You’re at your doctor’s waiting room. No one likes to hear that they are going to need surgery, let alone that it might be a robotic-assisted procedure, which is highly possible with today’s fast paced advancements in medical technology. 

What, exactly, is robotic-assisted surgery?, you ask yourself. You allow your imagination to go wild. You picture robotic surgeons with tentacles for arms that shapeshift into lethal-looking scalpels and needles. Or microbe-sized robots that infect human cells to transform them per programming from a secret government institution. 

The reality of robotic-assisted surgery, or RAS, is much less fantastical than the descriptions above. On the other hand, the technology is considered cutting edge, and has moved healthcare in ways once considered science-fiction. 

Here are five misconceptions about surgical robots and the facts debunking them. 

Misconception: The surgery is performed by robots. 

Fact: The surgery is performed by the surgeon. 

This is the most common misconception. Simply, RAS is a tool like a scalpel, forceps, EKG machine, or medical tablet. The surgeon controls the various precision-guided robotic arms that hold and manipulate miniaturized instruments using hand and foot controls. The process can be summarized as:

  • The surgeon makes one or more small incisions into the patient’s body.
  • They place thin tubes called ports into the incision. The robot is attached to these ports.
  • A camera system called an endoscope is placed through one of those ports. This allows the surgeon to have a highly precise, 3D view of the area.
  • Surgical instruments necessary for the operation are placed through the other ports.
  • The surgeon watches through the endoscope and controls the various arms to perform the operation. Normally, they are sitting a few feet from the patient. (Though surgeries can be done remotely.)
  • An assistant stands nearby and helps by changing the instruments as required.

Misconception: RAS is a new technology. 

Fact: Robots have been used for surgical procedures since the 80s.

A robotic surgical arm called the PUMA 560 is considered the first such medical device. It was used in 1985 during an open surgery. Over a decade later in 1997, a robot called Mona assisted Dr. Jaques Himpens of Belgium in the removal of a gallbladder (cholecystectomy).

Robot-assisted surgery technology saw a leap forward in 2000. That was the year the FDA approved the da Vinci Surgical System, the most well-known RAS. There were also two firsts that year as well:

  • Dr. Arnold Advincula performed one of the first robotic-assisted removal of a uterus (hysterectomy) in the US. 
  • Physicians in New York used a system called Zeus to perform a cholecystectomy remotely on a patient in France. 

Misconception: There is very little difference between RAS and traditional surgery.

Fact: There are many advantages.

We have actually covered many of the benefits of robotic-assisted surgery in the operating room in an earlier post. Many are based on the fact that much smaller incisions can be made using RAS than traditional surgeries like laparoscopic and ﹘ especially ﹘ open. This results in lower risk of infection, reduced blood loss, and smaller scars. Hospital stay is shorter as well. There’s also less pain for patients recovering from procedures.

The Zeus mentioned earlier showcases RAS for telehealth, which simply cannot be done using traditional surgeries. In 2014, researchers from both New York-based Mount Sinai Health System Icahn School of Medicine and the Umea University in Sweden did studies on the feasibility of RAS done remotely. There were two studies, one on conducting ultrasound exams while the other for echocardiogram. They showed, among other things, diagnostic processing time dropped from an average of 114 days to 27 while wait time for patients to see a specialist plummeted from 86 days to 12. Clinicians are hopeful that such results can further increase patient satisfaction especially in hard-to-reach places like farms.   

Finally, the surgeon suffers less fatigue. Operations can last for hours. In most of them, the  surgeon has to stand the entire time. They then have to bend, twist, and turn to get their numerous surgical tools into the right positions. 

RAS largely eliminates such body movement. As Dr. Gerard M. Doherty, surgeon-in-chief at Brigham and Women’s Hospital in Boston, points out, “there is this ergonomic advantage. We move the arms of the robot while sitting comfortably. I have one surgeon who told me it will extend his career by a decade.”

Myth: RAS is virtually risk-free.

Fact: A surgeon’s skill primarily determines the risk, not RAS.

Many medical devices have some risk associated with them. A legacy anesthesia machine could be displaying the wrong information to the anesthesiologist’s medical computer. Or an infusion pump could leak because it was refurbished through a third-party medical device manufacturer instead of its OEM.    

The main parts of any RAS system include its robotic tower and attendant arms, its camera, binocular lenses for 3D, and the various instruments. An unpowered system cannot move on its own. And when it is powered up, safety mechanisms are in place to prevent any motion when not in use by the surgeon. 

Despite every precaution, risks associated with surgical robots like da Vinci include electric arcs to instruments freezing up or moving out of control due to a computer error. Complications are extremely rare but can result in electric burns, loss of large amounts of blood, and punctured organs and other vital tissues.

Experts say in many such cases, 30 percent were the result of device failure, followed by incorrect device operation setup (25 percent), user error (20 percent), other (11 percent), inadequate training (7 percent), and maintenance issues (7 percent). 

In lieu of these rare risks, the medical community is hopeful. A paper published in the Agency for Healthcare Research and Quality points to the surgeon’s skill as the primary reason for complications. It then concludes that those with greater familiarity with the technology performed better than those without but with equal skill. In the study, Adverse Events in Robotic Surgery: A Retrospective Study of 14 Years of FDA Data, which was published in 2016, the researchers concluded:

“Despite widespread adoption of robotic systems for minimally invasive surgery in the U.S., a non-negligible number of technical difficulties and complications are still being experienced during procedures. Adoption of advanced techniques in design and operation of robotic surgical systems and enhanced mechanisms for adverse event reporting may reduce these preventable incidents in the future.”

Misconception: Surgical robots are just a fad

Fact: The market looks to grow. 

The market for surgical robots worldwide was estimated to be $6.4 billion in 2021. Research firms such as Markets and Markets project demand will reach $14.4 billion by 2026 and more than $20 billion by 2030. 

The da Vinci Surgical System by Intuitive Surgical Inc. is currently the dominant OEM of surgical robots. It will face more competition from other manufactures as demand continues, as well as the introduction of new technologies like augmented intelligence for virtual assistants for surgeons. 

Closing Thoughts

To many people, robotic-assisted surgery conjures up images found usually on the movie screen. The reality is quite different though what surgical robots can do is amazing. 

Which of the above facts did you find interesting about robotic-assisted surgery? Would you take it if it was offered to you? Or prefer traditional surgical techniques?  

Contact an expert at Cybernet if you’re interested in learning more about the role of robotic-assisted surgery for your medical group. 

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