The advantages of robotic surgery versus conventional keyhole surgery

Robot Surgery

Dr. Matt Hewitt

Consultant Obstetrician and Gynaecologist

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The advantages of robotic surgery versus conventional keyhole surgery

There are many advantages of robotic surgery over conventional ‘straight stick’ keyhole surgery which are listed in detail below.

  • The surgeon sees a 3D view of the operating field.
  • The surgeon is able to control the stereo endoscope using the operating arms and foot pedal and is not reliant on an assistant.
  • The Stereo endoscope remains motionless, unless purposely moved by the surgeon. This enables increased magnification of the surgical field.
  • The disadvantage of the fulcrum effect of straight-stick surgery (hand moves left, instrument tip moves right) is lost in robotic surgery with the instruments mimicking exactly the movement of the surgeons hands.
  • Different sensitivity settings on the console enable the surgeon to choose the degree of movement of the instrument tips relative to hand movements depending on the type of surgery being undertaken.
  • The surgeon is seated with arms rested decreasing surgeon fatigue. Use of the ‘clutch pedal’ temporarily disengages the arm controls from the instrument tips enabling the surgeon to return his arms to a more comfortable position should they become hyper-extended or flexed during surgery.
  • The ‘da Vinci S’ system has 3 operating arms all of which are controlled by the surgeon who is able to switch between each instrument using the 'clutch' pedal. On disengaging one arm to use another the non-operating arm remains stationary but will still maintain tension on grasped tissue.
  • The ‘endowrist’ laparoscopic instruments used in the da Vinci system allow seven degrees of movement thereby mimicking the full range of the surgeon’s hand compared with 4 degrees of movement with straight-stick surgery..
  • The robot cart holds the surgical trocars so that the fulcrum point is directly on the abdominal wall and thus decreasing the movement on the abdominal wall which reduces local trauma.
  • The ‘endowrist’ instrument tips and stereo endoscope are disengaged from control if the surgeons head is removed from the console and remain stationary. This is advantageous in teaching scenarios where a trainer may wish to demonstrate or assist a trainee during a procedure. The newer version of the da Vinci sytem, the Si HD, has a dual console where the trainer can operate with the trainee simultaneously.
  • Changing operating instruments can be done at speed as the newly replaced instrument returns to exactly the same place as the removed instrument and does not need to be tracked into the pelvis with the endoscope.

In summary the surgical view, magnification, ease of manipulation of instruments and comfort and independence for the surgeon afford a better surgical experience that is of benefit to the patient and surgeon.

 

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