We can describe Robotic Surgery or robot-assisted surgery as performing certain operations through tiny holes using the “da Vinci” system. Robotic surgery provides numerous advantages to both patients and surgeons as it is the next step in minimal invasive surgery after laparoscopic surgery, which replaced conventional surgery.
With the help of instruments mimicking the movements of the wrist, intuitive motion control, high-resolution three dimensional images, it allows the surgeon to perform complex procedures using the laparoscopic method, transcending the limitations of conventional open surgery and laparoscopic surgery technologies. With this method, the surgeon sitting in the console can obtain a clear three-dimensional view of the operation site.
In which areas of general surgery is robotic surgery employed?
- Adrenal glands
- Obesity operations
- Colorectal surgery
What does robotic surgery offer to a patient?
Reduced loss of blood and need for blood transfusion.
Robotic surgical procedures are associated with less blood loss, particularly in cancer surgery. Consequently, this reduces the need for intraoperative or postoperative blood transfusion.
Less pain, less painkillers.
As robotic surgery eliminates the need for large incisions, patients have less postoperative pain, and thus require fewer painkillers.
Robot-assisted procedures result in shorter hospitalization as compared to open surgery. Patients recover faster and resume their everyday-life activities.
Less risk of infection.
The risk of infection is reduced in robotic surgery since incisions are small and there is less bleeding.
Improved cosmetic outcome
Robotic surgery does not require any large incisions in the abdominal wall, and all interventions are carried out through 3 or 4 tiny holes in the abdomen. Thus, scarring is very insignificant.
High-resolution 3-D image
While standard laparoscopic images are obtained by a single camera, robotic surgery employs two “High-Definition” cameras during the surgery, providing a three dimensional image with a 10x/12x magnification. The robotic instruments reach places in the body that are normally unreachable by the surgeon’s hand, and enable the surgeon to see structures which are too small to be seen by the naked eye. Thus the surgeon can operate in areas of abdominal or other body cavities, which otherwise cannot be reached in open surgery.
Better range of motion
The robot has four robotic arms. One controls the camera and the other three hold surgical instruments. The two arms represent the right and left hands of the surgeon. The other arm allows additional tasks such as separating and retracting the tissue, and tracking surgical suturing. The robot is equipped with an articulate “EndoWrist” instrument. This device allows seven degrees of freedom and two degrees of axial rotation, mimicking three movements of the arm, three movements of the wrist for grasping or cutting. These instruments of greater range of motion and dexterity eliminate many challenges encountered during the two-dimensional laparoscopic surgery procedures.
A system filtering hand tremors
The hand movements of the surgeon are scaled and translated to the robotic arms through a computer system. Even minor tremors of the hands are eliminated by this robotic technology. So procedures requiring high sensitivity can be easily carried out.
Robotic Surgery in General Surgery
General surgery is another discipline where robotic surgery systems are widely used. As is the case with all other disciplines, robotic surgery systems bring important advantages to doctors and patients both. As with all other operations performed with da Vinci, the use of robotic surgery in general surgery operations offers great advantages for patients, including less incision and thus less pain, and shorter bleeding and recovery periods.
Obesity operations and colorectal surgery are among the operations where robotic surgery is used most successfully.
Surgical procedures performed with da Vinci robot in general surgery
- Robotic surgery in diseases of the colon and rectum
- Robotic surgery in obesity treatment
- Robotic surgery in gastric diseases
- Robotic surgery in pancreatic diseases
- Robotic surgery in diseases of the liver and bile ducts
- Robotic surgery in endocrine disorders (thyroid and adrenal glands)
- Robotic cancer surgery
Robotic Surgery in Urologic Diseases
Urology is another discipline where da Vinci robotic surgery is widely used. Da Vinci robotic surgery is successfully used particularly in radical prostatectomy (removal of the prostate), the surgical treatment of prostate cancer, and also in several urologic operations. Da Vinci robotic surgery which is increasingly used owing to the advantages brought to the patient and the doctor is also employed successfully in radical nephrectomy (removal of a whole kidney), partial nephrectomy (removal of the renal tumor), pyeloplasty (revision of the ureteropelvic obstructions), radical cystectomy used in bladder cancers, and removal of a sac in the urinary bladder called bladder diverticulum (bladder diverticulectomy).
In robotic surgery, every stage of surgery is performed with great precision with features such as 3-dimentional image with 12x magnification and multi-directional movement of the robot.
Surgical procedures performed with da Vinci robot in urology
- Robotic surgery in prostate cancer
- Robotic surgery in kidney cancer
- Robotic surgery in pyeloplasty-ureteropelvic junction obstructions
- Robotic surgery in bladder cancer
- Other urologic surgery procedures
Robotic Surgery in Gynecological Diseases
In gynecological surgery, a majority of extremely serious gynecological operations like cancer operations, removal of the uterus, removal of large myomas can be performed with robotic surgery. The system offers comfortable suturing inside the abdomen and even suturing by rotating the arm to such degree which is impossible for a wrist. The detailed image of the tissue obtained with 10x magnification brings great comfort to the surgeon.
Cancer operations, hysterectomy (removal of the uterus), myomectomy (removal of myomas), sacrocolpopexy (correction of the vaginal vault prolapse), fallopian tube surgery (repair of the channel between the ovaries and the uterus) are operations that are frequently performed in the area of gynecology.
Surgical procedures performed with da Vinci robot in gynecology
- Robotic surgery in uterine and cervical cancer
- Robotic surgery in myoma operations
- Other gynecological surgery procedures
Robotic Surgery in Thoracic Surgery
Robotic surgery or robot-assisted surgery is performing certain operations through tiny holes using the “da Vinci” system. With the help of instruments mimicking the movements of the wrist, intuitive motion control, high-resolution three dimensional images, it allows the surgeon to perform complex procedures using the laparoscopic method, transcending the limitations of conventional open surgery and laparoscopic surgery technologies.
da Vinci Si model consists of three inter-connected parts:
Surgical procedures performed with da Vinci robot in urology
- Surgeon console
- Patient unit with 4 interactive arms
- High resolution, three dimensional image system
The surgeon sitting in the console obtains a clear three-dimensional view of the operation site. The system measures the motions of the surgeon’s hand in the main console and filters and transfers them to interactive robotic arms. Micro movements of da Vinci instruments are controlled by the computer processor of the system. The small sensitive hands of the da Vinci system provide a freedom of movement beyond the ability of the human wrist and render it possible to perform maneuvers that are hard to achieve with traditional laparoscopic and thoracoscopic instruments. Compared to 180 degrees range of motion of the human wrist, each arm of da Vinci has 540 degrees range of motion, providing the surgeon with more movement capability.
Thoracic surgery procedures
Today in thoracic surgery, practical operations including removal of a whole lung (pneumonectomy), or of one lobe (lobectomy) or a segment (segmentectomy) can be performed, In addition, the robot is used in esophagus operations and removal of masses and cysts in the mediastinum, the central cavity between the two lungs.
Differences between robotic surgery and videothoracoscopy in thoracic surgery
In videothoracoscopy, a two-dimensional image is used, so the sense of depth is lost and hand-eye coordination problems occur. In that case, the risk for major complications increase as the procedure is performed close to vital organs. However, when operating with the robot, 10-12x magnified, high resolution and three-dimensional images are obtained. In videothoracoscopy, the instrument has limited movement capabilities. However, the robotic arm can give better outcome in complicated operations as it has higher maneuvering capability, rotating 540 degrees.
Can robotic surgery be used in cancer patients?
The most ideal patient group is patients with a tumor smaller than 5 cm in one lobe of the lung. In this group of patients, lobectomy can be performed very safely in accordance with principles of oncology, and mediastinal lymph node dissection which is very important for cancer patients can be performed. Also, there are already case reports in the literature describing removal of a whole lung. Experts note that much complicated, more invasive surgical procedures can be performed as the experience with robotic surgery is enhanced.
Robotic Surgery in Cardiovascular Surgery
What Are the Advantages of Robotic Surgery in Heart Diseases?
- Millimetric incision
- Less pain
- Less blood loss
- Lower risk of infection
- More aesthetic appearance
- Better and faster recovery
The rib cage is not opened in robotic heart surgery and the surgery is performed through small holes. In this way, there is less blood loss, lower risk of infection, less pain, a more aesthetic appearance and a very comfortable and faster recovery time. In this sense, the patient can return to normal life more comfortably in almost one quarter of the normal heart surgery recovery time.
In robotic cardiac surgery, in patients undergoing by-pass, the heart is reached through a 3-millimeter hole opened on the left side of the chest and the operation is performed with a small incision of approximately 3 to 4 cm. In heart valve surgeries, removal of some cardiac tumors and closing of some heart holes, the operation is performed with 4 millimetric holes and a small incision of 4 cm on the right side of the chest.
In Which Heart Diseases is Robotic Surgery Performed?
It is performed for mitral valve replacement and repair, tricuspid valve replacement and repair, ASD closure, VSD, PDA and heart tumors.
Mostly mitral valve surgeries, tricuspid valve surgeries, so-called “ASD closure” (holes between the atria), closing some small VSDs (holes between the heart ventricles) and removing some heart tumors can be performed quite easily using a robot through tiny holes on the right side of the chest. Closing of the PDA (the hole between the main artery of the heart and the vein leading to the lung) is performed through the 3-millimeter hole opened on the left side of the chest.
In the case of the heart vessels, we can replace whole vessels either using a heart-lung machine or one or two vessels without using a heart-lung machine and without stopping the heart.
How is Robotic Surgery Performed?
The surgeon operates the patient by controlling the four robotic arms by means of a console. Robotic arms function as cutter, gripper, burner and retractor. The surgeon can view the inside of the body in 3D on the console with the help of a camera.
With the robotic arms on the patient, a second cardiac surgeon is present at the bedside to deliver the necessary instrument to the robotic arms. The surgeon performs the operation via a console located 3 to 4 meters to the patient. The two arms of the console have been developed in a way that the surgeon can use the 4 arms on the patient.
One of the four arms on the patient is the camera, the second and third arms act like the surgeon's right and left arms, and the fourth arm is used to remove the tissues that may interfere with the surgeon (retraction). It is possible for the surgeon to immobilize any arm in any way, as well as to hold the arms without moving, to move them in a way that a human hand cannot and to eliminate the tremors in the human hand.
Does Robotic Surgery Shorten the Duration of Heart Surgeries?
The duration of the operations performed with the help of robotic surgery is getting shorter every day, thanks to the experienced hands in this field.
The initial long robotic heart surgery duration was equated with the conventional cardiac surgery duration as experience gained at the end of the learning process. In fact, experienced hands in robotic surgery shorten this duration even more when compared to conventional surgeries. The shortened surgical duration has a very positive effect on the time for recovery of the patient in surgeries using the heart-lung machine. In the future, this duration will be shorter following the developments in robotic technology and with the increasing experience of robotic surgeons.