The Challenges of Robotic Surgery: Overcoming Limitations

Robotic surgery has revolutionised the way many medical procedures are performed, and it has found applications in several medical specialities, including urology, general surgery, and surgical oncology. However, lack of tactile feedback and potential socio-economic factors, such as the high cost of implementation and lack of trained personnel, may limit its accessibility and application. Specific enhancements focused on improving financial and technical support can help improve access and potentially transform the surgical experience for surgeons and patients. This article focuses on the limitations encountered by robotic surgery.

Types of Robotic Surgery and their Limitations

Heart Surgery- Robot-assisted heart surgery, also called closed-chest heart surgery, is a minimally invasive heart procedure performed by a heart surgeon. Surgeons use a differently designed computer console to control surgical instruments on thin robotic arms.

Types of robotically assisted heart surgeries:

• Mitral valve repair
• Septal mastectomy
• Tricuspid valve repair
• Atrial septal defect (ASD0 repair
• Patent foramen ovale (PFO) repair

Challenges: While offering many potential benefits, robotic-assisted heart surgeries have challenges. Some of the major challenges include:

• Cost: Robotic surgical systems are expensive to purchase and maintain.
• Technical complexity: Robotic-assisted heart surgeries are highly complex procedures that require advanced equipment and specialised training. Technical failures can impact patient safety and lead to surgical delays or cancellations.
• Limited tactile feedback: Robotic surgical systems do not provide the same level of tactile feedback as traditional surgery, making it difficult for surgeons to assess the texture and manipulate delicate tissues.
• Longer operating times: Some robotic-assisted heart surgeries may take longer to perform than traditional open-heart surgeries
• Patient selection: Not all patients are good candidates for robotic-assisted heart surgeries, and the decision to use this technique must be carefully evaluated on a case-by-case basis.

Gastrointestinal Surgery- Robotic surgery is developing in the minimally invasive treatment of gastrointestinal tumours. In gastrointestinal oncology, robotic surgery is performed using robot-assisted surgery systems. In this system, the robot does not operate autonomously but is controlled by the surgeon.

Types of Gastrointestinal Surgery:

• Colectomy
• Gastrectomy
• Pancreatectomy
• Gastric bypass

Challenges:

The main limitations of robotic gastrointestinal surgery are the

• learning curve,
• the higher cost of robotic surgery compared to conventional and
• laparoscopic surgery, and
• the longer operative time, including set-up and operating issues.

Gynaecology surgery- Robotic surgery in gynaecology is one of the latest innovations in minimally invasive surgical technology. With the help of a narrow, lighted scope and tiny tools controlled by a robotic system, gynaecological surgeons treat various conditions affecting the female reproductive organs.

Types of Gynecology surgery:

• Lung resection
• Mediastinal mass reduction
• Thymectomy

Challenges: There are several problems with current robotic surgery for gastrointestinal cancer. One of these problems is that it is difficult to provide conclusive proof of the usefulness of robotic surgery. However, compared to open surgery, the advantages of robotic surgery in terms of minimal invasiveness are readily apparent. Still, there is no difference in the invasiveness of robotic surgery compared to traditional endoscopic surgery. Conversely, disadvantages such as long operation time and increased medical costs are also easily manifested in objective data.

Furthermore, in gastrointestinal cancer surgery, precise lymph node dissection performed by robotic surgery is expected to improve the cure rate and reduce intraoperative and postoperative complications. However, conventional endoscopic surgery allows adequate lymph node dissection and permanent healing without serious complications. Therefore, it can be difficult to demonstrate that robotic surgery is superior to endoscopic surgery.

Also read about more: Latest Advancements In Robotic Surgery

Limitations of Robotic Surgery

• It is not widely available and is only available in centres that can afford the expensive technology and have specially trained surgeons. This can limit patient access to these procedures and may result in unequal access to healthcare. In addition, patients in rural or remote areas may not have access to robotic surgery due to the lack of specialised equipment and trained personnel, which can lead to disparities in healthcare outcomes. The high cost of robotic surgical systems can also result in higher healthcare costs for patients who require these procedures, further exacerbating healthcare inequalities.
• Another limitation of robotic surgery is that there may be situations where the surgeon needs to convert to an open procedure with larger incisions if there are complications. For example, scar tissue from previous surgeries can make it difficult for robotic technology to complete the procedure. Sometimes, the surgeon may need to switch to traditional open surgery to ensure patient safety. In addition, unexpected complications during the procedure may require the surgeon to convert to open surgery.
• One of the risks associated with robotic surgery use is the potential for nerve damage and compression. During robotic surgery, the surgical instruments and arms may pressure nearby nerves and tissues, which can cause nerve damage or compression. This can lead to complications, including numbness, weakness, and pain.
• Robotic malfunction is a potential limitation of robotic surgery, but it is an extremely rare occurrence. The surgical robots used in modern robotic surgery systems are highly advanced and undergo rigorous testing and maintenance to ensure their reliability and safety. However, like any other technology, there is always a risk of technical failure, potentially impacting patient safety and leading to surgical delays or cancellations.

Robot-assisted surgeries are not only a risk of human error while using a robotic system, but there is a chance of mechanical failure. For example, system components like robotic arms, cameras, towers, binocular lenses, and instruments can stop in the middle. In other cases, electrical current from a robotic instrument could leave the arm and be mistakenly applied to surrounding tissue, causing unintended burns. Similarly, robot-assisted surgery can lead to nerve paralysis due to extreme body positions or direct nerve compression that can occur when using a robot. Robotic surgery also takes longer than non-robotic surgery in surgical centres with fewer robots or by less experienced surgeons.

Over time and as technology improves, most of the shortcomings identified will be corrected. However, only time will tell if using these systems is worth it. If the cost of these systems remains high, they do not reduce the cost of routine surgery. In addition, the robots are unlikely to be available in all operating rooms and, therefore, less likely to be used for surgery routines.

What can be done to improve robotic surgeries?

Technically, much work remains to be done before the full potential of robotic surgery can be realised. Although these systems have greatly improved skill, they have yet to exploit the instrument's full potential or include the full range of sensory input. One of the holy grails of robotic surgery is to provide systems with realistic force reflexes and tactile feedback; however, many mechanical joints inherently introduce additional friction to the entire driveline. Therefore, it is difficult to distinguish between frictional forces originating from robotic systems and forces originating from living tissues. This limitation can be overcome by developing new computer algorithms and tiny sensors that can be placed at the end of the instrument.

Control handles for systems like the da Vinci detect the movements of the surgeon's hand and are electronically activated, and can transmit force information to the surgeon. As with conventional surgery, tissue tension and any range of biological data can be provided. Continued research and development in robotics and medicine can help improve the capabilities and accessibility of robotic surgery, ultimately benefiting patients and healthcare providers alike.

Conclusion

Robotic surgery faces few drawbacks, but it is likely to involve continued advancements in technology and research, expanding the applications of robotic surgery and improving patient outcomes.

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FAQs

Ques. What is the failure rate of Robotic surgery?
A. These studies reported device error rates and error-related conversion rates between 0.4 and 8.0% and between 0.1 and 2.7%, with an average of 3%.

Ques. Is it possible that the robotic arm may seize up and stop working mid-operation?
A. Robotic arms used in surgery are designed with multiple fail-safes and redundancy systems to prevent them from seizing up and stopping working mid-operation. These systems ensure the robotic arm can continue functioning even if one or more components fail.
For example, most robotic surgery systems have backup power sources and multiple motors that can continue to operate even if one fails. Additionally, most systems have built-in sensors that detect any issues and alert the surgical team before a failure can occur.

Ques. Is it true that robots perform whole surgery?
A. No, it is not true. The surgical robot is operated by a trained surgeon who uses a console to control the robot's movements.

Ques. Can there be a way to improve Robotic surgery? 

• Here are some possible ways to enhance robotic surgery:
• Improved Sensory Feedback
• Expanded Capabilities
• Cost Reduction