Robotic surgery, applications in oncology and gynecology

Great advancements have been made in all fields of medicine due to new technologies, yet probably the most futuristic breakthrough can be found in surgery. Robotic surgery has been widely used in Italy thanks to its high level of precision and the fewer side effects patients experience. Italy has become a European leader in the use of these new techniques with the installation of the Da Vinci surgical system at the Catania Hospital Policlinico. In Europe, only France is equal with the same number of robots followed by Germany and Great Britain. Globally, instead, Italy comes third to the United States and Japan.

Advantages of robotic surgery

A robot similar to the one at the University of Catania is a system of state of the art technology that allows a surgeon to operate on a patient, from a console, using four small robotic arms that are barely larger than a needle. The arms contain all the instruments needed during surgery to make incisions, cauterize, stitch, etc. Robotic arms allow more surgical gestures than normal surgery, while a micro camera on an endoscope gives a three-dimensional view ten times more powerful than the normal vision of the human eye. 3D vision allows the surgeon to be “immersed” inside the patient’s body. In robotic surgery, internal organs are reached through small incisions instead of a long cut with a scalpel, allowing for less invasive surgery and, thus, less risk of infection, less bleeding, minimal scarring and, consequently, shorter hospital stays.

Applications in oncology and gynecology

Today, this kind of surgery is widely used in the field of urology, where it is used in 66% of all surgeries (statistic, 2017). The use of robots in the operating room, however, is spreading to many other fields, such as gynecology, where it is used in 11% of all surgeries. Robotic surgery is indeed indicated for the treatment of gynecologic tumors. Traditional surgery in this field included large incisions and prolonged postoperative pain or less invasive surgeries, such as a vaginal hysterectomy, but with extremely limited working space for the surgeon. Gynecological robotic surgery reduces the defects of traditional surgery, but reaps all the benefits. A laparotomy involves simple and precise movements, while a laparoscopy involves small incisions, greatly reducing both the risk of side effects and hospital stays as well as avoiding large abdominal scars, an important factor especially for women. Continual research is being done into even more accurate instruments.

A new robot has recently been introduced. The SenHance Robotic System (Transenterix USA), a new-generation system for minimally invasive surgery, has brought about many new features to robotic surgery. The most important is that it allows the surgeon to feel the pressure/traction generated by the instruments on tissue, a function made possible by multiple sensors in the robotic arms. This feature allows for greater awareness on behalf of the surgeon and, thus, more accuracy in the surgical procedure.

Limits and doubts when thinking about the future

The greatest limitation to robotic surgery, especially in a time of scarce economic resources, is the high cost of robotic devices, which cost around 2-3 million euros not to mention maintenance expenses that amount to approximately 100,000 euros per year. This type of investment can only be justified by an extensive and continued use of the device. A possible risk in the future, however, is that surgeons become much too accustomed to operating through the use of robots and are no longer capable of using their own hands in more complicated cases. Currently, however, these high costs are justified by the excellent response from both patients and surgeons and, thus, research continues to bring the precision of robotic surgery to even more medical fields.

© Domedica s.r.l.

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