W

ith medical technology evolving at an extraordinary pace, surgical robots are making inroads into the operating room. Robotic-assisted minimally invasive surgery signifies a remarkable technological progress for a wide range of procedures traditionally requiring open surgery. By allowing surgeons to perform complex operations through small incisions, it diminishes the level of patient ordeal and helps considerably improve patient outcomes.

What is robotic surgery?

Robotic surgery is the use of very sophisticated robots in assisting surgeons to perform very intricate surgery. It was developed in the late 90s to overcome the limitations of the popular key-hole surgery. Traditional key-hole surgery is widely used for many surgical operations now; for instance, removal of the appendix, gallbladder and for colon cancer.

In key-hole surgery, a small fiber-optic camera is inserted near the umbilicus. Surgery is performed with the help of two or three small instruments inserted through small holes in the abdomen.

This key-hole surgery is very popular as patients experience less pain after surgery and faster recovery. However, there are some limitations of this key-hole surgery that makes it more difficult and less accurate in some types of surgical procedure. Robotic surgery has many unique and advanced features that overcome the problems of traditional key-hole surgery.

What are the special features of robotic surgery?

The surgeon is still in full control of the operation. Instead of using his hands or key-hole instruments, the surgeon uses several very small robotic hands to perform the surgery. These robot arms are very flexible and function almost like human hands.

Moreover, the robotic hand does not have any physiological tremor of the human hands. With the use of these very small, flexible and steady robotic hands, a surgeon can perform very delicate surgery with unparalleled precision. In addition, the robotic system offers a 3-dimensional (3D) vision for the surgeon that is not available in traditional key-hole surgery.

Together with the higher magnification and high definition visual effect of the robotic camera system, identification and preservation of the small but important nerves and blood vessels can be achieved with ease during complex surgery. With very good visualization and high accuracy, surgery can be performed with minimal complications using the robotic system.

What are the types of procedure suitable for robotic surgery?

The use of robotics has rapidly penetrated many procedures in surgery over the past 10 years. Robotic surgery has been used for heart bypass, prostate removal, stomach cancer, colorectal cancer, thyroid nodules, etc.

In prostate surgery, the use of robotics is now widely accepted and recognized as a standard of care. The Da Vinci Robotic system has been approved for use in gastrointestinal surgery by United States Food and Drug Administration (FDA) since 2000. Singapore is one of the first few countries in Asia to acquire a surgical robot in 2002. And since then, this robotic system has been successfully applied in many procedures.

In the year 2003 and 2004, Singapore was the leading center for robotic surgery and provided training for many surgeons in Asia who were keen to acquire the skill of robotic assisted surgery. The use of robotics in colorectal cancer surgery has been popular with surgeons only over the past few years with South Korea, Hong Kong and Singapore being the leading centers in Asia that offer this advanced surgical procedure.

What are the additional benefits of robotics in colorectal surgery?

Robotic surgery offers all the benefits of traditional key-hole colorectal surgery to patients, like faster recovery, shorter hospital stay, fewer complications, lesser wound infection and smaller scars.

In surgery of the rectum, especially for cancer of the lower rectum, the robotic system offers many advantages over the traditional key-hole surgery. As the rectum is located in the narrow pelvis and performing surgery in the tight confines of the pelvis can be quite challenging. With the greatly improved visualization, precision, control and dexterity provided by the robotic system in the narrow pelvis, injuries to the tiny nerves that control the bladder, bowel and sexual organs can be avoided.

As a result, the chances of incontinence and sexual dysfunction can be minimized after surgery for rectal cancer. In addition, the cancer tissue can be completely removed without breakage or spillage, thereby reducing the chance of the cancer recurring after surgery.

Robotic surgery has been for used for heart bypass, prostate removal, stomach cancer, colorectal cancer, thyroid nodules, etc.

Dr. Ng Kheng Hong is a colorectal and general surgeon who has a very keen interest in robotic-assisted surgery and champions the use of robotics in various surgical disciplines. www.khngsurgery.com.sg