Surgical robotics has made significant strides in changing patient care. The birth of robotic surgery took place at a time where there was an increasing demand for greater surgical precision and safer operations, and in an era where surgeons were increasingly adopting minimal invasive surgical (MIS) technologies to enhance their outcomes. The clinical introduction of the Puma 560 in 1985 led to the first surgical robot being applied to perform selective brain biopsies. It was designed to outperform hand biopsies in terms of accuracy and surgical precision. W

Surgical robotics has made significant strides in changing patient care. The birth of robotic surgery took place at a time where there was an increasing demand for greater surgical precision and safer operations, and in an era where surgeons were increasingly adopting minimal invasive surgical (MIS) technologies to enhance their outcomes. The clinical introduction of the Puma 560 in 1985 led to the first surgical robot being applied to perform selective brain biopsies. It was designed to outperform hand biopsies in terms of accuracy and surgical precision. Work with this robot and several others suggested that a digitally programmed tool linked to a surgical cutting device could offer higher levels of operative accuracy when compared with conventional surgical methods. This in-turn led to a paradigm shift in surgical thinking, whereby surgical robots could potentially offer more than “an equivalent-to-open operation with smaller incisions”, to one where an operation with a robot would allow a higher level of tissue discrimination, dissection and repair. Over 30 yr since their introduction, surgical robots occupy an influential role in today’s surgical ecology. Their increasing application is derived from the technical benefits of modern robotic platforms, but also from the conceptual science-fiction effect of robotics on modern society where robots represent the pre-eminence of cutting-edge technology. Technical advantages for the surgeon include: the potential for better visualisation (higher magnification) with stereoscopic.

However, there are still many areas where adoption of robotics is limited due to limited patient outcomes justifying the increased surgical difficulty, cost and risk due to the MIS (Minimally Invasive and Robot-Assisted Surgery) approach compared to open surgery. Furthermore, minimally invasive systems still heavily rely on using rigid instruments with dexterous distal wrists, which have been noted for their limitations when considering new surgical paradigms for accessing internal anatomy without skin incisions (e.g. natural orifice surgery) or by using a single incision. The continued demand to allow deep access into the anatomy has motivated researchers in the past decade to explore three key areas: dexterous snake-like robots for surgery, magnetically actuated devices and micro robots. This paper provides an overview of progress made in these areas while first addressing the key technical challenges presented by the newly emerging surgical paradigms of natural orifice surgery and single port access surgery.

The benefits of these minimally invasive approaches (such as laparoscopy and thoracoscopy) included:

1. reduced wound access trauma,
2. shorter hospital stay,
3. improved visualisation,
4. less postoperative wound complications (ranging from wound infections to incisional hernias),
5. Less disfigurement. As such they were designed to offer an equivalence to open surgery with less tissue trauma and speedier discharge that in turn was anticipated to offer
6. Increased cost-efficacy.

Advantages and disadvantages of humans and surgical robotic systems

• Human

Advantages

• Good judgement
• Adaptable and able to improvise
• Able to use qualitative information
• Easy to train
• Easy communication with humans

Disadvantages

• Limited mechanical precision
• Prone to fatigue, tremor, inattention
• Cannot work in hazardous environments
• Limited quantitative abilities
• Robot

Advantages

• Good mechanical precision
• Untiring and stable
• Can work in hazardous environments
• Multimodal sensory integration

Disadvantages

• No judgement
• No qualitative abilities
• Limited in haptic sensation
• Expensive

The healthcare industry has witnessed paradigm shift from open surgeries to minimally invasive surgeries (MIS). Minimal invasive surgeries are witnessing high demand across all disease areas due to the advantages offered such as smaller incisions, minimum blood loss, shorter hospitalization period, quick recovery, minimal post-operative side-effects and reduced costs. Surgical robots are widely used in minimally invasive surgeries that enable surgeons to perform procedures with higher precision, flexibility, and control. The da Vinci surgical system was one of the first robotic-assisted, minimally invasive surgical systems cleared by the U.S. FDA. Currently, a wide range of da Vinci systems and technologies are used by surgeons across the globe.

Moreover, rapid rise in chronic disorders including cancer, cardiovascular diseases, spine disorders across the globe are expected to drive the demand for robot-assisted surgeries in the future. One of the core advantages of robotic surgery has been its “promise” to offer a shorter learning curve when compared with MIS platforms as a result of its “intuitive” technical adoption. This has been demonstrated in some studies, though there is no large scale randomized evidence to support this finding at this time. Limitations for this evidence suggest that in the current era, most practising surgeons almost universally become familiarized with MIS techniques before they go on to practice robotic surgery, so that a true comparison of their learning curves could be biased in this setting.

Challenges for Surgical Robot

Though current robotic systems are able to address the manipulation requirements for a very large set of surgical applications, the adoption of robot-assisted MIS over open surgery or manual laparoscopic surgery has not gained wide acceptance across all surgical disciplines. Beyond the socioeconomic reasons and difficulties in carrying out cost-benefit analysis in light of post-operative outcomes, there are key technical hurdles that explain this low rate of adoption. Minimally invasive surgery can be categorized into MIS in shallow and large spaces and MIS in deep surgical fields and confined spaces. With the exception of achieving basic capabilities of manipulation in confined spaces, current systems are subject to many design constraints leading to difficulties in modelling, sensing and control.

The challenges of limited visualization and the sensory deficiency associated with use of current robotic systems can impact the surgeon’s ability to carry out surgical tasks as easily as in open surgery. These challenges present situational awareness barriers that limit the surgeon’s ability to interpret the surgical scene, to associate the scene with preoperative imaging information and to safely complete surgical interventions.

Conclusion

As techniques in automation improve in the field of robotics, so will robot for surgery. While Robot systems demonstrate supervised execution of surgical plans in practice, perfecting and implementing the more complex and involved tasks shown involved in medical field. In addition, we must exercise caution that the objective is not to remove the human from the surgical team but to enhance the efficacy of a surgery, and generate new surgical approaches. Surgical robotics has made significant strides in changing patient care. However, there are still many areas where adoption of robotics is limited due to limited patient outcomes justifying the increased surgical difficulty, cost and risk due to the MIS approach compared to open surgery.