Robotic surgery

Definition

Robotic surgery is a technique in which a surgeon performs surgery using a computer that remotely controls very small instruments attached to a robot.

Alternative Names

Robot-assisted surgery; Robotic-assisted laparoscopic surgery; Laparoscopic surgery with robotic assistance

Description

This procedure is done under general anesthesia (you are asleep and pain-free). The surgeon sits at a computer station nearby and directs the movements of a robot. Small instruments are attached to the robot's arms.

The surgeon first inserts these instruments into your body through small surgical cuts. Under the surgeon’s direction, the robot matches the doctor’s hand movements to perform the procedure using the tiny instruments.

A thin tube with a camera attached to the end of it (endoscope) allows the surgeon to view highly magnified three-dimensional images of your body on a monitor in real time.

Why the Procedure Is Performed

Robotic surgery is a type of procedure that is similar to laparoscopic surgery. It also can be performed through smaller surgical cuts than traditional open surgery. The small, precise movements that are possible with this type of surgery give it some advantages over standard endoscopic techniques.

Sometimes robotic-assisted laparoscopy can allow a surgeon to perform a less-invasive procedure that was once only possible with more invasive open surgery. Once it is placed in the abdomen, a robotic arm is easier for the surgeon to use than the instruments in endoscopic surgery.

The robot reduces the surgeon’s movements (for example, moving 1/2 inch for every 1 inch the surgeon moves), which reduces some of the hand tremors and movements that might otherwise make the surgery less precise. Also, robotic instruments can access hard-to-reach areas of your body more easily through smaller incisions compared to traditional open and laparoscopic surgery.

During robotic surgery, the surgeon can more easily see the area being operated on. The surgeon is also in a much more comfortable position and can move in a more natural way than during endoscopy. However, robotic surgery can take longer to perform, due to the amount of time required to set up the robot. In addition, the robot is expensive to use and may not be available in many hospitals.

Robotic surgery may be used for a number of different procedures, including:

• Coronary artery bypass
• Cutting away cancer tissue from sensitive parts of the body such as blood vessels, nerves, or important body organs
• Gallbladder removal
• Hip replacement
• Hysterectomy
• Kidney removal
• Kidney transplant
• Mitral valve repair
• Pyeloplasty (surgery to correct ureteropelvic junction obstruction)
• Pyloroplasty
• Radical prostatectomy
• Tubal ligation

Robotic surgery cannot be used for some complex procedures. For example, it is not appropriate for certain types of heart surgery that require greater ability to manipulate instruments in the patient’s chest.

Risks

The risks for any anesthesia are:

• Reactions to medications
• Problems breathing

The risks for any surgery are:

• Bleeding
• Infection

Robotic surgery may have fewer risks than open and laparoscopic surgery.

Before the Procedure

You cannot have any food or fluid for 8 hours before the surgery. If you are having certain types of abdominal surgery, your surgeon may recommend that you cleanse your bowels with an enema or laxative the day before surgery.

Stop taking aspirin, blood thinners such as warfarin (Coumadin) or Plavix, anti-inflammatory medications, vitamins, or other supplements 10 days before the procedure.

After the Procedure

You will be taken to a recovery room after the procedure. Depending on the type of surgery performed, you may have to stay in the hospital overnight or for a couple of days.

You should be able to walk within a day after the procedure, depending on what type of procedure was done. Avoid heavy lifting or straining until your doctor gives you the okay. Your doctor may advise you not to drive for at least a week.

Convalescence

Because the surgical cuts are typically smaller than with traditional open surgery, robotic surgery may lead to:

• Faster recovery
• Less pain and bleeding
• Less risk of infection
• Shorter hospital stay
• Smaller scars

References

Eichel L, McDougall EM, Clayman RV. Basics of laparoscopic urologic surgery. In: Wein AJ. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 7.

Gomez G. Emerging technology in surgery: Informatics, electronics, robotics. In: Townsend CM, Beauchamp RD, Evers BM. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa:Saunders Elsevier;2007:chap 19.

Lanfranco AR, Castellanos AE, Desai JP, Meyeres WC. Robotic surgery: A current perspective. Ann Surg. 2004;239:14-21.

Oleynikov D. Robotic surgery. Surg Clin N Am. 2008;88:1121-1130.