Robotic surgery - advantages and disadvantages

DR PRAVIN JOHN on AND DR JOHN THANAKUMAR on advantages and disadvantages of Robotic Surgery

1. Date 25th Feb 2024, Continental Hosptial, Hyderabad HIGHLIGHTS OF ROBOTIC SURGERY Dr Pravin H John & Dr John AC Thanakumar. MS,FALS, FIBC MS, MNAMS, FRCS, FRCS, Dip MIS(fr), FIAGES, FALS www.anurag-hospital.com ]

2. WHAT IS A ROBOT? Machine that resembles a human and does mechanical, routine tasks on command  Any mechanical device that operates automatically with human-like skill  “A robot is not a machine….it is an information system with arms”   

3. Definition Robotic surgery or Robot Assisted Surgery allows many complex procedure with more precision, flexibility and control than standard procedures

4. Preamble Robotic surgery is usually associated with minimal access surgery with small multiple incision to access the abdomen or chest. It is also used in open surgery. The common surgical robots involve the use of a camera arm and one or many arms for doing the operation. The surgeon sits at the console by the side and the operating assistant surgeon sits next to the patient to help out with the actual robotic arms which are basically controlled from the console.

5. EARLY ROBOTS

6. The ethos behind robotics in surgery Better vision with larger flexibility and more control is exercised by the surgeon Delicate or impossible manoeuvres by the ordinary means can be performed by the surgeon assisted by robots.

7. Robotic surgery make the MAS very doable. Advantages of MAS include tiny incisions, less pain, easy recovery and early return to normal activity. There is less hospital stay and hence less costs

8. IS IT FOR EVERYONE? Robotic surgery is not for everyone. It is available only in some centres in the country. Some surgeries do not require robotics and hence a choice has to be made in conjunction with a robotic surgeon

9. ROBOTIC UROLOGY Urologists led the way in robotics. Robotics Radical Prostatectomy preferable over conventional lap surgery Robotic pyeloplasty Robotic kindney operations are becoming more popular - transplants Robotic removal of cancerous lesions from single kidney patient.

10. ROBOTIC GYNECOLOGY Robotic Wetheim’s hysterectomies Robotic sutured myomectomies Robotic tuboplastics Robotic retroperitoneal lymphadenectomy

11. ROBOTIC GENERAL SURGERY Robotic cholecystectomy Robotic groin hernia repair Robotic fundo-location Robotic spleen preserving - pancreatectomy

12. Caval Dissection Right Left Video 3 Video 4 Caudal-to-Cranial Dissection Stable Anterior Liver Retraction by the 4° arm Low CVP (< 5 cmH 2 O)

13. Kelly Clamp Crushing Technique Endowristed Instruments Trocars Not Strictly Positioned Curved and Linear Resection Margins Inflow Occlusion Sometimes Necessary Easy Recognition of Vascular Structures Intra-Hepatic Vascular Control Video 7

14. ROBOTIC COLORECTAL SURGERY Robotic colectomies with intracorporeal anastomosis Robotic pouch surgery for Ulcerative Colitis

15. ADVANTAGES OF ROBOTIC SURGERY Vision is better with 3D depth perception Suturing at anastomosis is far better Collateral damage to surround organs is less So recovery is faster Bleeding is less Less sepsis due to minimal incisions or Single incision robotic surgery

16. ROBOTIC WRIST WITH 6 DEGREES OF FREEDOM

17. Advantages of Robotic Surgery Less pain as incisions are small Blood loss is minimal Surgeon vision and access are better with good ergonomics

18. Advantages of Robotic Surgery (conted.) Less stay in hospital Complications are less Early return to normal activity

19. ADVANTAGES FOR THE PATIENT More precise surgical work Less pain Fewer complications Less hospital stay Shorter recovery

20. ADVANTAGES FOR THE SURGEON 3D Vision gives surgeon the depth and better vision No tremors Better ergonomics with better sitting comforts Hence better dexterity of movements with augmented instruments Better access to the interior Can do complicated operations using robot

21. DISADVANTAGES Human presence Fault consequence Time Cost Efficiency &Compatibility

22. SUMMARY Robotic Surgery AKA Robot assisted surgery allows for more precision, better control by the surgeon where the patient has less pain, minimal scar, early return to normal work. Win win opportunity to everyone

23. FUTURE There is always a future of new technology in the developing world