ROBOTIC SURGERY

The operation of the surgeon using wrist-like arms on the patient from the surgeon’s console next to the patient in the operating room is known as robotic surgery. Known as the Da Vinci Robotic Surgery System, robotic surgery was originally developed to meet the health needs of astronauts. Following that, it was planned to conduct remote operations in warfare surgery. With robotic surgery, surgeries can be performed around the world for about 20 years and in Turkey for 10 years. With small incisions like laparoscopic surgeries, surgery is performed with the help of a robotic 3D camera (based on the principle of providing depth like the human eye and providing vision from different angles) and robotic hand tools.

What is robotic surgery?

This surgical method, also known as the da Vinci robotic surgery system, is the most advanced form of minimally invasive surgery. The Da Vinci Robot is the only example of a robotic surgery system in the world. It consists of three main parts: the surgeon console, the patient console and the image tower. Commands from the surgeon console are transferred to the Da Vinci robot located on the patient console. The da Vinci robot is outfitted in a sterile special sheath. As in laparoscopic surgeries, incisions are made in the abdominal wall according to the operation to be performed and instruments called trocars that allow hand tools to easily enter and move into the abdomen are inserted. According to the surgery to be performed, the 3D imaging system is entered through the appropriate trocar. Since the imaging device is robot-controlled, it does not vibrate and the surgeon has a realistic three-dimensional vision. Since the optical system transmits the image with high resolution and fiber optic cameras, there is no image loss even if the image is zoomed in. In narrow spaces and at great depths, the surgeon can provide a better than normal field of view. The hand tools required for the surgery are then introduced through additional trocars. Robotic console connections are provided with hand tools. The surgeon sits on the surgeon console and manages the robotic console movements with hand movements. Robotic arms, which have a rotation angle of 720 degrees, allow movements that are not possible for human hands to be made easily. Small tremors in the surgeon’s hands are not reflected in robot-controlled surgical instruments. Thus, the margin of error that can be experienced in surgery is reduced to the lowest possible level.

Robotic Surgery usage in General Surgery

Robotic surgery can be used in most general surgery operations.
• Colon and rectal surgery: It increases the mobility in the narrow area of the pelvis, especially in rectal surgery.
• Obesity and Metabolic Surgery (Diabetes Surgeries): It provides guidance of the intestines and a comfortable anastomosis in the abdomen in diabetes surgeries.
• Liver Resections (Hepatectomy, Segmentectomy): With a wider viewing angle, the bile ducts and blood vessels in the liver can be seen more easily, allowing surgery to be performed with fewer complications and less bleeding.
• Whipple Surgery, Pancreatectomy and Distal Pancreatectomy for pancreatic cancer. Especially in whipple surgery, it enables the anastomosis between the pancreatic duct and the newly formed pathways between the biliary tract and the small intestine with more comfortable manipulation.
• This method can be used also in Stomach and Esophageal Cancer Surgery.

 Robotic Surgery in Urology

Urology is one of the departments where robotic surgery is used most frequently.

• Prostate Cancer Surgery: The mobility in the narrow pelvis increases with robotic surgery and the nerves close to the prostate are protected with clearer vision, so problems such as erectile dysfunction and urinary incontinence are much less common after the operation.
  • Kidney Surgeries: Kidney cancer, urinary tract stricture surgeries, complete or partial removal of the kidney ensures that the vessels feeding the kidney are freed and their mobility is high. It minimizes the risk of possible complications.

Robotic Surgery in Gynecology

Gynecological surgeries are mostly performed in a narrow area in the inner part of the pelvis, just like urological surgeries. Robotic surgery provides increased mobility in this narrow space.

• Gynecological cancer surgeries: Especially in the case of cleaning the lymph nodes, which will be performed in case of necessity in these surgeries, it allows the protection of both vessels and nerves easily.
• Myomectomy surgeries.
• Uterine Prolapse Surgeries: It allows for the release of a portion of the vagina in the deep pelvis as well as the detection of the patch, if desired.
• Robotic Surgery in Cardiovascular Surgery.
• Coronary Artery Bypass Surgery.
• Disruptions in Rhythm.
• Heart Valve Replacements.

Robotic Surgery in Otorhinolaryngology and Head and Throat Surgery
In the surgery of tumors and cysts in the larynx, pharynx, tonsils, tongue and mouth, no incision is made on the patient’s skin. It is made with incisions made inside the mouth and is called transoral robotic surgery. In these surgeries, 2-armed robots are used rather than 4-armed robots.

Robotic Surgery Advantages
There are numerous advantages to using robotic surgery technology because it allows many complex surgical procedures to be performed concurrently.
• The robotic surgery system, which performs surgical operations with a small incision, is in the patient’s favor as it provides less trauma and pain in the patient’s body, minimal scarring, a shorter hospital stay and faster recovery time. It causes less wound infection.
• Another situation that can be counted among the advantages of robotic surgery is the use of robotic arms that can imitate the movements of the hands and have an articulated structure. It offers more dexterity and precision than is possible when compared to traditional methods. Robotic arms can rotate at an angle of 720 degrees and do not vibrate.
• The use of high-resolution 3D cameras in robotic surgery allows surgeons to see areas that they normally cannot see with the naked eye. The normally seen image can be magnified 10 times without loss of image. This means that the surgeon dominates more areas and sees the operation in all its fine details.
• The physician gets less tired as he works sitting down. Thus, during long-lasting operations, the stress level of the physician decreases while the concentration level increases.

Difference Between Robotic Surgery and Endoscopic Surgery
After the use of robotic surgery in various fields of medicine, the first clinical results about robotic heart surgery were obtained in the 1990s, and its use has increased rapidly since the 2000s.

• Although robotic surgery is likened to endoscopic surgery, the main difference from endoscopic surgery is that the surgeon operates the robot’s arms remotely by watching them on a monitor.
  • The robotic surgery method in heart surgeries provides the following possibilities:
  • Thanks to the three-dimensional cameras that can enlarge the operation area, hard-to-see areas such as bleeding areas can be seen and large blood loss is not experienced.
  • Since the operation is performed through 3–4 8-millimeter holes, people may feel less pain compared to an open operation and the scar on the skin will be smaller.
  • A small surgical incision and less blood loss allow people to be discharged within 1-2 weeks and the return to normal physical activities becomes easier.
  • Since the sternum does’nt need to be cut, the risks of moving the sternum or getting an infection are low.

In Which Areas is Robotic Surgery Used?

Robotic surgery is used in many medical branches such as gynecology, urology, otolaryngology. Operations take place as follows:

• The procedure is performed with general anesthesia.
• In order to use the robot, a surgeon and an assistant must be present in the operating room.
• Necessary surgical instruments are attached to the arms of the device. The surgeon, on the other hand, sits at the command center called the “console”, which is also located in the operating room. It controls the surgical instruments that enter the body through one or more holes.

Laparoscopy And Robotic Surgery Are Not The Same Thing

Robotic surgery can avoid some of the technical difficulties encountered in laparoscopic (closed method) surgery. In laparoscopy, pipes are inserted into the spaces between the organs through the holes and a 2-dimensional image is obtained with the tools and camera pushed into these inflated spaces. There is no direct contact with the organ, the incisions are very small, the person loses less blood, heals quickly and there is no trace of surgery. In robotic surgery, the image is obtained in three dimensions and with high resolution. Push-in tools can rotate 540 degrees. Especially in urology and intestinal surgery, robotic surgery gains importance because the organs are lower and deeper. It is aimed to minimize the risk of error with robotic surgery.

Not For Use in Patients Who Have Previously Undergone Surgery

In thyroid surgeries, it is possible to operate under the armpit with robotic surgery for those who are uncomfortable with the scar on the neck. In robotic surgery, an incision is made under the armpit and a tunnel is created under the skin. The robot’s arms are inserted here to create a working area. This method avoids incisions made from one ear to the other in thyroid cancer and neck lymphatic defects. However, robotic surgery cannot be applied to very large goiters, people who have had previous surgery, very advanced cancers, or people with a body mass index above 30. Since the muscle is not cut and stretched during the surgery, there is no pain and the person will be able to go home the next day.

Favorable for Gynecological Cancer Cases

Robotic surgery is a preferred surgical method, especially for cancer patients. It allows operations that were previously performed with incisions of 20–25 cm to be performed through several holes. It shortens the discharge time and can return the person to daily life within a week. Robotic surgery is especially important for cancer where time is very important in treatment. Because receiving chemotherapy and radiotherapy after surgery can shorten the healing time of the surgical incision.

Ovarian Cyst Surgery

Ovarian cyst surgeries are usually performed laparoscopically through 3 or 4 holes. However, these surgeries can be performed through a single hole, using only the belly button. Robotic technology has been used in recent years because it is difficult to perform the surgery using instruments in a narrow area with standard laparoscopic surgery. Robotic surgery’s computer program can alleviate technical difficulties.

Is the Robot Doing The Surgery?

The procedure performed in the robotic surgery method is defined as “robot-assisted laparoscopy surgery.” Besides the definitions of “open surgery” and “laparoscopic surgery,” it is adopted as a newly developed third surgery method. Contrary to popular belief, a robot does not perform surgery; it is carried out by a team of experts in using the robot.
Today, with the robotic surgery system, many operations can be performed in different surgical branches, especially urology, cardiovascular surgery, general surgery, gynecology and ENT.
The robotic surgery method is also used in myoma surgeries. In these operations, while the uterine fibroid is removed, large cavities occur in the uterine wall and these cavities and the uterine wall must be closed very well so that they do not affect the person’s future pregnancy. Robotic surgery can suture the same as open surgery due to the 3D image and the ability of the robot arms to make wrist movements. Especially with large fibroids, the area to be closed is larger.