Page 22 - Swsthya Winter Edition Vol 1 Issu 3 DEC 2020 Circulation copy BP

SURGERY

History of Robotic Surgery and

Current Applications of Robotics

Dr Santoshi J Nagaonkar
MB, MS, DNB (General Surgery)
DNB (Genito-urinary Surgery)
FRACS (Urology), Fellow European Board of Urology
Consultant Urologist and Robotic Surgeon
P D Hinduja National Hospital, Mumbai INDIA

The revolutionary industrialisation took • Stabilisation of instruments within the robotically. Other surgeries which could
place after the end of II world war and the surgical field be benefited in reducing the morbidity by
major turn-around was introduction of • Mechanical advantages over traditional using the daVinci system are thymectomy,
Robotics in engineering. However, it took laparoscopy LIMA/ RIMA retrieval, MVR etc.
another half century for medics to identify • Improved ergonomics for the operating
and explore its usage in the field of surgery. surgeon Otorhinolaryngology/Head and Neck
Surgery: Preliminary data of transoral
Dr Cloud Abbou, a French urologist Across multiple surgical specialties, robotic robotic surgery indicate its utility for
performed the first ever Robotic surgery was felt to offer the greatest resections of benign and malignant lesions
Prostatectomy. Dr Mani Menon, another advantage in complex reconstructive and of the pharynx and larynx. Oncologic
urologist from Detroit pioneered and oncological processes. resections of the supraglottis, tonsil and
popularized this technique. tongue base have been shown to be feasible
The potential advantages of robotic surgery with potential advantages compared
‘Robota ’ is a Czech word which means extend across many different surgical to traditional approaches. Preliminary
“forced labour” coined by a playwright, subspecialties. evidence indicates that these advantages
Capek. may include avoidance of mandibulotomy,
Urology: While the most mature outcomes avoidance of tracheostomy, decreased
Asimov’s three laws- data in the field of robotics are for radical operative time, reduced requirements for
prostatectomy, robotics may also offer complex reconstructions, and avoidance
1. 1. A robot may not injure a human advantages for cystectomy, pyeloplasty, of external excisions. Transaxillary
being, or through inaction, allow a nephrectomy (partial, complete and thyroidectomy has been proven to be an
human being to come to harm (Zeroth donor) and ureteral reimplantation. effective method in patients who remain
Law). Robotic surgery may ultimately replace conscious of having a neck scar.
open surgery for some complex urological
2. 2. A robot must obey the orders given procedures. Pediatric Surgery: Over 50 different types
to it by human beings except where of abdominal and thoracic procedures have
such orders would conflict with the Gynecology: Robotic surgery has been performed in pediatric patients.
First Law. shown promise in hysterectomy for both
benign and malignant disease, as well as
3. 3. A robot must protect its own myomectomy. In myomectomy, the robot
existence as long as such protection may provide substantial benefit by allowing
does not conflict with the First or minimally invasive fertility sparing options.
Second Law. It is also beneficial for tubal reconstruction.
The robot may provide potential advantages
Though Leonardo DaVinci has been credited for pelvic reconstructive surgery.
in conceptualising and fine printing the first
ever scientific sketch, the idea of having General Surgery: Procedures where it
a mechanical labourer was thought well may be of particular value include Heller
before that by Chinese and Indians. myotomy, paraesophageal hernia repair,
gastric bypass, gastric resection for
Worldwide to-date, over 5000 daVinci neoplasm, biliary reconstructive surgery,
systems have been installed and the total transhiatal esophagectomy, transthoracic
number of robot-assisted procedures esophageal surgery, distal pancreatectomy
performed worldwide are approaching with splenic preservation, and selected
over 2 million. colorectal procedures.
Current Scenario and Clinical Applications Thoracic Surgery: Robotic surgery offers
Advantages of surgical robots- clear benefits in the resection of solid
• Superior visualisation including thoracic tumors, particularly those located
3-dimensional imaging of the operative in the apex of the chest. Benign or malignant Leonardo da Vinci and Dissection
field esophageal tumors may also be resected

22 Volume: 1 I Issue: 3 I 2020