Robotic Surgery

( roshan lal recent advances 13 ch 1)

It grew out of the concepts of telesurgery and minimally invasive surgery

The da Vinci robotic surgical system was introduced in 1997 when robotic
cholecystectomy was the first clinical procedure to be performed.
The current available daVinci and its components
Surgeon console
Stereo viewer showing 3D image of the operative site
Multijoint master control that are exactly replicated at the robotic arm of
the pt
Patient (robotic) cart
Robotic arms 4 each has shoulder, elbow and wrist ; Endowrist
techonology 3 deg of freedom in the wrist and the combined arm has 7 deg of
freedom.
The arms carry 12 mm camera -- Endoscope has 2 optical channels to
provide 3D vision and rest 3 8 mm ports
The vision cart
Images are projected to the steroviewer of surgeon console and also to the
vision cart.
Setting up the robot docking
Surgical arm homing; sterile draping for 4 arms ;
patient positioning and anaesthesia. Pt cart is positioned
instruments connected to robotic arms
surgeon takes his place at the master console
Advantages of robotic surgery over minimal access surgery (MAS)
Stereoscopic depth perception two channel endoscope, better
magnification the endoscopes used in MAS
Better Hand eye cordination with used of robotics than MAS as software
aligns the motion of the tools with the camera frame of reference whereas the
camera is in the hand of assistant in MAS.
Dexterity and Intuitive movement endowrist technology, motion scalling
where large and crude movements of the surgeon are converted to fine and
small movements in the robotic arm
Robotics in urology
Urology has seen the maximal use of Robotics
Robotic radical prostatectomy (RRR) m/c robotic procedure performed
world wide. It hs as effective as open radical prostatectomy with advantages of
lesser blood loss, lesser chances of injury to the nerves with lesser chances of
impotence and lesser risk of urinary incontinence. Surgery in the narrow pelvis
especially urethral anastomosis has been revolutinized.
Robotic nephrectomy donor nephrectomy can be performed with
increased vessel lengths. Robitics has been a big impetus for partial
nephrectomy and nephron sparing surgery.
Robotic cystectomy

Urologic reconstructive procedurespyleopasty

Robotics in Gastrointestinal surgery

Robotic fundoplication and cardiomyotomy benefit while dissecting
behind and around the esophagus and for suturing
Gastric malignancies
Colorectal surgeries maneuverability in the depth of pelvis, Low anterior
resection, APR. Total mesorectal excision safe and feasible with less conversion
rates than MAS.
Robotic in hepatobiliary and pancreatic procedures
Robotic cholecystectomy first ever robotic procedure to be performed in
humans
Robot assisted pancreatic resection performing fine dissections and
anastomosis
Hepatic resections dissections at the hilum, hepatocaval dissections and
biliary reconstruction

Robotics in Bariatric surgery

Gastric bypass
Sleeve gastrectomy
Gastric banding
Robotics in cardiovascular and thoracic surgery
Robotic mitral valve replacement and repair
Minimally invasive coronary artery bypass grafting (mini-CABG)
Vascular procedures abdominal aorta and splenic artery aneurysms
Robotic thymectomies, robotic esophageal resections
Disadvantages of robotic system
Higher cost of acquisition(da Vinci system costs around 10 crores),
maintainence and recurring cost of instrument.(Each Instrument cost around 1.5
lac and last 10 operations . 4 instruments are used. Drapes 10k per operation)
Trained mapower required, learning curve
Future developments
Lack of wide range of instuments (vessel sealing device, laser, ultrasound)
that are available in other laparoscopic surgeries.
Robotic single port surgical techniques are being experimented
An area of research is incorporation of all the patient data like ultrasound,
CT, MRI etc to create a virtual patient and reharse the surgery on the virtual
patient before actual surgery.