Robotic Surgery: Applications, Limitations, and Impact on Surgical Education

Bishoy Morris, MBBCH (Hons)

Limitations of Robotic Surgery

Although rapidly developing, robotic surgical technology has not achieved its full potential owing to a few limitations. Cost-effectiveness is a major issue^[43]; 2 recent studies comparing robotic procedures with conventional operations showed that although the absolute cost for robotic operations was higher, the major part of the increased cost was attributed to the initial cost of purchasing the robot (estimated at $1,200,000) and yearly maintenance ($100,000).^[43,44] Both factors are expected to decrease as robotic systems gain more widespread acceptance. However, it is conceivable that further technical advances may at first drive prices even higher.^[45] Decreasing operative time and hospital stay will also contribute to the cost-effectiveness of robotic surgery.^[44]

Other drawbacks to robotic surgery include the bulkiness of the robotic equipment currently in use.^[1,7] Lack of tactile and force feedback to the surgeon is another major problem,^[1,19] for which haptics (ie, systems that recreate the "feel" of tissues through force feedback) offers a promising, although as yet unrealized, solution.^[46,47]

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Cite this: Robotic Surgery: Applications, Limitations, and Impact on Surgical Education - Medscape - Sep 27, 2005.

Introduction
What Is Robotic Surgery?
Clinical Applications of Robotic Surgery
Limitations of Robotic Surgery
Telepresence Surgery
Robotic Surgery and Surgical Education
Conclusion
References

Table 1. Laparoscopic Limitations/Robotic Solutions
Laparoscopic Problems/Limitations	Robotic Surgery Solutions/Potential
Two-dimensional vision of surgical field displayed on the monitor impairs depth perception	Binocular systems and polarizing filters create 3-dimensional view of the field
Movements are counterintuitive (ie, moving the instrument to the right appears to the left on the screen due to mirror-image effect)	Movements are intuitive (ie, moving the control to the right produces a movement to the right on the viewer)
Unstable camera held by an assistant	Surgeon controls camera held in position by robotic arm, allowing solo surgery
Diminished degrees of freedom of straight laparoscopic instruments	Microwrists near the tip that mimic the motion of the human wrist
Surgeon forced to adopt uncomfortable postures during operation	Superior operative ergonomics: surgeon comfortably seated on the control console
Steep learning curve	Shorter learning curve

Table 2. Clinical Applications of Robotic Surgery
Field	Operations Performed via Robotic Surgery
Robotic gastrointestinal surgery^{[1,16,17,18,19,20]}	1997: Himpens et al.^[17] -- first robotic cholecystectomy Antireflux operations, Heller's myotomy, gastric bypass, gastrojejunostomy, esophojectomy, gastric banding colectomy, splenectomy, adrenalectomy, and pancreatic resection reported to date
Robotic urologic surgery^{[21,22,23,24]}	Radical robotic prostatectomy is the most common operation performed robotically and is gaining widespread recognition in the United States and EuropeNephrectomy and pelvic lymph node dissection also reported
Robotic gynecologic surgery^{[25,26,27,28]}	Robotic hysterectomy, salpingo-oophorectomy, and microsurgical fallopian tube reanastomosis
Robotic cardiothoracic surgery^{[29,30,31,32,33,34]}	Surgical robots allow cardiothoracic surgeons to perform complex cardiothoracic procedures while avoiding the significant morbidity of sternotomy and thoracotomyHundreds of robotic coronary bypasses have been performed to dateMitral valve repairs, atrial spetal defect repair, pericardiectomy, lobectomies, and tumor enucleations
Robotic oncologic surgery^[3]	Esophageal tumors, gastric cancer, colon cancer, thymoma, and retromediastinal tumors
Robotic pediatric surgery^{[35,36,37,38]}	Pyeloplasty for ureteropelvic junction obstruction, antireflux procedures for gastroesophageal reflux disease, and pediatric congenital heart diseases, such as ligation of patent ductus arteriosus

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Robotic Surgery: Applications, Limitations, and Impact on Surgical Education

Limitations of Robotic Surgery

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