Best Practice & Research Clinical Obstetrics & Gynaecology
12Robotic surgery – Advance or gimmick?
Section snippets
Definition and history of robots in medicine
The term ‘robot’ was first used in 1921 in a play by the Czech playwright Karel Čapek, entitled Rossom's Universal Robots. The word ‘robot’ is derived from the Czech word ‘robota’, which means ‘forced labour’ or ‘serf’.1, 2 One of today's definitions of the term robot is ‘a device that automatically performs complicated often repetitive tasks’.3 Thus, only the earlier inventions, such as PUMA 560, PROBOT, and ROBODOC® are robots true to the official meaning, as they carry out tasks
The da Vinci® Surgical System
Intuitive Surgical, Inc. was founded in 1995. After securing licenses on the technologies developed by several institutions and merging ideas and inventions into a commercially available medical device, the first version of the da Vinci® Surgical System was launched in 1999. In July 2000, the device received US Food and Drug Administration approval for laparoscopic surgery.15 The da Vinci® system consists of three core components: a surgeons console, a patients-side cart and a high-definition,
Conventional laparoscopy
Minimally invasive surgery has many well-known advantages, including reduced blood loss, less pain, fewer infections, reduced hospital stay, and faster return to normal life.26 Conventional laparoscopy, however, is associated with disadvantages for the surgeon, thus hampering the widespread use of this minimally invasive approach.27, ∗28 Learning laparoscopic skills and being confident in advanced laparoscopic actions, such as suturing, is a challenging and often time-consuming task.
Advantages of the da Vinci® Surgical System
The da Vinci® Surgical System has several special functions aimed at overcoming the limitations of conventional laparoscopy and to mimic characteristic features known from open surgery. The three-dimensional, high-definition imaging allows stereotactic vision of the operation field, making depth perception possible. Additionally, the area of interest can be magnified up to 10 times. The surgeon's hand movements can be scaled (5:1, 3:1, or 1:1)10 so that large movements of the surgeon's hand are
Disadvantages of the da Vinci® Surgical System
Despite the numerous advantages of the da Vinci® Surgical system, it certainly has substantial drawbacks that hinder the widespread implementation of its usage. Although the learning curve for robotic surgery is less steep than for laparoscopy, extensive training is also needed before surgeons can operate on patients. Additionally, the theatre team also need training to become familiar with the device set up as well as with the solution of potential problems during procedures. Hence, the
Learning and training
It is assumed that robotic surgery is associated with a less steep learning curve than conventional laparoscopy, owing to the more intuitive handling of robotic instruments and three-dimensional vision. In fact, in-vitro studies comparing learning curves for laparoscopically and robotically performed exercises (e.g. knot tying or paper cutting) revealed faster learning curves and better performances in the robotic groups.37, 38, 39, 40 Differences in learning curves were most significant for
Costs
A reliable statement about the expected costs for hospitals aiming to introduce robotic surgery is difficult to make, as various components influence cost calculations, including factors related to hospital and healthcare systems. Cost calculations can be approached in different ways, depending on inclusion or exclusion of the initial purchase costs of the robot, the inclusion of societal costs associated with lost work time of the patient or, in general, on the parameters included in the
Studies
At present, evidence for safety and efficacy of robotic surgery can be largely obtained only from retrospective studies often containing just a small number of participants or including the first cases of robotic surgeries carried out where the surgeons are at the beginning of their learning curves. Therefore, the results of these studies must be interpreted with caution, which makes it difficult to draw any firm conclusion on the efficacy of robotic surgery compared with other approaches.∗28,
Conclusion
Robotic surgery offers certain advantages for the surgeon, but the validation of equal or better patient outcomes compared with laparoscopy and laparotomy through RCTs is still lacking. Results from such trials are urgently needed to draw any firm conclusions about the efficacy of robotic surgery. As to the question whether robotic surgery is an advancement or just a technical gimmick, the advantages and disadvantages must be weight against each other in the light of the respective expertise
Conflict of interest
None declared.
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