Robotic Surgery

Introduction

Robotic Surgery is a breakthrough surgical technique which is an effective, minimally invasive alternative to both open  and laparoscopic surgery.

Until now we had two options for surgically treatable diseases:

• Traditional Open Surgery, which means cutting skin and tissues so that the surgeon has direct access to the structures or organs involved. Open surgery involves large incisions and leaves scars.
• Minimally Invasive Surgery (MIS) or Keyhole/Laparoscopic Surgery is typically performed through small incisions or operating ports,rather than large incisions, resulting in reduced trauma to the patient, fewer complications, potentially shorter recovery times,and reduced hospitalisation costs.

Despite the widespread use of MIS in hospitals, today, adoption of laparoscopic techniques, for the most part, has been limited to a few routine procedures. This is mostly due to the limited capabilities of laparoscopic technology, including 2D video images and rigid instruments, which surgeons must rely on to operate through small incisions.

However, with the da Vinci Surgical System (Robot), surgeons are now able to offer a minimally invasive option for complex surgical procedures as well. The da Vinci System is a sophisticated robotic platform designed to expand the surgeon’s capabilities and offer a minimally invasive option for a major surgery. Only da Vinci overcomes the limitations of both the traditional open surgery and conventional MIS.

Robotic Surgery, computer assisted surgery and robotically assisted surgery are terms for technological developments that use robotic systems to aid in surgical procedures. Robotic Surgery was developed to overcome both the limitations of MIS and enhance the capabilities of surgeons performing open surgery.

Some of the major benefits experienced by surgeons using the Robotic Surgical System over traditional approaches have been

• Greater Surgical Precision
• Increased Range of Motion
• Improved Dexterity
• Enhanced Visualisation
• Improved Access

Whereas the benefits experienced by the patients include:

• Shorter Hospital Stay
• Lesser Pain
• Lower Risk of Infection
• Lesser Blood Loss
• Fewer Transfusions
• Less Scarring
• Faster Recovery
• Quicker Return to Normal Daily Activities

Prostatectomy performed using the da Vinci Surgical System significantly reduces the incidence of urinary incontinence and impotency in comparison with the conventional methods of surgery.

The system is called ‘da Vinci’ in part because Leonardo da Vinci invented the first robot. He also used unparalleled anatomical accuracy and three dimensional details to bring his masterpieces to life. The da Vinci Surgical System similarly provides physicians with such enhanced detail and precision that the System can simulate an open surgical environment while allowing operation through tiny incisions.

Withda Vinci, small incisions are used to introduce miniaturised wristed instruments and a high definition 3D camera into the body. The da Vinci Surgical System consists of an ergonomically designed surgeon’s console, a patient cart with four interactive robotic arms, a high-performance vision system and patented EndoWrist instruments. At the da Vinci console, the surgeon operates while seated comfortably, viewing a highly magnified 3D image of the body’s interior. To operate, the surgeon uses master controls that work like forceps.

As the surgeon manipulates the controls, da Vinci responds to the surgeon’s input in real time, translating his or her hand, wrist and finger movements into precise movements of miniaturised instruments at the patient-side cart.
It is important to know that surgery with da Vinci does not place a robot at the controls; a surgeon controls every aspect of the surgery with the assistance of the da Vinci robotic platform.

Since the introduction of the da Vinci System more than ten years ago, the da Vinci System has been used successfully in tens of thousands of procedures. Its safety and efficacy have been documented in hundreds of clinical publications. The literature supporting da Vinci’s use is extensive, covering all surgical specialties where the system is used.

The US Food and Drug Administration (FDA) has cleared the da Vinci Surgical System for a wide range of procedures including radical prostatectomy, radical cystectomy and partial nephrectomy, various gynaecological, and head and neck procedures.

The da Vinci System is a robotic surgical platform designed to enable complex procedures of all types to be performed through 1-2 cm incisions or operating ‘ports’. The following procedures can be performed using the da VinciSurgical System:

Uro-Oncology Procedures

• Radical Prostatectomy for Prostate Cancer
• Radical Cystectomy for Urinary Bladder Cancer
• Radical and Partial Nephrectomy for Kidney Cancer
• Adrenalectomy for Adrenal Tumours
• Partial Cystectomy for Selected Urinary Bladder Cancers
• Lymph Node Dissection for Urological Cancers   

Urology Procedures

• Pyeloplasty (for PUJ Obstruction)
• Ureteric Reimplantation
• Bladder Augmentation

Gynaecological and Gynaec-Oncological Procedures

• Total Abdominal Hysterectomy (Uterus Removal) for Non Cancer Conditions
• Myomectomy (Fibroid Removal)
• Endometriosis
• Pelvic Floor Repair
• Radical Hysterectomy (for Cancer Cervix)
• Total Abdominal Hysterectomy with Lymph Node Dissection for Cancer Endometrium

The cost of the surgery will be higher than Laparoscopic surgery. But due to shorter hospital stay, minimal complications and lesser incidence of blood transfusions, the cost is compensated, and thus, gets competitive.

Currently, the da Vinci Robotic Surgical System is being used in hundreds of hospitals worldwide, in major centres in the United States, Austria, Belgium, Canada, Denmark, France, Germany, Italy, Japan, Romania, Saudi Arabia, Singapore, Sweden, Switzerland, United Kingdom, Australia, Turkey and the Netherlands.

This service is available only at Kokilaben Dhirubhai Ambani Hospital, Mumbai