When most people hear about “robotic surgery” for the first time, they most likely picture a scene from some sci-fi movie with a scary-looking walking and talking robot splitting some unconscious patient open. However, “robotic surgery” is not really surgery performed by an independent robot without the need for a human surgeon.

On the contrary, robotic surgery is a new type of surgery “that replicates the surgeon's movements in real time. It cannot be programmed, nor can it make decisions on its own to move in any way or perform any type of surgical maneuver without the surgeon's input.” It “enables surgeons to be more precise, advancing their technique and enhancing their capability in performing complex minimally invasive surgery.” Seated at a console a few feet away from the patient, the surgeon actually views an image of the surgical field while operating in real-time, through tiny incisions, using very small instruments.

Robotic surgery is a very expensive surgery that is mostly useful for operations that are described as minimally invasive. Typically, a complex procedure like cardiac surgery requires an excellent view of the operative field and the ability to maneuver instruments within tight spaces with precision and control. Historically, surgeons have used invasive approaches for this procedure, such as splitting the breastbone and pulling back the ribs. About a foot-long incision is required to provide visibility and allow room for the surgeon to get his or her hands and instruments very close to the operative site. However, the large incision can result in significant pain, blood loss and a long recovery for patients.

Therefore, smaller incisions are preferred and have been lately used to perform a variety of cardiac procedures. But the smaller the incision, the less access the surgeon has to see and operate. Therefore, the use of a robot allows the surgeon “greater surgical precision, increased range of motion, improved dexterity, enhanced visualization and improved access.” As a result, patients can expect a “shorter hospital stay, less pain, less risk of infection, less blood loss, fewer transfusions, less scarring, faster recovery and a quicker return to normal daily activities.”

Or at least that is what companies that manufacture these kind of robots are claiming. The only scientific study that is related to the issue compared men with prostate cancer who had surgery with four-inch incisions with those who had laparoscopic surgery, many with a robot. (Laparoscopic surgery is a minimally invasive surgery that includes the performance of surgical procedures with the assistance of a video camera and several thin instruments, with or without the assistance of a robot). The study concluded that patients that had laparoscopic surgery had shorter hospital stays, lower transfusion rates and fewer respiratory and surgical complications that those who had regular incisions. However, they also had more incontinence and impotence.

Therefore, it appears that we still don’t have enough evidence whether robotic surgery is worth the extra costs. For more information though, please refer the Journal of Robotic Surgery.