This past summer I had the opportunity to witness the impact of technology in healthcare from a front row seat. I spent a month shadowing anesthesiologists at a prestigious hospital in New York City, where I saw procedures in the operating room ranging from brain surgeries to c-sections to robotic heart surgeries. I was fascinated by the expansive implementation of technology in these procedures, with unique machinery used for many complex surgeries.
One area that particularly fascinates me is robotic surgery - a procedure that refers to doctors utilizing robots to guide their actions. It is a common misconception that robotic surgery is independent of human control and involves only the machinery and the patient. In reality, this type of surgery includes one or more robot arms that are remotely and accurately controlled by doctors from a nearby console (Chopra et al., 2022). A laparoscope, a small tube with a light and camera, is inserted along with the robotic arms to provide a clear view of the procedure for the surgeons. This tool can capture the patient's insides with a three dimensional view (Mayo Foundation, 2022). The robotic arms are controlled by a joystick, much like the ones used in video games, which can replicate the movements of the wrist and provide dexterity.
Technology in healthcare is a controversial topic and this is certainly true when it comes to robotic surgery. As with any surgical procedure, there are certain risks that come with it. However, research shows that there are more pros than cons for certain procedures when it comes to human versus robotic techniques. Some pros for robotic surgery include the enhanced precision, flexibility, and control during the operation which allows for a clearer and closer view of the surgical site compared to traditional techniques. Robotic surgery also makes it easier for surgeons to avoid surrounding nerves and organs (UC Davis). The surgeons are able to perform more complex techniques with smaller tools and an instrument steadier than a hand. In fact, some procedures, previously deemed impossible, have even been enabled by the implementation of robots.. Furthermore, robotic surgery is less invasive and has been found to have a decreased risk of complications like surgical site infection, less pain and blood loss, shorter hospital stay and recovery time, and smaller scars (Mayo Clinic, 2022).
On the other hand, there are specific risks associated with robotic surgery, with the most prominent being technological malfunction. There is not only the risk of human error with the surgeon operator but also the potential for mechanical failure when robots are introduced. Some common risks include electrical arcing which can lead to sparking or burns and nerve paralysis due to extreme body positioning or direct nerve compression. There is also an associated high cost of robotic surgery since the machinery is difficult to maintain, therefore often increasing the surgical price. Additionally, robotic surgery is not meant for everyone. There are certain medical situations, or comorbidities, such as a recent heart attack, that make a patient a bad candidate for robotic surgery (Pai et al., 2023).
This summer I was lucky enough to be able to observe heart surgery while sitting in one of the robotic consoles next to the head surgeon for a robotic mitral valve replacement. There were two robotic consoles, but they only needed one for the procedure, so I was allowed to sit in the other console and observe the procedure through the 3D laparoscopic lens. The experience was unforgettable. There was such a clear and accurate field of view through the robotic lens and the precision of the surgeon through the robotic arm was incredible. Another surgeon sat next to the patient and changed the robotic arms to what the head surgeon required, took out the specimens, and talked through the surgery with all those involved, including the anesthesiologist and nurses in the operating room. There was very little blood loss and when the surgeons explained the typical recovery process for this kind of procedure I was shocked. The idea that such a potentially invasive surgery, operating on one’s heart, could be reduced to a few hours and have fairly minimal scarring and recovery process is amazing. While there is certainly room for further research in the area, it is reassuring that technology has the potential to play such an important and impactful role in medicine today.
Reviewed by: Jerry Liu
Graphic by: Radhika Subramani
References
Chopra, H., Baig, A. A., Cavalu, S., Singh, I., & Emran, T. B. (2022). Robotics in surgery: Current trends. Annals of medicine and surgery (2012), 81, 104375. https://doi.org/10.1016/j.amsu.2022.104375
Mayo Foundation for Medical Education and Research. (2022, May 6). Robotic surgery. Mayo Clinic. https://www.mayoclinic.org/tests-procedures/robotic-surgery/about/pac-20394974
Pai, S. N., Jeyaraman, M., Jeyaraman, N., Nallakumarasamy, A., & Yadav, S. (2023). In the Hands of a Robot, From the Operating Room to the Courtroom: The Medicolegal Considerations of Robotic Surgery. Cureus, 15(8), e43634. https://doi.org/10.7759/cureus.43634
Robotic surgery: Risks vs. rewards. Patient Safety Network. (n.d.). https://psnet.ahrq.gov/web-mm/robotic-surgery-risks-vs-rewards
UC Davis Health, P. A. and M. (n.d.). About robotic surgery at UC Davis Health. Robotic-Assisted Surgery | Surgical Services | UC Davis Health. https://health.ucdavis.edu/surgicalservices/roboticsurgery/#:~:text=The%20key%20differences%20of%20using,avoid%20surrounding%20nerves%20and%20organs.