Robotic cardiothoracic surgery

India Premjithlal Bhaskaran, Medical Student, SCTS School Student Ambassador

Robotic surgery is a type of minimally invasive surgery in which the surgeon is assisted by a computer-controlled robot during the procedure. The surgeon’s skill is enhanced by the robot, which allows them to operate complex surgical tasks in small spaces inside your body that would otherwise need open surgery.

The surgeon directs the robot’s actions and the robot’s precision is superior than that of a human hand working alone. The surgeon manipulates the instruments using master controls during a robotic surgical system-assisted procedure, allowing for precise and delicate motions and the instruments translate surgeon’s movements into real-time accurate movements within your body. It only reacts to the exact hand and finger motions of the surgeon. It includes a greater selection of specialty equipment, including 8 and 5mm tools, and is lighter and easier to manoeuvre. Longer robotic arms enable surgery on larger patients, allowing surgery to be performed at a greater range of procedures.

While operating, MRI and CT scans can be given to the surgeon and increased high-definition vision can benefit the surgeon because it essentially doubles the resolution. The robotic tool outperforms the human hand in terms of dexterity and range of motion. The robotic arms have a full 360-degree rotational range. This enables your surgeon to do procedures that would be impossible to perform without the robot. It has been suggested that robotic-assisted surgery is more ergonomic with less surgical fatigue because the surgeon is situated in a comfortable posture away from the patient. At the same time, two surgeons can operate.

While each surgery is different, the general steps to a robotic-assisted surgery are making one to two centimetrelong incisions into the body, inserting miniature robotic instruments and a powerful 3D camera into the body and the surgeon then sits at a nearby console (a large computer) to direct the procedure in hard to reach spaces by watching the area of the operation which can be seen at a more highly magnified level, with excellent resolution. The surgeon’s hand, wrist, and finger movements are transferred to the tools attached to the robot’s arms via the computer interface. The replicated movements have the same range of motion as the surgeon, providing the most precise control possible.

There are numerous advantages of having a robotic assisted surgery, including a shorter recovery time and hospital stay, less blood loss, fewer blood transfusions, improved pain management, smaller incisions with minimal scarring, lower infection risk and a faster return back to normal life.

Robotic cardiac surgery offers lower risks than open-heart surgery, which is one of its key advantages. To open the chest, the surgeon does not need to cut through the sternum in robotic surgery. Many of the risks associated with openheart surgery are eliminated. As with any type of surgery, robotic cardiac surgery necessitates general anaesthesia with intubation. On the side of the chest, a surgeon will make a series of keyhole-sized incisions to facilitate the insertion of robotic arms. Depending on the treatment, you may need to be placed on a heart-lung machine. In some circumstances, due to the complications and complexity of the case, the surgeon may not be able to complete the surgery using the robot and open-heart surgery will be needed. Other dangers may exist, depending on medical conditions.

The popularity in thoracic procedures is also increasing with satisfactory outcomes. Complex thoracoscopic treatments such as thymus surgeries, resection of anterior mediastinal tumours and lobectomies are performed with robotic surgery, which has been demonstrated to be safe and successful. For several thoracic surgical diseases, robotic aid considerably simplifies the thoracoscopic approach.

In terms of mortality and significant adverse events, robotic surgery is comparable to traditional surgery. The expensive initial capital investment and continuing maintenance requirements are now impeding its widespread deployment. It has been chastised for its high costs with an average cost per patient. What is concerning is the procedure’s costeffectiveness, particularly in terms of patient outcomes. The steep learning curve involved with operating robots is another important restriction, as a skilled operator requires more than 200 procedures to become proficient. However, proponents say that the expenditures can be offset by a shorter stay in intensive care and a shorter hospital stay. Suggesting that the total cost of running a hospital has not increased considerably as a result of robotic technology.

In the realm of advanced surgery, safety and quality are the top priorities. It’s vital to remember that enthusiasm for incorporating the surgical robot into cardiothoracic surgical practice should be followed up by suitable training, cautious patient selection, and the construction of a team-based robotic programme. There are multiple centres in United Kingdom with simulation and educational tools to complement our training and we teach surgeons to be the best and most skilled in their field. n