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

Bishoy Morris, MBBCH (Hons)

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In This Article

Telepresence Surgery

Telepresence surgery and robotic telementoring are 2 revolutionary applications achieved by linking a robot to a telecommunication system, such as SOCRATES (Computer Motion).[1,3] In telerobotic procedures, the surgeon operates from the surgeon's console, which is thousands of miles away from the slave robotic arm mounted on the patient; the surgeon's commands are relayed to the slave manipulator via fiber-optic cables.[1] The first major transatlantic surgery was a telerobotic cholecystectomy performed by surgeons in New York, NY, on a patient in Strasbourg, France, in 2001.[48,49] Since then, many telerobotic operations have been performed. Telepresence surgery allows surgeons to operate wherever their skills are needed without being in direct contact with the patient. Although this virtual surgery has many implications, good and bad, one touted as potentially beneficial is the delivery of surgical care in medically underserved areas.[50,51] However, with a purchase cost around $1 million, a surgical robot is too expensive for places where it is most needed. For example, in Africa the average annual per capita healthcare expenditure is around $6.[52] When finances are not limiting, robotic surgery presents the potential for delivering surgical care to patients who have no direct access to a surgeon. The National Aeronautics and Space Administration (NASA) is exploring the use of surgical robots for emergency surgery on astronauts in a submarine to simulate conditions in space in a project called NEEMO 7.[53] The Pentagon is investing $12 million in a project to develop a "trauma pod" surgical robot to operate on soldiers wounded away from home.[54] A "concept video" extrapolating how such systems can evacuate wounded soldiers under enemy fire and then operate on them is available online.[55]

In telementoring, an expert surgeon guides another surgeon operating miles away; both surgeons "share" the view of the surgical field and control of the robotic system and communicate via microphones. Telementoring can potentially be used for teaching surgical skills to junior surgeons all around the world by expert colleagues.[56,57,58,59]

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