Dr. Rupashree Dasgupta is a Senior Consultant Robotic and Laparoscopic Gynaecologist and Gynae Onco Surgeon at Apollo Multispecialty Hospitals, Kolkata.
Background
Robotic surgery represents a remarkable convergence of technology and medicine, and much of its groundbreaking development can be traced back to the innovative efforts of the National Aeronautics and Space Administration (NASA). Initially conceived in the 1970s, the integration of robotic systems into surgical practices began as a military initiative, sanctioned by NASA and financed by the Defense Advanced Research Projects Agency (DARPA). The primary aim was to create a system that could operate in the absence of a surgeon, ensuring that astronauts in space and soldiers in combat zones received critical medical care even when direct human intervention was not possible.
Canada witnessed the dawn of robotic surgery in 1983 when an orthopaedic surgeon and a dedicated team executed the first successful robotic-assisted surgical procedure. However, the roots of this technology stretch even further back to 1958, when Dr. John Kwoh and his team were part of an important milestone in the development of robotic surgery when they utilised a robotic arm to perform a brain biopsy, guided by computed tomography (CT). This pioneering effort laid the groundwork for subsequent advancements in robotic surgical technology.
This was an early example of robotics in medicine, laying the foundation for further innovations in the field. Using a robotic arm for medical procedures was a pioneering effort at that time, long before the more well-known milestones in robotic surgery such as the first successful robotic-assisted surgery in 1983.
This early work by Dr. Kwoh and his team is an important part of the history of medical robotics. It helped pave the way for modern advancements in surgical technology, including precision in surgeries, minimally invasive procedures, and the development of robotic systems used widely in surgery today.
Dr. John Kwoh is recognised for his pioneering work in several notable robotic systems that emerged as the field evolved, each contributing unique capabilities to surgical practice. PROBOT marked a significant milestone as the first surgical robot designed specifically for prostate operations. Following closely was ROBODOC, which facilitated hip replacement surgeries with unparalleled precision. The ZEUS Robotic Surgical System (ZRSS) further enhanced the landscape of robotic surgery, paving the way for the widely recognised
Da Vinci Surgical System, which has since revolutionised many surgical procedures with its advanced dexterity and control.
The robots currently used in surgical procedures are configured in a master-slave arrangement, where the surgeon acts as the master, skillfully controlling robotic arms—the slaves—that are engineered with multiple degrees of freedom. A pivotal moment
in this technological journey occurred when the ZRSS successfully conducted the first robotic gynaecological surgery in Cleveland, Ohio, focusing on reconnecting fallopian tubes. This marked a significant step in robotic-assisted surgeries, which advanced further in 2009 with the introduction of the Da Vinci Surgical System in Israel.
In recent years, the adoption of robotic-assisted keyhole surgery in gynaecology has flourished, driven by remarkable technical advancements. Among these innovations, 3D visualisation stands out, offering enhanced depth perception, which is vital for distinguishing delicate anatomical structures. The technology also minimises hand tremors, providing surgeons unparalleled level of precision and the ability to delicately single out tissues. These enhancements contribute not only to a shorter learning curve for surgeons, making it easier for them to adapt to new methods, but also significantly boost their comfort during procedures compared to traditional keyhole and open abdominal surgeries.
When comparing robotic-assisted keyhole surgery to conventional approaches, the advantages are clear: surgical performance improves without extending operating time. This modern technique also results in minimal blood loss and reduces the incidence of intra or post-operative complications, all while decreasing the likelihood of necessary conversions to more invasive abdominal surgeries. Additionally, surgeons using robotic assistance report experiencing fewer musculoskeletal issues both in the short and long term, showcasing an important ergonomic benefit. Thus, surgeons equipped with robotic technology are more capable and achieve superior surgical outcomes for their patients.
Applications in Gynaecology and Gynaecologic Oncology
Robotic-assisted surgeries can be used for almost any procedure that is done with traditional methods like open surgery or laparoscopic surgery. This flexibility leads to better results for patients and makes surgery easier for doctors, showing how robotics is changing the field of gynaecology and gynaecologic cancer treatment.
Highlights
Surgeon-Controlled Robotic Arms (Master-Slave System) – In the innovative realm of robotic surgery, the surgeon acts as the master, skillfully manipulating specialised controls that translate their precise hand movements into electrical signals. These signals guide the robotic instruments with remarkable accuracy, allowing for intricate surgical procedures.
3D High-Definition Vision – Surgeons benefit from an enhanced three-dimensional view through a mere 8mm incision, providing incredible depth perception and allowing them to visualise anatomical structures with unparalleled clarity.
Endowrist Instrumentation – The robotic systems feature advanced Endowrist instruments that mimic the range of motion and dexterity of the human wrist, enabling surgeons to perform delicate manoeuvres that would otherwise be challenging or impossible.
Intuitive Motion and Surgical Dexterity – With intuitive motion capabilities, surgeons can operate seamlessly, maintaining full control while benefiting from motion scaling that filters out unintended tremors, ensuring a steady hand during complex procedures.
Reliable Replication of Surgical Standards – This cutting-edge technology guarantees consistent delivery of high-standard surgical outcomes, ensuring that patients receive the best care possible every time.
Advantages for Surgeons
Immersive Viewing – Surgeons can utilise a high-definition, three-dimensional view through 8mm incisions, giving them a comprehensive view of the surgical field.
Depth Perception and Magnification – With 10x magnification, intricate details are easily discernible, facilitating precision.
Camera Control – The surgeon retains command over the camera, allowing for dynamic adjustments during the procedure.
Enhanced Access – The system overcomes the natural limitations of human wrist movement, enabling access to previously unreachable areas easily.
Confined Spaces – Surgeons can operate effectively within limited spaces, expanding their capabilities.
Minimised Disease Transmission Risk – The robotic system reduces the likelihood of infection, providing a safer environment for surgeons and patients.
Advantages for Patients
Minimally Invasive Approach – The use of an 8mm incision results in reduced pain and discomfort.
Less Trauma – Patients experience diminished physical trauma compared to traditional surgery.
Reduced Blood Loss – The precise movements and techniques involved lead to less bleeding during and after the procedure.
Accelerated Recovery – Patients benefit from faster healing times, enabling them to return to their daily activities sooner.
Shortened Hospital Stay – With less invasive procedures, patients typically enjoy a decreased duration of hospitalisation.
Lower Medication Requirements – The reduction in pain and trauma translates to a decreased need for post-operative medications.
Applications in Gynaecology and Gynaecologic Oncology
Robotic Endometriosis Resection – This procedure involves the meticulous removal of abnormal cysts (chocolate cysts) and growths from the pelvic region while preserving the uterus and surrounding organs.
Robotic-Assisted Hysterectomy – Ideal for complex cases, such as those involving obese patients or individuals with a history of multiple surgeries, this technique simplifies the removal of the uterus.
Robotic Myomectomy – This procedure focuses on the removal of uterine fibroids while leaving the uterus intact, promoting future reproductive options.
Robotic Sacrocolpopexy – This procedure addresses uterine prolapse, using innovative techniques to restore anatomical support.
Robotic Interventions in Gynaecological Cancers – The platform enables effective treatment of endometrial and cervical cancers through small incisions, minimising the need for larger abdominal cuts.
Conclusion
Using computer technology in the operating room is a major step forward in surgery. By adding robotic systems, we can reduce or even eliminate the need for traditional open and laparoscopic surgeries, along with their limitations. This progress helps improve precision, safety, and overall results in surgical care.
