharia S P, Falcone T. Robotics in reproductive medicine. Fertility and Sterility. 2005; 84(1): 1-11.

12. http://www.businessinsider.com/the-future-of-robotic-surgery-2012-7?IR=T

13. Video links: http://www.ted.com/talks/catherine_mohr_surgery_s_past_present_and_robotic_future.html
http://www.youtube.com/watch?v=AdfyTp5XgKU (by uconn)



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