Ethique Info

Accueil > Médecine > Debate on the future of the usage of robots for minimally invasive (...)

Special English written article on new medical techniques : usage of robotics

Debate on the future of the usage of robots for minimally invasive surgery

Is a Revolution underway for Robotics-assisted Surgery ?

mardi 20 mai 2008, par Picospin

Robots are a fast-growing segment of the US medical device industry. The advantages of the new technical approach could consist of : 1. Precise tremor-free movement of the robot ; 2. Optimal method to spare nerves crucial to organ control ; 3. Robot’s ability to handle small miniaturized tools that may lead to : 4. Less invasive procedure and faster recovery for the patient. 5. Improved protection of surgeons from physical stress and prolonged exposure to X-rays.

Preliminary results

There are many articles, presentations, abstracts that support this view. In heart surgery, there are reports showing that for mitral insufficiency the technique should be able to avoid any valve replacement and to use instead valve repair using the Carpentier’s technique (Calvinho P, Antunes M, Coimbra, Portugal). The indication for using this technique was recently confirmed by the Department of Surgery, Division of Cardiothoracic surgery, University of Pennsylvania (Woo YJ, Nacke EA) who stress the beneficial results obtained using the robotic assisted minimally invasive surgery in 25 patients (pts) as compared to 39 pts who underwent sternotomy. Final conclusions demonstrated that pts who underwent mitral valve reconstruction with minimally invasive robotic assistance were able to avoid sternotomy, required less blood product transfusion and experienced shorter hospitalization. In abdominal procedures, similar good results could be obtained including small incisions or complete elimination of external incisions, improved visualization and manipulation thanks to a video feedback and task assistance from arbitrary orientations within the peritoneal cavity.

Results in heart, abdominal surgery

Other reports underlined the advantages using robotic techniques in hernia repairs, cholecystectomies, using a robotic arm, a harmonic scalpel, laparoscopic spine surgery, colon resection, gastric surgery. There were no errors in technical performance but shortening of the time required for performance of procedural tasks, improved versatility and concentration for the surgeon, and fatigue reduction. It is anticipated from the preliminary data that costs and risks will be reduced, safety and versatility will be increased. These improvements should be increased further by more sophisticated technology and better simultaneous education of the surgical team.
Despite the fact that there are still many companies that are reluctant to develop the technique because of a lack of sufficient evidence that robotics improves outcomes for patients at a cost hospital can absorb, some specialists in the field of surgery are conscious that robotic assisted procedures will be used extensively in the near future because of better practice of surgeons, remote usage of the devices, improved overall results due to optimization of results even by low skilled doctors, procedure shortening, quick recovery and less blood loss. The remote control would allow high gifted surgeons to operate from remote electronic consoles and monitor all required procedures and help doctors of varying ability perform at the level of the world’s top surgeons.

From the New York Times : Feder BJ, May 17, 2008