Q & A with Dr. Rani Bhat
Robotic Surgery Who Operates: Robot or Doctor?
Surgery in gynecology & oncology can be performed mainly by two ways – open surgery or minimally-invasive surgery (keyhole surgery). Minimally–invasive surgery consists of laparoscopic surgery and robotic – assisted surgery. In laparoscopic surgery, surgeon holds the instruments and operates, where as in robotic surgery the robot holds the instruments and the surgeon maneuvers the robotic arms and performs the surgery.
Robotic surgery is clearly a wonder of modern medicine. Who would have imagined that such a wide variety of surgeries could be performed with the assistance of a robot using instruments through tiny incisions.
What is robotic surgery?
Robotic surgery is a minimally invasive surgery (keyhole surgery), in this type of surgery you will not have a large incisions (cut) on your tummy for your surgery but instead you will have one 12 mm and three 5mm cut and with help of thin surgical instruments that fit through these tiny cuts they are attached to the robotic arms and the surgeon manuvers these arms and surgery will be performed.
Robotic arms will allow the surgeon to have maximum range of motion and precision of the instruments. The da Vinci’s robot also has a magnified high-definition 3-D camera that guides the surgeon to see better during the procedure. The surgeon controls these instruments from a console located in the operating room.
Can a robot operate on its own?
No, robot can’t operate on it’s own. Robotic surgery is always performed by a surgeon.
I strongly believe in the human touch in medicine. In my practice as a gynecologic and oncologist, I often do robot-assisted surgery. The most important part of surgery is decision-making. It’s not enough to make a stitch, but you have to know where to sew and what to sew, as well as how and why to sew. Even the most advanced and perfectly programmed robot can’t do that.
Robots will never replace the surgeons, but could be useful extensions of them. Surgeons will decide why to operate, and what to do; robots can help with the “how” component. Robotic surgery extends the ability of surgeon to help patients.
How is robotic surgery different from laparoscopic surgery?
Most doctors would agree that in selected cases minimally-invasive surgery is preferable to open surgery. Sometimes patients are given a choice between two minimally-invasive techniques: laparoscopic and robot surgery.
After discussion with your doctor, you can decide which is best in your case.
Laparoscopic surgery
Robotic surgery
Advantages
Small cut rather than one large one
Less blood loss
Less pain at operation site
Less noticeable scars
Shorter hospital stay which means lower hospital costs
Faster recovery hence you can get back to work early
Small cut rather than one large one
Less blood loss
Less pain at operation site
Less noticeable scars
Shorter hospital stay which means lower hospital costs
Faster recovery hence you can get back to work early
Has 3D, high definition & magnified camera–which allows for better vision of operating field and greater precision during surgery
Instruments used for robotic surgery are “wristed” just like human wrist and they move like hand. This provides range of motion like wrist and this reflects in less manipulation of tissues leading to less bleeding and less post-operative pain than with laparoscopic surgeryLimitations
Video images is only 2D, hence depth of operating field is not as accurate as robotic surgery
Laparoscopic instruments doesn’t have endowrist hence have a limited range of motion (up & down and side to side) which can make it difficult to work in tight spaces.
For surgeon it’s a steep learning curve before they become a full-fledged laparoscopic surgeon
Needs special training
Da Vinc robot is not available in many centers
Only few trained robotic surgeons are available in India
Is robotic surgery safe?
Yes, robotic surgery is safe when performed by trained surgeon.
Is robotic surgery right for you?
Robotic surgery is not offered for all patients, discuss with your surgeon if your condition can be treated with robotic surgery and if you would benefit from robotic surgery.
Discuss about various options and techniques, such as laparoscopic surgery and conventional open surgery.
If you would benefit from robotic surgery, then you should opt for robotic surgery since it has many more added advantages compared to laparoscopic surgery.
“Remember not all surgeries can be performed using robot”
Will robots replace surgeons in the future?
Surgeon makes many decisions for the betterment of patients outcome. Robots could assist surgeons, but won’t replace them, therefore for successful surgery surgeon is always need.
“Robotic surgery no substitute for doctors in the operating room”