Robot Assisted Surgery

Introduction:

Robot assisted surgeries are the surgical procedures which utilize a robotic system controlled by a physician or a surgeon (via a computer). The robotic system has an attached camera to help the operator to see the organ being operated upon. These systems are known for their precision, accuracy, delicacy, and overall efficient controlling options. Since their invention, they have been used and currently are used in urological, neurological, endoscopic, cardiovascular, gynecological surgeries, and similar operations. Robot assisted surgeries have been in practice since 1990 after the approval of the technology by the Food and Drug Administration (FDA), although the history of Robot assisted surgery dates back to 1985 when it was

first used to perform a neurosurgical biopsy. [1]
The robot used at that time was designed by PUMA, and subsequently named the PUMA 560, its first known major operation was performing a neurosurgical biopsy. After the success of the surgery the same PUMA robotic system was then used for transurethral prostatic resection. This robotic system was followed by the FDA approved AESOP system for endoscopic surgeries by Computer Motion in 1990. Since then there has been a rapid breakthrough in the development of this technology. The initial advantage that motivated bio-engineers to pursue this technology in the first place was its highly sought after precision and accuracy, especially when paired with a non-invasive system. Additionally, the promise of minimal invasion was also noticed to be the driving factor with the adoption of robot assisted surgeries. But it was not until 2000 that any real breakthrough occurred in this field, and this innovation is accredited to da Vinci Surgery Systems. [1] In the recent past, there has been a rapid rise in the trend of Robot assisted surgeries. Specifically, in the area of hysterectomies. Subsequently, a rise from 0.5% to 9.5% of all Robot assisted surgeries has been seen between 2007 and 2010. [2] The current trends in hospitals are changing, whereas people prefer robot assisted hysterectomies to their outdated counterpart (abdominal hysterectomies). Realizing the increasing trend of importance towards robot assisted hysterectomies, the company should pursue this technology while it is still in its infancy, in order to get a ‘jump’ on other companies that would eventually come to this conclusion. The vast market, and growing target audience would increasingly benefit the profit margins of the company.
1. Hysterectomy: Introduction and Procedure
a. Introduction:
Hysterectomy, a surgical procedure that involves the removal of the uterus.

This procedure may be carried out for several reasons. Among the major reasons for getting a hysterectomy, some notable ones are, uterine cancer, thickening of uterus (Adenomyosis), and endometriosis or the external development of the tissue lining the uterus. Lastly, pelvic pain and chronic vaginal bleeding may also lead to the decision to get a hysterectomy. Before going for a hysterectomy all possible treatment options are exhausted, the only exception being in the case of cancer, whereas surgery is the only viable option available. Knowing the reason for surgery is important as it dictates the types of hysterectomy that needs to be pursued. Depending upon the reason, surgery may involve complete (total hysterectomy), or partial removal of the uterus and the cervix. Or in a rare case it may involve removal of only the upper part of the uterus, more technically referred to as a subtotal hysterectomy. In severe cases like in cancer the surgeon might go for a radical hysterectomy, a procedure which not only involves complete uterus removal, but also the removal of the cervix and tissue surrounding the uterus. [3] According to leading statisticians, one in every nine women in the United States undergoes the procedure during their

lifetime.
b. Procedure:
As far as procedures of hysterectomy are concerned, there are two common approaches used by surgeons. These two approaches are Abdominal hysterectomy, or an open surgery approach, and a Minimal Invasive Procedure (MIP) approach. [3] Abdominal hysterectomy is considered an open surgery approach. In this surgery, the surgeon makes a 5 to 7-inch incision in the abdominal region and then proceeds to remove pieces of uterus through that cut. The cut is sealed later on, after the surgery, and usually results in a sizable scar. A MIP hysterectomy can be performed in one of the following several ways. Either the surgeon carries out a vaginal hysterectomy (cuts through the vagina to remove the uterus), or the surgeon may go with laparoscopic hysterectomy option instead. Laparoscopic surgery (the utilization a camera to visualize the organ being operated on) itself has three further types. Either it is a simple laparoscopic surgery (small cuts in belly to remove the uterus). Or it is a vaginal laparoscopic surgery (hysterectomy via a vaginal incision). Lastly, it can be a Robot assisted laparoscopic hysterectomy, which is the topic in question. This procedure uses small cuts, and a surgeon controlled robot fitted with tools to carry out a hysterectomy. [3]
2. Da Vinci Robot:
Developed by Telepresence Machines (contracted by the US military and NASA), the da Vinci robot serves as the ‘gold standard’ in technologically advanced surgery systems currently being offered on the market. Approved by the FDA in 2000 after being successfully shown to be effective in the treatment of prostate cancer. [1] The robot has three main components, a cart (holding a light source and cameras), called the ‘vision cart’, the master console (where the surgeon sits), and a last component is where the operating ‘arms’ of the system lie. There are also two cameras being used to generate the 3 dimensional image. This is done to further assist the surgeon. The Da Vinci robotic system is an example of surgical systems based on the Master-Slave approach, whereas the robot is directly controlled by a surgeon’s inputs. Although it should be mentioned that the input into the robotic system is not a ‘one-to-one’ relation in which the surgeon moves a distance and the system does the same. But in fact the opposite is true, in which the surgeon’s motions are scaled back in order to gain the precision needed for said surgeries. [2]
3. Conflicting Points
As with every technological advancement there are a few draw backs, especially when the technology in its infancy, robot assisted surgeries are of no exception. Robots of any kind are susceptible to breaking down, and while you could make the case that so are people (sickness), the chance of a robot breaking down mid-surgery is a risk some people might not want to take. Also the cost associated with a breakdown could cost the hospital a decent amount of money to fix, somewhere between $1428 and $17823 for a mid-level problem. However, it has been shown that Da Vinci System is very reliable, especially when used by a trained professional. The advantages for this procedure are its precision, accuracy, and from the perspective of the surgeon its ease of use, and general reliably. The smaller cuts translate to smaller scars, less overall pain, and a decreased recovery time.
4. Conclusions:
After going through the details of the technology, underlying working principles, and mechanisms, the following conclusions have been drawn.

Various factors were kept in mind, including the social, economic, and disease related perspectives. The technological perspective is that the robot assisted hysterectomies are great innovation in the field, it is most certainly a stepping stone for completely autonomous robotic surgeries. The positives associated with the technology such as the reduced pain and scarring, no doubt outweighs negatives, such as the slightly increased price. Because of its positive aspects, the technology is also socially well accepted, both in the case of surgeons performing the surgery, and the women undergoing it. This phenomenon is easily explained by the increased reliance on technology that society as a whole has, and will continue to rely upon. The precision and accuracy provided by robotic assisted surgeries provide a clear motive for both parties involved. From the surgeon’s perspective the ease of use is the key advantage, and from the patient’s perspective its promise of a less invasive procedure (leading to overall less pain) is a key benefit. The risks that were mentioned are comparatively less important. For example, bleeding is a common risk, no matter which technology is being implemented. Bleeding can only be minimized by making precise cuts and being able to stitch them properly. This is more of a comment on the surgeon’s ability to

master the Da Vinci system. However, it is worth mentioning because adds another negative to robotic assisted surgeries is that the surgeon has to receive additional training, more than likely paid for by the hospital.
Economic Feasibility:
Economically, the procedure is a bit more expensive than when compared to a normal abdominal hysterectomy. The economic feasibility of this technology will play directly into whether or not it should be adopted. According to a study published in American Journal of Medical Association the cost of robot assisted hysterectomy is approximately $2,189 more than when compared to that of normal abdominal hysterectomy. This difference in costs puts this technology a bit of a disadvantage. But the increasing popularity toward adopting this technology as mentioned before is evidence that the increased cost is not scaring people away from getting one. It has been predicted by certain medical journals and statisticians, that as the technology continues to grow the economic gap between the robotically performed surgeries in general, and the traditional ones will lessen. And eventually robotically performed hysterectomies will become the new standard. [6] So taking all of this information into account it would be wise for the company to get in on robotically performed hysterectomies while they are still in their infancy. This will assure that the company stays ahead of other companies that will eventually come to the same conclusion. The future of the company is at stake, and by getting in on the ground floor the company is assured to make a profit, and help women obtain increasing less expensive and less invasive hysterectomies.