Credit: Katie Hyams
What’s better than having a robot operate on you? How about two robots?
Christine Lockton, a 63-year-old cancer patient, recently underwent surgery in which she had a hysterectomy and part of her colon removed simultaneously.
The double surgery, which took place at the Royal Marsden Hospital in London, utilized a robotic system known as the Da Vinci Surgical System. Two surgeons manipulated different robots during the operation.
Lockton was able to return home just days after the procedure, which was less invasive than an open surgery.
One of Lockton’s surgeons, Dr. Shahnawaz Rasheed, a specialist in colorectal cancer, says using robotic technology in the operating room can lead to a faster recovery for patients.
“There are a number of benefits of this minimally invasive procedure, importantly for our patients. They lose less blood, experience less pain, recover quicker, and leave hospital sooner. The robotic surgery allows us to see in close detail in 3D-magnified images, and with its three arms maximizes surgical precision,” he told Healthline.
Dr. Shahnawaz Rasheed
The Da Vinci system gives surgeons a three-dimensional, high-definition view inside a patient’s body, while the controls offer a greater range of movement.
But unlike a futuristic sci-fi movie, the robot doesn’t operate by itself.
“Robotic surgery is not autonomous but is controlled by us the surgeons. We introduce the ‘arms’ surgically. These have instruments attached, including a high-definition 3D camera. The surgeons will go to the robotic console, while at least one assistant will stay by the bedside. We control the arms from the control console, manipulating tissue, much in the same way a surgeon would when carrying out open surgery, and remove the cancer,” Rasheed said.
For Lockton’s surgery, Rasheed worked with Dr. Marielle Nobbenhuis, a consultant gynecological oncology surgeon at Royal Marsden, to remove both the womb and part of the colon.
“In this particular case, we worked sequentially to do this. Both surgeons are unable to have control of the arms at the same time, rather ‘take in turns’ as such from where we are sat at opposite consoles, removing the womb where the cancer had advanced, and the part of the colon, the primary site,” he said.
Is system worth the cost?
The Da Vinci system has received praise from many practitioners but has also faced criticism for its expense.
The “Si” version of the system costs just under $2 million, plus several hundred thousand dollars in maintenance fees every year.
As of September 2017, there were 4,271 Da Vinci Surgical System units installed around the world. Of those, 2,770 are in the United States and 719 are in Europe.
Royal Marsden has been using the Da Vinci system since 2007. Rasheed says the cost is worth it.
“We believe that the benefits to the patient — including decreased trauma, better recovery times, and less time in hospital — justifies the cost,” he said.
In the United States, the Food and Drug Administration (FDA) approved the system for use in 2000, and the robots are now used around the country.
“While the robot is extremely expensive… the fact that nearly every major hospital in the country owns at least one, and many own several systems, shows it is an expense well justified by the benefits it offers,” Dr. Abie Mendelsohn, a head and neck surgeon at the University of California Los Angeles (UCLA), told Healthline.
How it helps surgeons
Mendelsohn argues there are several aspects to surgery in which using a robot like the Da Vinci can lead to better performance than what surgeons can do by themselves.
“The eyesight, vision, is magnified and extremely well illuminated,” he said. “The image offers depth perception and ability for fluorescence imaging. The camera is moved and directly controlled by the surgeon (as compared with laparoscopic surgery in which an assistant moves the camera after direction by the surgeon). The instruments can rotate several times over, which is much more than a human wrist can do. The instrument motion can be scaled down to remove a natural tremor or to go in extremely slow motion if desired. The instruments can be paused in any position or action to provide a steady, unmoving point of stability or retraction.”
As well as this, the instruments in the Da Vinci come in either an 8-millimeter or 5-millimeter diameter, about the width of a pencil. They are able to reach into cavities that can’t be accessed by the human hand.
The surgical robot can be used in at least seven surgical subspecialties, including colorectal, gynecologic, and urologic surgeries. It’s of particular use in areas with remote or recessed locations.
In urology, robotic surgery is now commonly used for cancers that could previously only be treated with open surgery.
“During the past 10 years, robotic surgery has facilitated a change in how a number of urological cancers are treated. In younger patients with testicular cancer that has spread to the lymph nodes, robotic surgery can now be used as an alternative to radiotherapy. Previously, surgery would not have been used due to the large incision that would have been required,” Dr. David Nicol, professor, consultant urologist, and chief of surgery at Royal Marsden, told Healthline.
“Our patients’ quality of life has improved. As a large abdominal incision is not needed, they can return to work and normal activity a lot sooner,” he added.
Surgeons conducting the operation also receive some health benefits.
“Conducting lengthy conventional surgical procedures can be physically demanding and lead to neck, shoulder, or back problems,” Dr. Paris Tekkis, a professor of colorectal surgery at Royal Marsden, told Healthline.
He uses the Da Vinci system and says lengthy procedures can be made easier through its use.
“The surgeon operates via tiny incisions in the body and controls the machine’s movements from the comfort of a seat at the console,” he said.
Don’t fear the robots
Many of the experts who spoke with Healthline emphasize that one of the biggest misconceptions about robotic surgery is that a robot autonomously operates on a patient.
“The main concern I hear from patients is the thought that I won’t be doing much of the surgery itself. This incorrect assumption comes from the mix-up between the term ‘robotic’ and ‘automation.’ Robotic simply means my actions and movements are translated into mechanical motion. We have a ton of examples in our lives of robotic action, especially in cars such as power steering and in airplanes with the wing control,” Mendelsohn said.
For his part, Mendelsohn says robots are and will continue to be necessary in the medical field, and aren’t something to be feared.
“We must separate our thoughts of science fiction and our knowledge of current technology. Our world is changing rapidly, and when technology can be safely and effectively applied to make medical care more successful, then it is our responsibility to do so. While there may come a time where computers and robots put me out of a job, I don’t think that day will be anytime soon,” he said.