The landscape of robotic surgery is rapidly evolving, with the “Future of robotic surgery” encapsulating the transformative trends and breakthroughs in this dynamic field. Currently, there are nearly 6000 da Vinci systems in operation globally, having executed an impressive 8.5 million procedures worldwide. In the UK alone, approximately 115 of these systems are strategically placed to cover a majority of geographical regions.
Globally, the primary domains for robotic surgery include general surgery and gynecology, but in the UK, urologists lead the charge, conducting more robotic procedures than any other specialty. The application of the £1.7 million da Vinci robot in the publicly funded NHS reflects the compelling need for heightened vision, precision, and control, particularly in procedures like laparoscopic prostatectomy.
Visionary Advancements:
With over 14 million laparoscopic surgeries performed globally each year, the da Vinci robots address a persistent challenge faced by surgeons — spatial perception in two-dimensional images. By immersing surgeons in a 3D-operating field with binocular endoscopic vision and 10–15x magnification, robotic surgery significantly enhances visualization of surgical planes. This revolutionary advancement improves technical capabilities, enhances appreciation of key structures, and contributes to better patient outcomes.
Precision Redefined:
Diverging from standard laparoscopy, the da Vinci system incorporates the Endowrist system, mirroring human wrist and elbow movement for an extensive range of motion. This, coupled with the elimination of the fulcrum effect seen in laparoscopic surgery, provides a distinct advantage. While expert laparoscopists may find minimal benefit, the intuitive Endowrist system proves highly advantageous to those trained in open surgery and surgical trainees.
Unmatched Control: Future of Robotic Surgery
The da Vinci system leverages robotic technology to eliminate physiological tremor, offering surgeons unparalleled control in minimally invasive settings. Enhanced ergonomics, including a seated surgeon, combined with motion scaling, contribute to more efficient, calmer, and safer laparoscopic surgery.
Future Horizons:
The future of robotic surgery envisions an expansion beyond its current strongholds. While urology has been a driving force in the UK, the potential for growth lies in areas such as ear, nose and throat (ENT), thoracic surgery, gynecology, and general surgery. Increasing commercial viability and accessibility will pave the way for the integration of robotic systems into a broader spectrum of procedures.
Innovative Systems on the Horizon:
The two-decade reign of the da Vinci surgical system is on the verge of transformation with the expiration of its patent. Novel systems, such as the Versius surgical robot by Cambridge Medical Robotics (CMR), are emerging with unique features like haptic feedback, single-port operating, and the incorporation of artificial intelligence. Versius, with its user-centric design and distinct features, marks a paradigm shift, offering an alternative to the established standards in robotic surgery. As we navigate the future of robotic surgery, these innovations promise to redefine the landscape, ushering in a new era of precision, accessibility, and efficiency.”
“Revolutionizing the Landscape: Innovations in the Future of Robotic Surgery”
In a departure from the da Vinci system, Versius takes center stage with its lightweight arms, ensuring effortless transport and deployment. The adaptability of Versius, allowing for the addition and removal of arm carts, positions it as a highly practical and portable solution. The open console, equipped with 3D glasses, not only provides an ergonomic advantage but also facilitates seamless team communication – a feature lacking in closed consoles. The system’s portability and user-friendly design position it as a formidable contender against the da Vinci system. Hospitals in Germany, Australia, and the UK have already embraced the Versius system, marking its global impact as of June 2021.
Johnson & Johnson’s Ottava: Pioneering Surgical Robotics
Healthcare giant Johnson & Johnson (J&J) unveils Ottava, a visionary surgical robot platform, amalgamating expertise from machine learning (Verb Surgical) and endoscopic procedures (Auris Health). Leveraging their extensive experience in medical devices through subsidiary Ethicon, J&J aims to create a groundbreaking robotic platform. Ottava, currently in development, boasts six integrated robotic arms within the operating table, offering a zero footprint device that optimizes space and enhances patient access. While questions linger about potential clashes when all six arms are in operation, Ethicon’s solid standing in the medtech industry forms the foundation of this innovative system. Ottava’s integration with energy and laparoscopic devices underscores Johnson & Johnson’s commitment to advancing minimally invasive and endoscopic robotics. With machine learning integration, Ottava is poised to pioneer artificial intelligence-assisted surgery, reducing errors, facilitating training, and aiding research outputs. Notably, J&J’s foray into orthopedics with the FDA-approved VELYS, a table-mounted robotic system enhancing bony cut accuracy, further solidifies their commitment to transformative surgical technologies.
Medtronic’s Hugo: Redefining Robotic-Assisted Surgery
Esteemed surgical technology company Medtronic enters the arena with Hugo, making its mark by performing the inaugural patient procedure – a radical prostatectomy. Embracing a modular, open-console design reminiscent of CMR’s Versius, Hugo gains an edge through compatibility with Medtronic’s globally trusted surgical instrumentation. The company doesn’t shy away from integrated AI technology, as evidenced by their acquisition of Digital Surgery Ltd, paving the way for AI-powered data analytics. Hugo emerges as a promising contender in the future of robotic surgery, showcasing the industry’s commitment to innovation and pushing the boundaries of what’s possible in surgical robotics.”
“Exploring Cutting-Edge Advancements: The Future of Robotic Surgery”
As we delve into the realm of novel and groundbreaking systems in minimally invasive surgery, two standout contenders emerge, poised to shape the future of robotic surgery.
Senhance Surgical Robotic System: Redefining Possibilities
TransEnterix’s Senhance Surgical Robotic System, originally conceived by the robotic division of Italian healthcare powerhouse SOFAR, stands as a formidable competitor to the da Vinci® system. With coveted CE approval for European use and FDA approval, Senhance introduces distinctive features that set it apart. An open remote control console equipped with 3D-HD visuals through specialized glasses, an innovative eye-tracking system for camera control, and three laparoscopic robotic arms on separate carts redefine the surgical landscape. Unlike the singular cart configuration of the da Vinci® system, Senhance offers laparoscopic handles with six degrees of freedom, providing surgeons unparalleled control over robotic instruments. Notably, the system incorporates haptic force feedback through laparoscopic handles, a groundbreaking feature enhancing the surgeon’s tactile experience. Licensed for abdominal, pelvic, and thoracic procedures in Europe (excluding cardiac surgery), Senhance has shown safety and efficacy in clinical trials, albeit in a limited scope, primarily covering gynecological and colorectal procedures. Successful animal studies in porcine partial nephrectomy and bovine pulmonary lobectomy further underscore the system’s potential.
Versius: Pioneering Surgical Precision
Developed by UK-based CMR Surgical, Versius emerges as a versatile solution designed for gynecology, upper GI surgery, colorectal procedures, and urology. The system boasts an open control console with a 3D-HD monitor requiring specialized glasses, accompanied by up to five collaborative lightweight robotic arms. These individually mounted arms, controlled from the open console, prioritize haptic feedback, ensuring the operating surgeon maintains a nuanced tactile connection. Versius places a strong emphasis on the compact, lightweight nature of its robotic arms, providing seven degrees of freedom and facilitating seamless setup and portability across theaters. While preliminary animal studies and cadaveric trials have taken place, the company anticipates filing for clinical use approval in 2018, signaling the promising trajectory of Versius in shaping the future of robotic surgery.
In conclusion, as we witness the evolution of these cutting-edge systems, the future of robotic surgery promises a paradigm shift, where innovation meets precision, offering surgeons unprecedented capabilities and patients enhanced outcomes.”
Bottom Lines of Future of Robotic Surgery:
Over the past two decades, the landscape of surgery has undergone a monumental shift with the emergence and widespread adoption of robotic technology. Dominating the arena of minimally invasive surgery during this period has been Intuitive Surgical’s da Vinci® surgical system. This comprehensive review provides an insightful exploration into the current state of robotic surgery, offering a detailed overview of both commercially available and innovative robotic systems currently in development. The emergence of these future systems has the potential to reshape the existing paradigm, fostering a more competitive market that could lead to a subsequent reduction in costs, making robotic surgery more accessible on a broader scale.
The transformative impact on training and comparative research remains challenging to predict, especially with the anticipated increased adoption of various heterogeneous robotic systems. The prospect of manufacturers collaborating to standardize certain aspects of their systems seems unlikely, given the substantial commercial stakes involved. Regardless of these challenges, the recurrent development and explosion of novel robotic systems are pushing the limits of what can be achieved with robotic surgery. As we steer the future, the vibrant landscape of robotic surgery promises further innovation, bringing us closer to a future where advanced surgical techniques are more widely available and reachable to all.
