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Robotic Surgery:
Understanding the procedure

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1.What is Robotic Surgery?

Robotic Surgery consists of using a robotic surgical system to perform operations on patients. Similar to minimally invasive surgery, it can be done solely or it can be performed alongside traditional open surgical procedure as well depending on the situation at hand. The Da Vinci system is the most used robotic system over the world. It consists of three components - the surgeon’s console, a patient cart, and the vision cart. All of these components work together to allow the surgeon to view what is happening and then mimics the moments to guide the instruments.

The surgeon’s console is the place where the surgeon sits. This is the area where he sees what is happening and has master control of how the instruments need to move. He can view high-definition real-time 3D images at the console. The patient cart is kept next to the patient’s bed where he is being operated on. The patient cart holds the camera and the instruments that are required for the surgery. The vision cart is the third component that is in charge of enabling the communication to take place seamlessly between all the components. The components of different surgical systems may vary depending on the particular system.

Robotic Surgery history dates back to the 1980s. In 1985, PUMA 560, was the first robotic surgical system that was used for the stereotaxic operation. Then, in 1988, PROBOT was used to perform transurethral prostate surgery. In 1992, ROBODOC was developed for femur cavity preparation. In the 1990s, when laparoscopic surgery started, minimally invasive surgery was introduced. Three systems were created by this time; Da Vinci surgical system, Zeus and AESOP Robotic Surgical systems. Da Vinci surgical system was developed by Intuitive Surgical Inc. and the AESOP and Zeus systems were developed by Computer Motion.

Computer Motion was acquired by Intuitive Surgical Inc. Within a few years, Zeus was discontinued. Today, the Da Vinci surgical system is the most used across the globe. There are presently four models of Da Vinci robotic surgical systems that are available; Da Vinci Si, Da Vinci X, Da Vinci Xi, and Da Vinci SP. These are designed for different types of robotic surgeries.

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2.Why is Robotic Surgery performed?

Why is Robotic Surgery performed?

Robotic Surgery is excellent for complex procedures that require a high amount of precision. Sometimes, highly complex surgeries are not possible in the traditional way. In such cases, Robotic Surgery might be the only option because it provides the flexibility that is required for the surgery to be completed. Robotic Surgery enables surgeons to thoroughly examine the area that is being operated on. This gives a clearer view to the surgeons which is highly beneficial for them to precisely conduct the operation because some things are not clear with the naked eye. Moreover, it gives more control over what is being done.

The advantages of Robotic Surgery are present for surgeons and patients. For the surgeon, it allows the surgery to be done with precision that was not possible before. This is why Robotic Surgery is great for delicate surgeries as well. During a normal surgery, the doctor is supposed to stand for hours performing the surgery on the patient. When robotic-assisted surgery is done, this is not the case. Hence, surgeon fatigue is minimised during Robotic Surgery as they can sit comfortably and use their hands to guide the robot to replicate their movements to perform the surgery.

In certain critical locations, Robotic Surgery is better because the robotic arms can reach places that are difficult for the surgeon’s hands to reach. This makes it a highly effective method for performing surgery in hard-to-reach areas.

There are many advantages of Robotic Surgery for patients. Robotic Surgery means faster recovery time which means they can get back to work much faster as compared to when they have surgery with traditional methods. The risk of infection is much lesser in Robotic Surgery and it is comparatively less painful. Since the surgery is minimally invasive, there is less damage and the scars are smaller.

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3.Types of robotic surgeries

Robotic prostate surgery makes use of smaller incisions to get the job done and this leads to much faster recovery time for patients. In conventional open surgery, a large incision is made in the abdomen of the patient. Through this, the surgery is performed while ensuring that the blood vessels and nerves are not damaged in the process. Robotic prostate surgery gives a more promising result since the chances of damage to delicate areas are less in this case. Moreover, surgery with a robotic surgical system is more precise.

Robotic kidney surgery might be required when one kidney or a part of a kidney needs to be removed. In traditional open surgery, a large incision, up to eight inches, might be required in order for the surgery to be performed. However, when Robotic Surgery is performed, the size of the incisions is much smaller and it is a minimally invasive procedure. Robotic kidney surgery for kidney conditions allows faster time for the body to heal and patients can resume daily activities in a comparatively short span of time.

Robotic gynaecological surgery means less pain after surgery and lesser blood loss. In traditional surgery, there is significant pain involved in any gynaecological surgery and there is usually physical trauma connected to the surgery as well. Moreover, large incisions are made in open surgery and this means longer recovery process. With Robotic Surgery, the incisions are much smaller and the recovery times are fewer which is a favourable situation compared to open surgery.

Robotic gallbladder surgery includes cholecystectomy which means removing the gallbladder. With the help of robotic surgical systems, surgeons can now perform the surgery with a single incision. This means fewer scars and the healing time is much lesser because of the lesser loss of blood compared to open surgery. Gallbladder surgery with robotic surgical systems is more beneficial to the patient as they can return to work much faster than if they had conventional open surgery.

Robotic colorectal surgery might be required in the case when a patient requires colectomy or has other conditions such as a benign tumour. Using robotic surgical systems, surgeons can better perform colon surgeries that were deemed impossible in the past. Smaller incisions and other benefits ensure that the nerves are not damaged when the surgery is being performed. In addition, tissue cutting is made a lot easier with robotic surgical systems since the view is much better and the precision is top-notch.

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4.Conditions where Robotic Surgery is used

There are many conditions that have had success with Robotic Surgery. The following are types of surgeries that have been successfully performed with the help of robotic surgical systems.


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5.Advantages and risks of Robotic Surgery

There are numerous advantages of robotic surgery such as:

  • The surgeon has a better view of what is happening during the operation which enables him/her/them to see better and make better decisions.
  • Robotic surgeries always mean less tissue damage for the patient which helps in faster recovery.
  • There are fewer chances of getting an infection when Robotic Surgery is performed with smaller incisions.
  • Patients experience lesser pain during Robotic Surgery due to the incisions that are much smaller compared to traditional surgery.
  • There is minimal blood loss when Robotic Surgery is performed and this means lesser blood transfusions are required as a result.
  • The surgeon has better access to the area where the operation is taking place because of the high-resolution camera that is used to show real-time images of the area.
  • Robotic surgeries allow complex surgeries to be performed that aren’t possible with traditional methods.
  • Robotic surgeries provide faster recovery times and fewer chances of infections for incisions that are much smaller.
  • The scars are less visible when robotic surgeries are performed when compared to traditional surgeries.
  • Robotic surgeries mean fewer complications due to surgery. Although there might be complications, the likelihood is much smaller.
  • There is no need to stay for a long time at the hospital. In traditional methods, you might be required to stay for weeks but in most robotic surgeries that’s not the case.
  • The surgeon has better flexibility and dexterity compared to traditional methods as s/he has clearer visuals.
  • Robotic Surgery is far more precise compared to traditional surgery methods because of the instruments and the precision of the robot.
  • There are some risks associated with Robotic Surgery and one of them might be a small infection. As with any surgery, there might be bleeding and the patient might experience breathing problems as a result of the surgery. The risks associated with Robotic Surgery are similar to open surgery although the risks are considerable lesser.

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6.Are you the right candidate for Robotic Surgery?

Usually, most people are ideal candidates for robotic surgeries. However, eligibility depends on the particular individual and the treatment that they require. Since Robotic Surgery is being used now more than ever, there are certain people that it may not be right for depending on their individual case. You and your doctor need to discuss in detail whether the Robotic Surgery is right for you or not. Your doctor is the one who will ultimately decide whether you are a good candidate for Robotic Surgery or not as he will know about your medical history too.

For instance, in the case of robotic-assisted mitral valve repair, the patient needs to be in good overall health. The patient should not have any type of calcium deposits on the leaflets of the valve and the patient should not have peripheral artery disease. The patient should not have any big coronary artery blockages if he wants to have Robotic Surgery. In addition, the patient should not suffer from any type of lung disease. For some health problems, there are many conditions that need to be met for you to be eligible for Robotic Surgery.

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7.Is Robotic Surgery safe?

Robotic Surgery and its safety depends on the surgeon who is performing it. People confuse the robotic surgical system by assuming that it is a robot that does the actual decision-making. But that is not the case. It is the surgeon, every single time. Robotic Surgery is safe when the surgeon has been given proper training to control the robotic surgical system and he is given information about how to use it thoroughly.

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8.What to expect in a Robotic Surgery?

What to expect in a Robotic Surgery?

Robotic Surgery process consists of the robotic surgical system and the surgeon or surgeons who are involved in the operation. The surgeon is the one who makes the decision and guides the robot surgical system to perform the surgery. The steps of what happens during the Robotic Surgery can vary according to the system in use and the operation specifics. However, the following provides a general outline of what happens during Robotic Surgery.

Your surgeon first makes incisions in your body. These incisions are usually one centimetre or two centimetres long depending on the surgical site and why the surgery is being done. Sometimes there might not be a requirement for skin incisions to be done.

Depending on the robotic surgical system being used, the arms contain different instruments that are required during the surgery. One of the arms contains a magnifying camera which provides high-resolution images to the surgeon.

Your surgeon is at the console the whole time and through the console, s/he has full control of what happens during the surgery as he controls the robotic surgical system. The way your surgeon’s hand moves is translated into how the robotic surgical system moves.

In newer robotic surgical systems, the surgeon has the freedom to scale the movements. That is, s/he can set the scale to two-to-one scale in which the robotic system’s arm will move two inches for every one inch of movement of the surgeon’s hand. This provides more flexibility.

The console provides precise and magnified images. This enables the surgeon to understand the entire area and get a clear view in real-time. Real-time 3D images are shown to the surgeon throughout so that s/he has a perfect view of the area that is being operated on.

The robotic surgical system provides minimal fatigue to the surgeon which is why complex surgeries can be done easily with this method. The surgeon has master control over the camera and every arm of the robotic surgical system.

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9.Robotic Surgery FAQs: All your concerns addressed

Q.   It feels strange to know that instead of a surgeon, it is a robot who is operating on me. Is it really that safe?

  1. People believe that it is the robot who is in control of the entire surgery. But nothing could be further from the truth. While a robotic surgical system is being used during the surgery, it is the surgeon who is in charge of the entire time. There is nothing to be afraid of because the surgeon is the one who directs the robotic surgical system about what needs to be done. The robotic surgical system is not making decisions at any point and cannot do anything on its own unless the surgeon directs it to do so.

    The robotic surgical system is mimicking the movements of the surgeon at all times. There is no thinking that is going on in the robotic surgical system at any point. Every movement of the robotic surgical system takes place because the surgeon has directed the system to do that. This is why it is important to remember that the surgeon is the one who is actually responsible for any robotic surgical system movements. Robotic surgical systems enable surgeries with far greater precision than a surgeon’s hand.

Q.   I have heard the term minimally invasive surgery and Robotic Surgery is a type of such surgery. What does it mean exactly?

  1. It is understandable that you might be confused about the term that is often used but hardly explained. Minimally invasive surgery means smaller incisions. Hence, when you are talking about minimally invasive surgery it means that the surgery can be performed without bigger incisions. There are several benefits of such type of surgery. Since smaller incisions are made, scarring is much lesser and the healing time is faster. There is less blood loss and there is a lesser risk of infection which means speedy recovery as well. This is why robotic surgical systems are great.

Q.   Is every doctor equipped to perform Robotic Surgery?

  1. Robotic Surgery is not available everywhere and no, not every doctor or surgeon can start doing Robotic Surgery immediately without any training. Doctors must be thoroughly trained first before they can perform Robotic Surgery on patients. Only after proper training is given to the doctors and they are seen to be capable enough to perform robotic surgeries will they be allowed to perform Robotic Surgery. This ensures that the doctors know how to use the robotic surgical system effectively before they perform any surgery.

Q.   What can I expect after Robotic Surgery?

  1. When Robotic Surgery is performed, the recovery time is fewer compared to when you have traditional surgery. However, the surgery that has been performed, the medical history, and the complications that may arise play a role in determining what will happen after Robotic Surgery. For some people, they need to stay for only two nights at the hospital and then they are free to return home. For others, it may take a bit longer. This is why it depends on the individual about how long the recovery will take and how smooth everything will be after the surgery. Usually, the time for recovery is much shorter.

Q.   How does a robotic surgeon know what is happening during the surgery?

  1. Before the surgery begins, a camera is put inside your body where the surgery is to take place. With the help of this, the surgeon gets clear images of the area that is going to be operated on. The surgeon makes decisions based on the real-time images shown at the console where s/he is sitting and directing the entire procedure. Note that what the surgeon sees in traditional surgery and what s/he sees during Robotic Surgery can vary. That is because during surgery, the camera is of high resolution and it is highly magnified. This means the surgeon is able to see more detailed and crisp images.

Q.   Since Robotic Surgery is minimally invasive does it mean I don’t need any pain management solutions?

  1. Just because Robotic Surgery is minimally invasive does not mean that there won’t be any pain at all. While the pain will be minimal, you might still be required to take pain medicines after surgery. This depends and varies from surgery to surgery and from patient to patient because every individual is different. Your doctor will discuss the pain management aspects with you well in advance so you are aware of everything and how you can relieve pain after completion of the surgery.

Q.   Is there anything special that needs to be done before the start of Robotic Surgery?

  1. Your doctor will let you know what you need to stop taking before the Robotic Surgery. There are certain medications that you should stop taking about 10 days before the surgery is to take place. Anti-inflammatory medicines, warfarin, supplements, and aspirin are some of the examples of medicines that you need to stop taking about 10 days before the date of the surgery. On the day of the surgery, you cannot have fluid or food at least 8 hours before the Robotic Surgery. Certain procedures might require for you to empty your bowels at least a day before the surgery.

Q.   What types of questions should I ask my doctor if my doctor has recommended Robotic Surgery?

  1. You should ask every concern that you have regarding the procedure because not everyone is comfortable with knowing that a robot will be used on them during surgery. You should ask your doctor about how choosing Robotic Surgery will benefit you and your loved ones. You should ask thoroughly about the risks that are associated with Robotic Surgery and if there are any risks that will affect your life in the long term. Knowing about short-term and long-term effects is important. You should ask about the effectiveness of Robotic Surgery compared to open surgery and Robotic Surgery cost in India.

    You should ask about your doctor’s experience with regards to Robotic Surgery. You might want to ask your doctor about the outcomes of the previous surgeries that have been performed using robotic surgical systems. Since every individual is different, you want to make sure that you know what to expect in advance so that you can make arrangements accordingly. You might want to ask about any technology-related concerns that you may be having regarding the surgery. It is recommended that you jot down all your questions so you don’t forget even a single question.

Q.   Which is the best place to have Robotic Surgery in India?

  1. Narayana Health Bangalore is one of the best Robotic Surgery hospitals in India. It trains surgeons so they have thorough experience of using robots during surgery and they are given all the tools to ensure they provide optimal results. Experienced surgeons at Narayana Health strive to provide maximum safety to the patients and ensure that patients are carefully selected according to criteria so they can safely have Robotic Surgery performed and get the best treatment. At Narayana Health, every patient’s health and well-being is given the top-most priority always.

    At present, Narayana Health provides minimally invasive surgery in the fields of gynaecology, urology and gastroenterology. If you have any condition that falls under these then you might be eligible for Robotic Surgery after discussion with your doctor. In the future, Narayana Health will provide Robotic Surgery in the fields of cardiothoracic surgery, head and neck oncology, and otolaryngology. Narayana Health aims to be the best and foremost when it comes to using the latest technologies to perform surgeries that are beneficial to patients and ensure minimal side-effects.

Q.   How Does the Robotic Surgical System Work?

  1. The robotic surgery involves making small incisions on the body and then advancing sophisticated medical instruments and high-definition cameras for operation. In some robotic surgeries, making an incision are not required at all. The surgeon manipulates the surgical instruments from a nearby console and performs the operation. The robots are capable of precisely mimicking the moves of the surgeon. Therefore, the surgeon stays in control throughout the operation.

Q.   What to expect from a robotic surgery?

  1. Unlike the traditional surgery, the doctor doesn’t have to stand over you to perform a robotic surgery. They can direct the surgery from a nearby console and carry out the procedure with precision and efficiency. Each surgery is different, but the general steps followed during a robotic procedure are mentioned below.
    • A tiny incision is made on the body that is no more than one to two centimetres long.
    • The surgeon advances a miniature robotic instrument along with a camera through the incision and reaches the area to be operated.
    • The surgeon then directs the procedure through a console or a computer, which offers a clear and magnified view of the area of operation.
    • The movements on the console are translated into precise and real-time movements of the instruments inside the body.
    • The robotic instruments offer better dexterity and range of motion allowing the surgeon to perform delicate surgeries in difficult places.

Q.   What are the Benefits of Robotic-assisted Surgery?

  1. Some of the benefits of having a robotic-assisted surgery are:
    • It offers a better range of motion and precision to the surgeon.
    • It offers a better access to the area that needs operation.
    • Hospital stay after the surgery is reduced.
    • Less risk of infection
    • Less pain
    • Less blood loss and fewer blood transfusions
    • Patients can go back to their daily routine quickly.

Q.   What Conditions Can be Treated with Robotic Surgery?

  1. Robotic surgery can help in the treatment and management of a wide range of conditions. Some of them include:
    • General surgery
    • Gynaecologic surgery
    • Head and neck surgery
    • Colorectal surgery
    • Heart surgery
    • Endometriosis
    • Thoracic surgery
    • Urologic surgery

Q.   How many days does it take to heal from robotic surgery?

  1. Generally, robotic assisted surgeries are minimally invasive. However, every patient and every procedure are different. Therefore, it is recommended to consult with your doctor regarding the recovery and after care. In general, patients stay in the hospital for a night or two after their surgery and can go back home. Most patients recover fully within six weeks of surgery.

Q.   Is there a difference between laparoscopic and robotic surgery?

  1. Robotic surgery is similar to a laparoscopic surgery in many areas. Both types of surgery require small incisions to be made on the body and then use a video camera and instruments to guide the operation. However, the difference with robotic surgery is that the surgeon sits at the computer and uses hand controls to manipulate the robotic instruments instead of holding the tools themselves.

    Another important distinguishing factor is the greater range of motion and precision that ensures less manipulation of tissues, less bleeding and less post-operative pain.

Q.   What is the Da Vinci Surgical System?

  1. The da Vinci Surgical System is an advanced robotic technology that doctors and physicians use to operate through small, dime-size abdominal incisions. The technology also allows them to perform surgery with direct ‘robotic arms’ along with specialized surgical instruments. A tiny endoscope helps the doctor to get a magnified and three-dimensional image of the operating area at their console. The console comes with controls to direct the movement of the robotic hands with precision thereby eliminating the natural tremor of the human hands.

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