Human-robot team: a robot assisted surgery

The robot is called the da Vinci Si Robot and it’s based in Theatre 14 at the Hallamshire Hospital. We use it for keyhole operations, essentially, so minimally invasive surgery. And it’s specifically used to remove organs, or part of an organ, such as a prostate, or part of somebody’s kidney or a person’s bladder, for cancer reasons.

Today we’re going to be doing an operation called a robot-assisted radical prostatectomy, which is removing a man’s prostate for prostate cancer. And it was the index operation that the robot was, essentially, designed for. This was the operation that the company had in mind when they designed the technology, though it’s now used by many specialties and it does lots of operations. So, initially, you have to still prep the patient and do the laparoscopic part to put the ports into the abdomen. And then you attach the robot to those ports, because there are special ports that come with the robot. So the machine is actually attached to the patient, and that’s all done sterile.

But once the robot’s attached and the instruments are inside the patient, then I un-scrub, and I go and sit down at a console, which is where you control the instruments and the camera from. So, it’s away from the patient’s side, but still in the operating theatre. You get all the benefits of laparoscopy, or keyhole surgery, in terms of pain, return to normal activities, discharge from hospital. But with the robot, you get added advantages for the patient and for the surgeon. For the patient, you get, essentially - the blood loss is lower. The complication rate is lower. The length of stay in hospital has been drastically reduced. The functional outcomes are much better with the robot compared to laparoscopy.

So, there’s definite benefits. But you also get benefits for the surgeons. It’s a 3D HD magnified view - so the view is much better. It allows much more precise surgery. The instruments, themselves, are articulated at the ends 360 degrees. So it’s just like the human wrist, it’s different to laparoscopic instruments, that’s why it’s easier to do things like suturing and precise dissection. There have been studies showing that surgeons get fatigue or musculoskeletal problems as their career advances. So, I think, for the surgeon, there is definitely a benefit in career longevity. It is a machine, so there are some technical problems occasionally. But on the whole, it’s an exceptionally reliable machine. You tend to get that many problems.

One of the main problems is you don’t get any tactile feedback. So, in open surgery, you’re able to feel the amount of pressure you’re applying to tissues and things. You don’t get that with robotic surgery. That is something they’re trying to develop, but that is one on the main downsides, you don’t get any tactile feedback. You are heavily reliant on having somebody at the bedside of the patient who’s actually scrubbed and assisting you, because you still need to be passed needles, instruments need to be changed. So you do need someone who’s trained and able to help you. That can be a challenge if that person’s inexperienced.

It became quite evident in my training that robotic surgery was going to be the future of surgery. It’s gone from strength to strength, and it will continue to improve as the years go by. And I think open surgery - it won’t become obsolete - but I think it will be done less and less. I think things are developing all the time. As you can see, the robot’s actually quite large. The newest development from Intuitive Surgical is that they’re trying to design a robot that you actually put inside the abdomen of the patient, so there will only be one tiny incision. The robot’s inside the abdomen and does the operation inside.

It’ll still be controlled in a similar way, but I think as the years go by, I think we’re probably ten years away from that. There will always be the possibility of operations being done without humans, but I think we’re many years away from that, to be honest.