The Current Generation of Surgical Robots
In this article:
– Surgical robots have more dexterity
– Robotic surgery uses haptic instruments
– Surgical robots can be expensive to buy and maintain
Surgical robots came with the digital era, as orthopedic surgeons and device manufacturers raced to bring advanced technology systems into the operating room.
Surgical robots moved surgeons away from patient tables and behind console controllers – where surgeons can manipulate mechanical arms, instruments, cameras with a broader range of motion and more precision than humans are capable. This technology leap solved problems of limited visibility and low mobility of conventional surgical instruments, and gave new meaning to minimally invasive surgery. Still, surgical robots were received with both high enthusiasm and intense scrutiny.
Many professionals in the orthopedics space see surgical robots as a fad, for clinical and operational reasons – claiming lack of studies showing significant clinical benefits of robotic surgery over conventional procedures and citing the low adoption rate of robotic surgery. Device manufacturers and technology companies are challenged with developing the next generation of surgical robots that are clinically proven to improve patient outcomes and can be more easily adopted into the workflow.
Surgical robots can feed information to the surgeon and process surgeon movements into highly precise surgical actions.
The most important factor in surgery is still the surgeon, who can sit at a console and direct the robot using joysticks, handles, and other manipulators. The console is also the vision center, displaying real-time data on screens. This includes camera views and information from specialized probes on the robotic arm.
The robotic arms have high dexterity, making very fluid, small-scale movements that a surgeon is not capable of performing with standard instruments.
The miniature wrists of a robotic arm can navigate in more directions without making the incision bigger, as needed to use traditional instruments. A smaller incision lessens the risk of infection and speeds up recovery.
Surgical robots are capable of motion scaling – turning millimeters of movement into micron increments – making a surgeon’s movements smaller and more precise. The computer can also filter out natural shakiness and tremors that everyone has in their hands for more certainty in navigation.
Overall, the dexterity of surgical robots helps prevent the surgeon from disrupting as many structures.
Robotic surgery uses intraoperative data to actively stop mistakes and minimize the chance of malposition, loosening and long-term wear.
While passive navigation can help with direction, they do not prohibit a surgeon from moving past a predefined zone. Pure mechanical guides – sextants, jigs, and laser cutting guides – simply do not respect the patient’s morphology. Surgical robots can provide active navigation for cuts, tracking instruments and only cutting within programmed zone boundaries.
The robotic arm will stop the burr beyond bony edges. The robot references patient specific anatomy in 3D space during the procedure and the robotic arm makes cuts using a burr instead of a bone saw in a preprogrammed zone. In orthopedics, this can help preserve soft tissue and cause less pain to the patient.
This accuracy is particularly useful in joint replacements, where a discrepancy in any length or angle can jeopardize the stability of the implant and hurt patient outcomes. A malpositioned implant can have overhang or underhang, in which the implant will cause bone bleed and pain. This unusual wear eventually causes the implant to fail. With the aging population and people staying active for much longer, the patient would likely need a revision surgery.
Surgical robots can perform calculated movements in tandem with tactile force sensors, lessening human error in surgery.
Surgical robots use haptic instruments that respond to tissue stretching, pulling, tension and balancing. They are equipped with accelerometers, gyroscopes, pressure sensors, and other subsystems to give real-time tactile feedback to the surgeon.
Haptic instruments are an extension of the surgeon’s touch – responding to touch sensation and force as a form of active navigation – but with a programmable grip. This means that the amount of force applied will not be too much force, as a human might do by accident using their tactile senses in a surgical site with limited visibility. Robotic surgery increases predictability and reproducibility.
Surgical robots require a large amount of upfront capital and time for technology integration and surgeon training.
Surgical robots are expensive, in terms of both up-front and maintenance costs. They are a big investment on the technical integration side because of limited device compatibility. One of the overall goals of robotic surgery is to reduce the time in, during and after a procedure – yet, surgical robots require hospital staff to complete extra tasks. Postoperatively, all of the intricate parts of a surgical robot have to be carefully sterilized.
Surgical robot systems need to communicate with preoperative imaging (CT scans and Xrays), preoperative planning (3D bone model, implant sizing, orientation, and positioning), and other intraoperative instruments (endoscopes, instruments, navigation). Seamless communication between surgical devices is just one part of our vision of Intelligent Surgery™.
Surgical robots have had a slow adoption because of the disruption from a typical clinical workflow. The operative process, communication, skill requirements, and instrument supply all have to be reconfigured with the adoption of a new system.
Surgeons have to learn new surgical skills interfacing with the console. Surgical robots are only as good as the surgeons using them, as with any medical technology. Surgeons have to learn new surgical skills interfacing with the console. While surgical robots are also more comfortable for the surgeon, who can be seated and can freeze robotic arm movement at any time during a lengthy procedure, reliance on high-technology equipment is bad.
On the whole, surgical robots can provide better clinical outcomes but low market penetration is a sign that device manufacturers are still tackling issues in cost and integration.
This article is part of the Intelligent Surgery™ Blog Series by Enhatch.