Now is the Time to Push for a Robot-Assisted Surgery Revolution

4/4/13

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with specialized instruments to reach biological structures. As a result, recovery time is far shorter and much less painful. And when the patient’s reduced hospital stay is taken into account, MIS is a very cost-effective option.

The real challenge is learning to perform minimally invasive procedures. The steep learning curve partially explains why in recent years nearly 90 percent of all surgical procedures were done in an open fashion.

For example, it can take a new surgeon numerous surgeries, sometimes hundreds, to master typical MIS gallbladder removal, or laparoscopic cholecystectomy, which is now the standard for this relatively straightforward surgery. The difficulty of MIS increases significantly in the case of more complex procedures, such as prostate removal.

Prostatectomy is challenging, as it involves intricate cutting to remove cancerous tissues without severing difficult-to-see nerves that control bladder and erectile function. In fact, a laparoscopic approach to prostatectomy is so challenging that only a handful of surgeons around the world have mastered it. Yet nearly 90 percent of all prostatectomies are now done with the assistance of the robot.

With robot-assisted surgery, the surgeon guides miniature motorized “wristed” instruments from a remote console, rather than manipulating “straight wristed” laparoscopic tools directly by hand as with conventional MIS. Robotics therefore allows surgeons to approach tissue from angles that aren’t possible with laparoscopic surgery. Robotics also allows the surgeon’s motion to be scaled so that large hand movements correspond to small instrument motion. In addition, hand tremor can be filtered out to allow for increased precision. A high-resolution 3-D view of the surgery is also standard in robotics, compared with the flat 2-D view that is typically found in MIS.

A less obvious but potentially even more significant advantage is that the robotic computer-mediated interface lends itself to virtual reality (VR) training. In a manner similar to flight simulation, a simulated environment is ideal for learning to control the robot. VR training also has the potential to introduce surgeons to a wide variety of surgical scenarios before they ever cut into a patient.

In other words, surgeons can climb the learning curve on simulated patients without risking injury to flesh-and-blood humans. Although the instrument costs are higher, the comparative ease of learning robotics does allow surgeons to reach expert levels of performance faster than with traditional MIS. A recent study has shown that a rigorous simulation curriculum can enable surgeons to perform a hysterectomy, or removal of the uterus, at expert levels on their very first case. This study, among others, emphasizes the real potential for training and testing of surgeons through simulation prior to live surgery.

Granted, the challenge of creating surgery simulators is greater than it is for flight simulation and the industry is still in its infancy. Just the same, robot-assisted surgery and simulation training is already helping address the challenge of increasing the adoption of minimally invasive procedures. This technology has just begun to change the way surgery is developed, taught, and performed. It has the very real potential to revolutionize healthcare, by boosting quality while cutting overall costs.

Jeff Berkley, PhD, is the founder and CEO of Seattle-based Mimic Technologies, which provides worldwide training and software for the da Vinci robot. Follow @

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