To overcome these limitations with minimally invasive surgery, medical robots were developed. In robot-assisted surgery, instead of directly moving the instruments the surgeon uses a computer console to manipulate the instruments attached to multiple robot arms. Similar to a computer gaming console, the computer translates the surgeon’s movements, which are then carried out on the patient by the robot. Other features of the robotic system include, for example, an integrated tremor filter and the ability for scaling of movements (changing of the ratio between the extent of movements at the master console to the internal movements of the instruments attached to the robot).
The console is located in the same operating room as the patient, but is physically separated from the operative workspace. Since the surgeon does not need to be in the immediate location of the patient while the operation is being performed, it can be possible for specialists to perform remote surgery on patients from many miles away. Robots can perform heart surgery without a human surgeon
In the United States, each robotic surgical system must receive approval from the FDA (Food and Drug Administration) for each surgical procedure during which a surgeon plans to use it. For example, clearance for use in gallbladder surgery does not allow a surgeon to use the same robotic system to, say, remove a tumor.
Commercially available robotic surgical systems have similar setups which include a control console with joystick-like hand controls and a 3-D viewer, at which the surgeon sits, and table-mounted robotic arms. One of the robotic arms holds the endoscope and the other two or three arms carry the surgical instruments.
As surgeons’ experience and robotic technology develop, it is expected that robot-assisted procedures will be applied to additional types of heart surgery.
Because patient recovery after robot-assisted heart surgery is quicker, the hospital stay is shorter. On average patients leave the hospital two to five days earlier than patients who have undergone traditional open-heart surgery and return to work and normal activity 50% more quickly. Reduced recovery times are not only better for the patient, they also reduce the number of staff needed during surgery, nursing care required after surgery, and, therefore, the overall cost of hospital stays.
Compared with other minimally invasive surgery approaches, robot-assisted surgery gives the surgeon better control over the surgical instruments and a better view of the surgical site. In addition, surgeons no longer have to stand throughout the surgery and do not tire as quickly. Naturally occurring hand tremors are filtered out by the robot’s computer software. Finally, the surgical robot can continuously be used by rotating surgery teams (Gerhardus 2003).
Nonetheless, there are disadvantages to minimally invasive robot-assisted heart surgery. The cost of robotic surgical systems lies between $750.000 and $1.2 million (as of 2005). Numerous financial feasibility studies have been done to determine whether it is really worth a hospital’s while to purchase such a system and opinions differ dramatically.
Surgeons report that, although the manufacturers of the systems provide training on this new technology, the learning phase is intensive and surgeons must operate on twelve to eighteen patients before they feel comfortable with the system. During the training phase, minimally invasive operations can take up to twice as long as traditional surgery, which ties up operating room and surgical staff time and keeps patients under anesthesia longer.
Not all surgeons are convinced that minimally invasive robot-assisted heart surgery is “the wave of the future”. Many cite the success they have with traditional surgery methods, fearing a complete disruption of the current practice of surgery. More convincingly, insurers argue that, while minimally invasive surgery may reduce hospital costs for each individual, the reduction in complications will lead to more minimally invasive surgeries being performed overall. Therefore, insurers fear that the total cost to the health care system will grow. Nonetheless, as potential patients become more educated about the physical and psychological side effects of traditional surgery, these consumers will push for less-invasive technologies. In parallel, as more surgeons begin using minimally invasive techniques, operating times will decrease.
Kypson AP & Chitwood WR Jr. (2004). Robotic applications in cardiac surgery. International Journal of Advanced Robotic Systems, 1(2), 87-92.
Gerhardus D (2003). Robot-assisted surgery: the future is here. Journal of Healthcare Management, Jul/Aug, 242-251.
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