Computer-based technology has infiltrated the healthcare system in recent years. One of the medical products emerging from the recent advancements in computer-based technology is robot-assisted surgery, which is the latest evolution of minimally invasive surgical operations that aims to provide smaller incisions, shorter recovery time, and less discomfort for patients as opposed to open surgery, the traditional option involving large incisions. Surgical robotics are able to reach into areas typically inaccessible by normal specialists without making a large incision. For surgeons, robot-assisted surgeries not only allow them to perform surgeries with more precision and flexibility, but also help to reduce their physical stress and fatigue. In the case of surgery performed through the da Vinci surgical system, the first FDA approved surgical robot, the surgeon sits comfortably behind a three-dimensional magnification screen and controls the miniaturized robot arms to make tiny incisions, providing better precision and dexterity.
However, there are still concerns about the widespread use of surgical robotics because of the high cost of the equipment and its maintenance as they have not yet shown significant monetary and patient benefits. The da Vinci Si Surgical system, which was launched in 2009, costs up to $3 million CAD for the initial purchase, training, and maintenance. Most robotic surgeries cost approximately $5000 CAD more than the traditional laparoscopic, minimally invasive surgeries. Although a benefit of using surgical robotics is potentially saving more on hospitalization costs because of reduced hospitalization periods, the high cost of operations may constrain its widespread use.
Whether surgical robotics allows for better surgical outcomes and shorter recovery time is still under much debate. A systematic review published in the Annals of Internal Medicine in August 2021 showed that there is little difference between robotic and conventional surgical outcomes. For example, of the 39 studies that reported incidence of complications, only 10% of studies showed fewer complications with robot-assisted surgery. The majority of studies showed no difference in terms of long-term outcomes, intraoperative complications, and conversion rate to open surgery upon failure of robot-assisted or laparoscopic surgeries, requiring a switch to open surgery. This review also concluded that robot-assisted surgeries had longer operative times than laparoscopy.
Although robot-assisted surgery has not yet shown clear clinical advantage, technological advancements, aging populations, and the increasing prevalence of chronic disorders are driving the market growth of surgical robotics. According to Research and Markets, the global surgical robotics market is anticipated to witness tremendous growth during the next decade and reach $16.77 billion in terms of value by 2031. Moreover, the development of fully automatic robots capable of performing end-to-end surgical procedures without any human intervention is underway. In 2016, the Smart Tissue Autonomous Robot performed intestinal anastomosis on a pig patient successfully.
It is expected that more and more surgical robots will aid in surgeries in the operating room. So, will surgeons be replaced by these robots in the future? It is likely that the fully automatic robots will take over the intricate technical surgical procedures on the operating tables in the long term, but fully automatic robotic surgery is still far from being put into general use. Moreover, the patients may not be comfortable putting their lives in the hands of a robot – technology may evolve rapidly and play an increasing role in the medical world, but it can never truly replace the trust and compassion that are built through the unique patient-surgeon relationship.
- Ho C, Tsakonas E, Tran K, Cimon K, Severn M, Mierzwinski-Urban M, Corcos J, Pautler S.Robot-Assisted Surgery Compared with Open Surgery and Laparoscopic Surgery: Clinical Effectiveness and Economic Analyses[Internet]. Ottawa: Canadian Agency for Drugs and Technologies in Health; 2011 (Technology report no. 137). ). [cited 2011-09-20]. Available from:http://www.cadth.ca/en/products/health-technology-assessment/publication/2682
- The Evidence Behind Robot-Assisted Abdominopelvic Surgery. Annals of Internal Medicine 2021,174(8), 1110-1117.