ROBOTIC SURGERY

                 (Surgical room)

The first recorded robot assisted surgical procedure was in 1985 when the PUMA 560 robotic surgical arm was used in a  delicate neurosurgical biopsy, a non-laparoscopic surgery. Then in 1988 PROBOT was used to perform transurethral prostate surgery. In 1992 an image guided system named Robodic Surgical System was developed for the use in prosthetic hip replacement. This was the only robotic system cleared by the Food and Drug Administration (FDA) for the use in orthopaedic surgery. In 1996 the AESOP 2000, replaced the pedals with a voice control system, allowing the surgeon to have control of the endoscope. By using its voice, the system eliminated the necessity of an assistant to hold the endoscope. The platform evolved to AESOP 3000 increasing the degree of freedom, and had its final platform with the AESOP HR (HERMES Ready) having integrated voice control and functions such as operation room lighting and movement of the operation table. This system was designed to improve image stability and reduce the medical personnel required in the operation room. As a result, Computer Motion, in 1998 presented the Zeus system with arms and surgical instruments controlled by the surgeon, introducing the actual concept of telepresence, in which the surgeon (master) commands the slave (robot). The surgeon console consisted of a video monitor and two handles which are able to manipulate the instruments, providing an enhanced interface and 2-dimensional display. The ZEUS robotic platform was used  for the first time in 1998 at the Cleveland Clinic for uterine tube anastomosis surgery.  Later, an open-heart grafting of the coronary artery was performed in Canada, in 2001.

Since then many developments took place in this field. Then came the most advanced surgical system, the Da Vinci Xi platform in 2014 with advanced instrumentation, vision, cart design, as well as table motion and set up automation. The future of the robotic technology is mostly based on improvement of hardwares and softwares. Robotic assisted surgery is currently used in  all surgical disciplines. Technology seeking smaller size of instruments and carts, easier and faster docking, automatic instrument exchanges, tissue-feedback technology, integration with radiological images and artificial intelligence are in perspective. For the past 20 years , the dominant used robot in robotic-assisted surgery has been Da Vinci. As on 2020, there are 5,700 Da Vinci units worldwide. The US, South Korea and China are on the forerun in manufacturing robotic systems.

6,44,000 robotic assisted surgical procedures performed in US in 2017. During the past 14 years, over 1.75 million robotic procedures were performed in the US across various surgical specialties. According to the published data the success rate of robotic surgery ranges between 94% and 100%. According to some published cost analysis the cost of robotic surgery in US in 2017 was $3,568 ($1,866 for instruments and accessories, $1,038 for robotic systems and $663 for the service contract) The global robotic surgery devices market is expected to reach $7.71 billion by 2023.

The first surgical robot was installed in India was in Escorts Heart Institute, by Dr Naresh Trehan in 2001. India's robotic surgery market in 2017 was INR 7.01 billion which is expected to reach INR 26.02 billion in 2024.

K V George