Robot-assisted surgery was developed to overcome limitations of minimally invasive surgery. Instead of directly moving the instruments the surgeon uses a computer console to manipulate the instruments attached to multiple robot arms. The computer translates the surgeon’s movements, which are then carried out on the patient by the robot. The console is located in the same operating room as the patient, but physically separated from the operative workspace, or in another place. Since the surgeon does not need to be in the immediate location of the patient while the operation is being performed, it can be possible for specialists to perform remote surgery on patients.
The da Vinci Surgical System comprises three components: a surgeon’s console, a patient-side robotic cart with 4 arms manipulated by the surgeon (one to control the camera and three to manipulate instruments), and a high-definition 3D vision system. Articulating surgical instruments are mounted on the robotic arms which are introduced into the body through cannulas. The device senses the surgeon’s hand movements and translates them electronically into scaled-down micro-movements to manipulate the tiny proprietary instruments. It also detects and filters out any tremors in the surgeon's hand movements, so that they are not duplicated robotically. The camera used in the system provides a true stereoscopic picture transmitted to a surgeon's console.
The da Vinci System is FDA cleared for a variety of surgical procedures including surgery for prostate cancer, hysterectomy and mitral valve repair, and more than 1,700 systems are used worldwide. The da Vinci System was used
in 280,000 procedures in 2010. The first generation of the da Vinci Surgical System, introduced in 1999, consists of an ergonomically designed surgeon's console, a patient-side cart with four interactive robotic arms, a high-performance vision system and proprietary EndoWrist instruments.
The second generation, da Vinci S, was released in 2002 and brings a more ergonomic design, slim telescopic arms, a larger range of motion for robotic arms, a higher image resolution, digital zoom, touch screen monitor with Telestration and TilePro function.
The third generation, da Vinci Si, was released in 2009. It has a more ergomonic console design, dual console capability, enhanced high definition 3D vision, updated user interface, extensability for digital OR integration.
The da Vinci system has proved his benefits in many surgical fields such as:
- cardiothoracic surgery: coronary bypass, mitral valve repair, pulmonary lobectomy for pulmonary cancer, thymectomy for myasthenia gravis
- gastrointestinal surgery: bariatric surgery (gastric bypass), colectomies for colon/ rectal cancer, gastrectomy for gastric cancer, hepatectomy, cholecystectomy for gallbladder disease, splenectomy, distal pancreatectomy, Whipple procedure for pancreatic conditions, Heller myotomy for achalasia, gastric fundoplication for gastroesophageal reflux, esophagectomy for esophageal cancer
- gynecology: myomectomy for uterine fibroids, treatment of endometriosis, reconnection of the fallopian tubes, sacrocolpopexy for uterine prolaps, hysterectomy for cervical or uterine cancer
- urology: partial / radical nephrectomy for kidney cancer, pieloplasty for urinary obstruction, cystectomy for bladder cancer, prostatectomy for prostate cancer
- other procedures: thyroidectomy for thyroid cancer, partial laringectomy for throat cancer
Major advantages of robotic surgery are precision, miniaturization, smaller incisions, decreased blood loss, less pain, and quicker healing time, reduced duration of hospital stays. Further advantages are articulation beyond normal manipulation and three-dimensional magnification, resulting in improved ergonomics.
The main advantage of this technique is that the incisions are very small and, consequently, patient recovery is quick. In traditional open-heart surgery, the surgeon makes a ten to twelve-inch incision, and then accesses the heart by splitting the sternum (breast bone) and spreading open the rib cage.
Compared with other minimally invasive surgery approaches, robot-assisted surgery gives the surgeon better control over the surgical instruments and a better view of the surgical site. In addition, surgeons no longer have to stand throughout the surgery and do not tire as quickly.