Author: Dr. Jibu Eapen Mathew, Senior Consultant - General Surgery & Robotic Surgery

One of the remarkable systems created by integrating the latest technologies in modern medicine is the surgical robot. Among these, the Da Vinci Xi is one of the most advanced operating systems that has brought revolutionary changes to the field of Robotic Surgery in general surgery worldwide.

What is a Medical Robot? Does it Operate on Its Own?

One of the major concerns among many people is whether robots make their own decisions and perform surgeries independently. However, this is a completely incorrect perception. Medical robots do not make decisions or perform surgeries on their own.

It is a Master-Slave System. This means that the surgery is performed entirely by an experienced surgeon. The robot is simply a device that accurately carries out the instructions given by the surgeon. This makes Robotic Surgery a surgeon-controlled procedure rather than an autonomous operation.

How Does the Da Vinci Xi Work?

• Surgeon Console: The surgeon sits at the console in the operating theatre and views the surgical area through high-definition 3D images.
• Patient-Side Cart: The robotic arms attached to the patient's body.
• EndoWrist Instruments: These translate the movements of the surgeon's fingers into precise movements of the robotic instruments in real time.

Benefits of Robotic Surgery from a General Surgeon's Perspective

Compared to laparoscopic (keyhole) surgery, Robotic Surgery vs laparoscopic surgery offers several advantages in the field of general surgery. These Robotic Surgery benefits can be particularly valuable in complex procedures requiring enhanced precision and control.

Benefits for the Surgeon

• 3D High-Definition Magnified Vision: The surgical area can be viewed with exceptional clarity, magnified up to ten times.
• Greater Range of Motion: The EndoWrist technology allows movement in more directions than the human wrist, with 7 degrees of freedom.
• Tremor Filtration & Motion Scaling: Natural minor tremors in the surgeon's hands are filtered out, allowing movements to be made with extreme precision.
• Superior Ergonomics: Even complex surgeries lasting several hours can be performed comfortably while the surgeon is seated.
• In areas such as the pelvis and deep regions of the abdomen, precise dissection and suturing can be performed while minimizing damage to blood vessels and nerves.

Benefits for the Patient

• Very small incisions, resulting in less blood loss.
• Significantly less pain after surgery.
• Reduced chances of infection.
• Shorter hospital stay.
• Faster return to normal life and daily activities.

These advantages have contributed to the growing adoption of Robotic General Surgery and Robotic Surgery in India.

Major Robotic Surgeries in General Surgery

Today, Da Vinci Xi Robotic Surgery is widely used in general surgery for the following conditions:

Complex Hernia Surgeries

(Complex hernias of the abdominal wall)

In complex inguinal, ventral, or recurrent hernias, robotic hernia surgery provides excellent precision for suturing the abdominal wall muscles together (Abdominal Wall Reconstruction) and placing mesh.

Gastrointestinal Cancers

(Stomach, colon and rectal cancers)

In rectal cancer surgeries, particularly those involving tumors close to the anus, the tumour can be removed while precisely preserving the nerves responsible for urinary function and sexual function. In stomach cancer surgeries, it helps in the complete removal of lymph nodes. Such procedures are an important part of robotic gastrointestinal surgery and robotic cancer surgery.

Hepato-Pancreato-Biliary (HPB)

(Liver, gallbladder and pancreas)

In procedures such as Whipple's Procedure for pancreatic cancer, removal of liver tumours, and complex gallbladder removal, Robotic Surgery helps in precisely cutting and suturing delicate blood vessels and ducts without causing damage.

Bariatric Surgery

(Surgery for obesity)

In patients with obesity, laparoscopic surgery can become challenging because of the thickness of abdominal fat. Robotic arms can be used to perform procedures such as gastric bypass and sleeve gastrectomy safely.

Foregut Surgeries

(Oesophagus and diaphragm)

Procedures such as Fundoplication for acid reflux disease, Achalasia Cardia surgery to treat obstruction of the oesophagus, and Hiatal Hernia surgery can be performed without large incisions in the chest or abdomen.

Is Robotic Surgery Expensive?

Like any new advanced technology, Robotic Surgery may initially cost slightly more than conventional procedures. However, considering the safety provided to the patient and the faster recovery, it can be considered cost-effective. Moreover, health insurance coverage is now available for most robotic surgeries.

Remote Surgeries (Tele-Surgery)

The Da Vinci Xi has been designed with future tele-surgery applications in mind as well. This means that patients in remote locations could potentially be operated on by expert surgeons working from centres equipped with similar robotic systems.