Dear Editor,
When a procedure is called “robotic,” it does not indicate that a robot is really
doing the work. Instead, it refers to surgical procedures in which doctors use robots
to guide their actions. One or more robotic arms may be used in robotic surgical systems,
which doctors can operate remotely and accurately from a console nearby. A laparoscope
is attached to one of the robot arms. Small surgical tools may be carried in the other
arms by the surgeons. The surgeon is able to see the tumor in three dimensions thanks
to a computer screen. Each robotic arm is controlled by a joystick similar to that
used in video games, which replicates the movements of the wrist and hand and provides
dexterity.
In comparison to conventional laparoscopic or minimally invasive surgery, robotic
devices are believed to have superior dexterity and range of motion. Surgeons may
now operate on sections of the body that were previously inaccessible and get a better
look at otherwise difficult-to-see areas. Minimally invasive operations often involve
robots. Small incisions are used in these procedures, as the name suggests. Less discomfort,
less bleeding, shorter hospital stays, and faster recovery periods are all common
benefits of this approach.
The robotic helper was created to improve on already excellent minimally invasive
surgery. In July 2000, the FDA approved the da Vinci Surgical System, the first surgical
robot, for general minimally invasive surgery [1]. Robotic prostate removal (radical
prostatectomy) was approved by the FDA in the following year. Cancer procedures including
gynecological cancers were approved by the FDA in 2005. The Senhance System, a comparable
robot, was approved by the FDA in 2017. Surgeons started employing robots for a broader
variety of cancer operations as more hospitals purchased this $ 2 million equipment.
Robotic assistants have been advertised as “where Star Trek meets Dr. Oz,” and many
patients have sought them out as a result of seeing them in ads. Patients' desire
for robotic procedures has fueled their wider acceptance, according to research. It's
not certain whether utilizing a robot for cancer treatment is better than conventional
methods, as the FDA cautioned in 2019.
Preoperative planning, surgical navigation, and surgical assistance may all be supported
by a variety of computer-assisted surgical systems. An RAS device is a form of computer-aided
surgical system that uses robots [2]. A range of surgical procedures may be performed
with RAS devices, which let the surgeon to employ computer and software technology
to control and move surgical tools via one or more small incisions in the patient's
body (minimally invasive).
Some of the advantages of a RAS device may include its capacity to aid minimally invasive
surgery and help with complicated tasks in restricted regions. In reality, the machine
is not a robot since it cannot carry out surgery without direct human intervention.
In the right hands and with the right training, robotic surgery may be a safe and
effective tool for completing specific surgeries. It is the goal of the FDA to ensure
that devices are safe and effective for their intended use [3]. Ensure manufacturers
provide proper training for both new and seasoned users of RAS devices. Medical device
training and education are not regulated or accredited by the FDA since they are not
part of the agency's purview. It is up to companies like pharmaceutical companies,
doctors' offices, and health care institutions to come up with and execute effective
training programs. Specialty certification organizations and professional societies
may also help to establish and fund training programs for its members' doctors of
certain specialties. The certification status of their specialist doctors is likewise
maintained by the specialty boards. The Hominis Surgical System, a revolutionary robotically-assisted
surgical device (RASD), has been given the green light by the US Food and Drug Administration
to go on sale in the United States. The Hominis Surgical System is designed for salpingo-oophorectomy
in conjunction with benign hysterectomy (removal of the uterus for non-cancerous reasons)
[4].
The Hominis Surgical System makes use of transvaginal (via the vagina) and laparoscopic
(through a tiny incision in the belly) minimally invasive surgical equipment and a
video camera to see the instruments within the patient during uterine removal. When
compared to traditional laparoscopic surgery, the transvaginal method involves fewer
abdominal incisions. Surgeons in the operating room use the Hominis Surgical System
console to control the tools throughout the process. Before using the device, surgeons
and operating room personnel must finish a rigorous training program developed and
provided by the company.
Additional to testing for performance and engineering, the FDA examined 30 patients
who had had transvaginal complete hysterectomy, salpingectomy, or salpingo-oophorectomy
for benign diseases, all using the Hominis Surgical System. More than six out of ten
patients had a variety of comorbidities, such as excessive cholesterol, osteoporosis,
or high blood pressure, which varied in severity from patient to patient. Using the
Hominis Surgical System, there were no conversions to an open or alternative laparoscopic
surgical method in any of the 30 surgeries performed. Minor blood loss, urinary tract
infection, and delayed healing of the top of the vagina (vaginal cuff) closure that
is done as part of a hysterectomy were among the observed side effects.
The FDA has not approved any RAS systems for use in mastectomy patients, and there
is insufficient data to support the use of RAS devices for breast cancer prevention
or therapy. The surgical procedure for patients having a mastectomy is different when
using RAS devices. It has not been proven how these changes would affect cancer prevention,
overall survival, recurrence, and disease-free survival in the long run.
In terms of medical technology, robotic surgery is nothing new. Many hospitals are
still reluctant to use robots for patients because of the high expenses, human resources,
and lack of competence required.
The future of robotic surgery, on the other hand, shows a quick growth towards precise
and least invasive versions of fundamental surgery. Post-op infections and other problems
linked with typical open procedures will also be less common in patients who have
had minimally invasive surgery. Robotic surgery is expected to be combined with other
cutting-edge technology in the future. Surgeons' job may be made easier with the aid
of artificial intelligence in the medical industry.
Though we may look to the future, robotic surgery will not be able to take the position
of human doctors anytime soon. Robotic systems, in their most basic, are here to augment
human abilities and improve post-operative results.
Provenance and peer review
Not commissioned, internally peer-reviewed.
Data statement
No specific data collected for the above manuscript.
Ethical approval
Not applicable.
Sources of funding
This study received no specific grant from any funding agency in the public, commercial,
or not-for-profit sectors.
Author contribution
Hitesh Chopra: Conceptualization, Data curation, Writing-Original draft preparation,
Writing- Reviewing and Editing. Atif Amin Baig: Data curation, Writing-Original draft
preparation, Writing- Reviewing and Editing. Simona Cavalu: Writing-Reviewing and
Editing, Visualization. Inderbir Singh: Writing- Reviewing and Editing, Visualization,
Supervision. Talha Bin Emran: Writing- Reviewing and Editing, Visualization, Supervision.
Trail registry number
1. Name of the registry: Not applicable.
2. Unique Identifying number or registration ID: Not applicable.
3. Hyperlink to your specific registration (must be publicly accessible and will be
checked): Not applicable.
Guarantor
Talha Bin Emran, Ph.D., Associate Professor, Department of Pharmacy, BGC Trust University
Bangladesh, Chittagong 4381, Bangladesh. T: +88-030-3356193, Fax: +88-031-2550224,
Cell: +88-01819-942214. https://orcid.org/0000-0003-3188-2272. E-mail: talhabmb@bgctub.ac.bd.
Consent
Not applicable.
Declaration of competing interest
All authors report no conflicts of interest relevant to this article.