Robot-assisted surgeries have come a long way since 1985, when for the first time, a robot was used to perform a brain biopsy with CT guidance. Today, robotic surgery is being used to perform complex surgeries which we have covered in earlier blogs. In this article, we will stay focused on its use in Orthopaedics and Trauma specifically.
Robot-assisted surgery has come a long way since 1985 when such a surgery was first attempted. In the last 2 decades, there have been significant advances and technological innovations in this field. Although the terms robotic and robot-assisted are used interchangeably, there is a slight difference between the two. While Robot-assisted surgeries refers to a master-slave configuration where the main surgeon sits on a computer console and operates the robot, Robotic surgery is more autonomous, which means, the robot can complete simple tasks such as suturing, on its own, without a doctor having to control its movements. For the purpose of this article, we are treating the two as one and the same.
The popularity and adoption of Robotic surgeries has led to many players entering the fray. Increased competition results in increased innovation and differentiation which is good for the industry. Some of the players and their flagship robots are:
So, what are the benefits of Robotic Surgery? Why are they becoming the default practice in some surgeries?
In the near future, both Robotic or Robot-assisted surgeries could become the default option for simple and routine procedures.
Compared to a few decades ago, the proportion of people with skeletomuscular conditions has increased in the recent past. This trend is only expected to continue. Sedentary lifestyle, substance abuse, obesity in childhood or adolescence, and higher life expectancy leading to an ageing population, are all reasons for this increase. While physiotherapy and medication can resolve some of the issues, more serious ones will require surgical intervention.
These surgeries used to be open-incisional or laparoscopic, attended to by an all-human team of surgeons in the past. In recent years, robot-assisted surgeries are increasingly being attempted, and are even successful, which has made them popular with surgeons and patients alike. We shall cover the more common ones below.
The inside of the knee-joint is a continuous region but it is divided into three compartments to simplify diagnosis and treatment:
Knee Osteo-arthritis (KOA), also called degenerative joint disease of the knee, is a condition in which there is wear and tear of the knee joint and progressive loss of cartilage at the joint. This is common in the elderly, and can cause severe impairment of their movement, affecting their lifestyle.
UKA is a procedure in which, bone and cartilage in one of the 3 compartments of the knee joint that is worst affected by KOA is resurfaced with plastic and metal plates. That is, metal or plastic plates are implanted on the affected bone and cartilage portions. This used to be an open-incisional surgery in the past, and more recently a laparoscopic procedure. In recent years, robotic surgery has emerged as a better alternative. There is better alignment of the implanted components, as a result, better movement, lower post-procedural morbidity and faster functional recovery, of the resurfaced tissues.
The procedure is also called Partial Knee Replacement.
TKA is done for patients with end-stage Osteoarthritis, to improve the quality of life, reduce pain, improve functionality and help the person resume sports or physical activity. Compared to UKA where only one compartment is affected, here all 3 compartments are affected. So, a TKA involves resurfacing the femoral condyles and tibial plateau of the knee joint with metal or polyethylene components.
While this used to be an open-incisional or laparoscopic procedure in the past, in recent years, robotic TKA has become more popular. Compared to traditional TKA, patients who have had robotic TKA showed fewer alignment issues in the leg, post-surgery.
Osteoarthritis can affect the hip joint causing severe pain in the hips and lower back, along with impaired mobility. When medication and physiotherapy do not help, a THA is undertaken where-in diseased parts of the hip joint are replaced by metal and/or polyethylene components (implants). The procedure is also called Hip Replacement Surgery. Traditional THAs come with a small risk of dislocation of the implanted components. Robotic THA is better in this respect, as several studies have shown 0% or negligible instances of component dislocation.
While THA is inevitable in people with severe damage to the hip joint, people with moderate damage to the hip-joint, have another option – called Hip Arthroscopy. When the patient is not responding to medication or alternate therapies, then a Hip Arthroscopy is done.
Arthroscopy is basically Laparoscopy for the hip joint, where the scope is modified or engineered specifically for orthopaedic procedures, and is called an Arthroscope.
The surgeon makes small incisions on the skin at the hip joint and inserts one or more scopes that carry camera-light-lens combination and surgical instruments at the tips. The camera relays images onto a computer screen which guides the surgeon’s movements. Using the surgical attachments, he/she can carry on whatever repair is required at the hip joint.
In recent years, the same procedure is being undertaken robotically for better results. The traditional surgery is technically demanding and comes with the risk of tremor and fatigue for the surgeon. The robotic procedure does not have these drawbacks.
Spinal metastases are tumours that affect the spine. They grow on the bone and result in damage to the spinal canal as well as compression of the spinal cord. Open-incisional and minimally invasive surgical procedures are undertaken to decompress the spinal column. This helps relieve pain, prevent neurological damage and stabilize the spinal column. One of the steps in the procedure involves the use of pedicle screws. The same can be done robotically today, with better accuracy, more effectively and safely. This reduces the need for a revision surgery which happens when the screws are placed using free-hand techniques in traditional surgery.
The shoulder can suffer damage due to trauma from accidents (like falling from heights, or vehicle collisions) or osteoarthritis. While open-surgery is inevitable when there is major damage, most of the time, the minimally-invasive arthroscopy is good enough. It can be used to repair torn ligaments, repair a damaged cartilage-ring (also called labrum) or repair a torn biceps tendon. It can also be used to correct shoulder instability, where-in, the shoulder joint becomes loose and slides around, or becomes dislocated in which case, it slips out of the ball-and-socket joint. All such corrections are now being undertaken robotically using the da Vinci surgical system.
There are various surgeries undertaken to correct deformities in the ankle and feet and this includes:
While these surgeries used to be open-incisional or arthroscopic till recently, now, today, they are partially robot-assisted. That is, where some of the steps in the procedure involve accurate or precise manoeuvres, a robot is used in order to improve efficiency and outcomes.
A Telerobotic surgical assistant called Trauma Pod has been developed and is being used to treat soldiers critically injured in the battlefield. The robot can accompany nurses and junior doctors to the operating room where the soldier is being treated. The robot has multiple arms that can track or count supplies, change tools and supply tools or consumables required in the procedure. It has also been used in surgeries to repair fractures due to trauma, for intramedullary nailing in brain surgeries post-trauma and to treat injuries to the brachial plexus.
The robot supports teleoperations where-in, a surgeon sitting in a remote location can manipulate the robot through an internet connection. Such teleoperations have been done to treat bowel anastomosis and for shunt placement (creating a bypass connection) for blocked blood-vessels.
Kauvery Hospital is globally known for its multidisciplinary services at all its Centers of Excellence, and for its comprehensive, Avant-Grade technology, especially in diagnostics and remedial care in heart diseases, transplantation, vascular and neurosciences medicine. Located in the heart of Trichy (Tennur, Royal Road and Alexandria Road (Cantonment), Chennai (Alwarpet & Vadapalani), Hosur, Salem, Tirunelveli and Bengaluru, the hospital also renders adult and pediatric trauma care.
Chennai Alwarpet – 044 4000 6000 • Chennai Vadapalani – 044 4000 6000 • Trichy – Cantonment – 0431 4077777 • Trichy – Heartcity – 0431 4003500 • Trichy – Tennur – 0431 4022555 • Hosur – 04344 272727 • Salem – 0427 2677777 • Tirunelveli – 0462 4006000 • Bengaluru – 080 6801 6801
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