Robotic Surgery

Robotic Surgery is the use of robots in performing surgery. "Surgery is performed by manipulating straight instruments while viewing the instruments on a monitor. Robotic surgery is the evolution of laparoscopy that addresses the drawbacks of laparoscopy"(NJ urology).Considering the never ending improvement of technology, this type of surgery is being used more by a day worldwide and has a potential to totally take over the field of surgery. However, as robotic surgery has its advantages, it also has its disadvantages.

1. History and Evolution of Robotic Surgery

History of robots industry can be linked to ancient Greeks, which had some kind of concept that we call today robots, many years before Christ. However, first recorded designs were in late 15th century. "One of the first recorded designs of a humanoid robot was made by Leonardo da Vinci in around 1495"( Wikipedia ). Da Vinci's notebooks were discovered later in the middle of 20th century. Term Robot came from Czech writer Karel Capek in 1921.

Robots in medicine didn't start to be used until late 20th century and there were several events that helped the integration of robotics into the medicine. "The first event was the creation and mainstreaming of computer technology. The second event was installation of robots in an American automobile manufacturing plant in 1961"( The Evolution). These events also helped because they introduced robotics to people in the United States. However, first robotic procedure in medicine came more than 20 years later. "Although laparoscopic procedures were performed in gynecology for many years, completion of the first laparoscopic cholecystectomy in 1985 was a contributing event in the development of medical robotic technology" (The Evolution).

Following that, robot was used to execute prostate surgery in 1988. 1992 was the first time that robot was used in the process of hip replacement. Robotic surgery continued to getting developed as people were able to do a surgery from a long distance. With these robots surgeons can be located in Europe, for example, and do the surgery in the United States. "Investigators such as Alberto Rovetta, PhD of Milan, Italy, have tried to work around the problem by having identical software programs at the two remote places, so the only thing transmitted is the hand signals. In 1993, Alberto Rovetta(15) was able to successfully perform a liver biopsy on a pig liver with the surgeon's station being at the NASA Jet Propulsion Lab (JPL) in Pasadena, CA and the manipulators and pig liver in his laboratory in Milan"(WEBSURG). In previously mentioned procedures robotic surgeries were run by human hand and it surgeons were not ready to try a procedure that will be totally done by robot, essentially unmanned. However, in 2006 robotic surgery came to that level that it was ready for surgery that didn't needed any assistance by human hand. "The first unmanned robotic surgery took place in May 2006 in Italy" (Wikipedia).

Use of robotics is largely expanding not just in surgery, but in medicine as whole, by a day. Today, robots are used in cardiac surgery, gastrointestinal surgery, gynecology, neurosurgery, orthopedics, pediatrics and urology.

2. Pros and Cons of Robotic Surgery

There are many advantages of the robotic surgery that have significantly improved medicine. Firstly, one of the main pros of robotic surgery is precision and miniaturization, meaning that incision is drastically smaller comparing to ones made with human hand. "The smallness of the incisions also causes many other advantages that make Robotic Surgery worth the risk. Due to the small and precise cuttings, the patents hospital stay is greatly reduced" (Thinkquest). Since cuttings are so precise, patience needs drastically less time to recover and risk of post surgery infections decreases as well. Besides these reasons that greatly help patients, there are many advantages from the doctors' side of view, too. Some of those are: enhanced 3D visualization, improved dexterity, improved access, and increased range of motion. "Enhanced 3D visualization provides the surgeon with a true 3-dimensional view of the operating field. Improved dexterity provides the surgeon with instinctive operative controls that make complex MIS procedures feel more like open surgery than laparoscopic surgery. Improved access: surgeons perform complex surgical maneuvers through 1-cm ports, eliminating the need for large traumatic incisions" (NJ urology). Another obvious advantage of robotic surgery is seen during the long surgeries, where surgeons as human beings can get tired in middle of procedure. However, with the help of robots even the longest surgery is achievable much easier. Finally, some would argue that robotic procedure is significantly more expensive and not worth it, however when everything is set and done, with the shorter recovery, the cost for the patient comes out pretty much even. "Dr. Michael Argenziano at New York Presbyterian Hospital said that on average, the robotic-assisted heart surgeries costs $2,000 more per operation, but in the end, the costs come out even because the patients recover sooner with the robotic procedure" ( Brown ).

There are several disadvantages of robotic surgery. To begin with, robotic surgery is a very new technology and is not totally proven. "Robotic surgery is a new technology and its uses and efficacy have not yet been well established. To date, mostly studies of feasibility have been conducted, and almost no long-term follow up studies have been performed" (Medscape). Furthermore, robotic equipment that is being used today is extremely expensive not just to buy, but also to keep and operate. Like any other technology, these machines go out of date rather quickly which creates more problems to hospital that are willing to purchase them." At this early stage in the technology, the robotic systems are very expensive. Another issue with the cost is the problem with upgrading the systems as they improve. Only when these systems gain more widespread multidisciplinary use the costs will become more justified" (Brown). Along with price, another con of these systems is their size, which is gigantic and creates the problem in operating room because when you put that machine along with surgeons and other staff it overcrowds the room. In conclusion, pros of robotic surgery outweigh the cons, which with the time will reduce.

3. Robotic Surgical System Types

Since robotic surgery systems started to be available for commercial use in 1985, there were several different models.

First robot that was non-laparoscopic was PUMA 560 and