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Evolution of Robotic Surgery
December 10, 2020 Dr. Cody Starnes

Evolution of Robotic Surgery

Posted in Minimally Invasive Surgery, Robotic Surgery

The History of Robotic Surgery

Dr. Cody Starnes

It seems that everyone in the United States has heard about robotic surgery in some form or fashion. There are robotic platforms for nearly every surgical specialty. Nevertheless, I will focus on a discussion of the robotic platform that is most widely known and applicable to general and bariatric surgery. In 2000, Intuitive Surgical received FDA clearance for its da Vinci robot named in honor of Leonardo da Vinci. There have been several generations of the robot with several iterations of software updates.

My introduction to robotic surgery started during my fourth year of general surgery residency. I was a senior resident on my minimally invasive and bariatric surgery rotation. Todd Wilson, M.D., FACS was my mentor at the time. Intuitive Surgical has a simulation software that allows surgeons to become familiar with the nuances of using the robot in surgery prior to applying it to human patients. It’s essentially awesome 3D virtual reality video games. Dr. Wilson expected and required that his residents obtain 90% or higher scores at least twice on every task prior to touching a patient. A requirement that exceeded even the hospital’s requirement. I was determined to become proficient and the best at robotic surgery. I saw the future of surgery and the potential that the robot has. It was my exposure as a fourth-year resident that led me to stick around at UT Houston and do a fellowship, 1 year of extra training after residency, in advanced minimally invasive and bariatric surgery. I was given the opportunity to play/practice with some of the latest surgical technology at that time with some of the leaders in minimally invasive surgery. Memorial Hermann Hospital in the Texas Medical Center was a robotic hot spot. In 2015, they had four da Vinci Si robots in use for surgeries, and four additional robots in their simulation lab.

The benefits of laparoscopic/minimally invasive surgery over open surgery are many and irrefutable. So, what about the robot? As it applies to patient outcomes, robotic and standard laparoscopic surgery are equivocal. So why use it? Let’s start by what it offers from the surgeon’s perspective. First and foremost, the surgeon gets to sit down and save his/her back. The layout and dimensions of the surgeon console are customizable to fit the body of the surgeon. Thus, providing for an ergonomic work environment. We get to visualize the patient’s anatomy with a 3D camera with high resolution images. The camera can also utilize fluorescent imaging to detect indocyanine green, a contrast agent, to enhance visualization of tissue perfusion, bile duct anatomy, location of ureters etc. The surgeon can even load your CT scan or ultrasound on his/her visual screen and reference it concurrently while operating. In standard laparoscopic surgery, the image is 2D and the surgeon cannot move their wrists. Imagine someone putting splints on your wrists so that could not bend them, and then telling you to perform surgery. That is standard laparoscopic surgery. The robot allows the surgeon to have full range of motion of their wrists to a greater degree that the human body can perform. Moreover, the software can cancel any fine physiological tremors in the surgeon’s hands to perform exceptionally fine and delicate surgery. I would like to emphasize that the robot is not “doing the surgery.” The robot, as it exists, cannot make decisions or independent movements. Every movement of the surgical instruments is under the complete control of the surgeon. As an aside, there are some cool artificial intelligence programs that can recognize a possible impending error on the surgeon’s part before it happens and alert him/her to maintain safety. There are also programs that are attempting to suture structures autonomously. However, that is still in its infancy. Thus, I cannot provide compelling literature/studies that the robot will result in a better surgical experience for you the patient. However, based on everything that I have presented, it only seems intuitive, no pun intended, that there is enhanced performance from the surgeon’s point of view. This in turn should lead to safer surgery for the patients.

Below are patient links to Intuitive Surgical and the Society of American Gastrointestinal and Endoscopic Surgeons. These are useful resources to learn more about robotic and minimally invasive surgery.