Robots Are Taking Over Your Surgical procedure (and You Ought to Be Excited)

Sept. 26, 2023 – On her flight to Atlanta, Robin Pollack nibbled gummy bears and sipped a cranberry juice cocktail. It had been every week since she’d gotten robotic surgical procedure to take away a cancerous abdomen tumor at MD Anderson Most cancers Heart in Houston, and she or he was heading dwelling – feeling surprisingly good.

The surgical procedure required 5 small cuts. “I now have 4 little dots and a 2-inch slit that he superglued shut,” Pollack mentioned. “After surgical procedure, I awoke hungry.”

She was off the bed and strolling in a day, and out and about city together with her husband inside every week, having fun with crème brûlée and eggs Florentine.

“I’ve not had one little bit of ache since,” she mentioned 2 weeks after surgical procedure. “I’ve not taken ache remedy, not even one Tylenol. I walked 2 miles yesterday.”

A greater post-operative high quality of life is one perk of robotic surgical procedure, mentioned surgical oncologist Naruhiko Ikoma, MD, who carried out Pollack’s process. 

There are pluses for the surgeon, as properly. “I really feel extra exact by way of dissection and in suturing,” mentioned Ikoma. “In typical open operations, surgeons use devices. … In robotic surgical procedure, surgeons really feel like they’re working with their very own fingers with exact ideas.”

Robotic surgical procedure, or robot-assisted surgical procedure, is greater than 20 years previous, however consultants consider it’s now poised for development. Propelling the expertise ahead are the very benefits that Pollack and Ikoma describe: improved accuracy, shorter restoration instances, and fewer ache. 

About 644,000 robotic surgeries had been carried out in america in 2021, and that determine is predicted to method 1 million by 2028. Tens of millions extra have taken place worldwide. The worldwide market hit $6.3 billion in 2022 and is projected to succeed in $26.8 billion in 10 years.

Robotic-assisted gadgets are FDA-cleared throughout many specialties. For prostate removals and hysterectomies, the usage of surgical robots is now extra frequent than not. It’s additionally rapidly growing in bariatric surgery and hernia restore, and has elevated steadily in hip and knee replacements. A number of surgical groups have pioneered robot-assisted kidney transplants, and not too long ago the Washington College College of Medication in St. Louis reported the primary robotic liver transplant in the U.S.

Probably the most extensively used robotic system within the U.S. is Intuitive Surgical’s da Vinci. The FDA first authorised a da Vinci in 2000 and has cleared newer fashions since then. Immediately, greater than 7,500 da Vinci surgical programs are in use in 69 nations throughout six continents. 

Dozens of different corporations have entered the sport. Advances in supplies science are driving smooth, versatile designs that may navigate winding pathways or function on a number of the physique’s most delicate tissues. 

Auris Well being’s Monarch, a versatile robotic endoscopic system, enters by means of the mouth into the trachea and bronchial passages to look at probably cancerous tissue within the lungs. The platform not too long ago earned a urological clearance for kidney stone removal. Different versatile robots enter the rectum and journey by means of intestines, as for colonoscopy. Nonetheless others snake by means of the nostril to succeed in the mind, or the thigh’s femoral vein to get to the guts. 

An improve of Stryker’s Mako robotic, presently used for hip and knee replacements, will allow its use in backbone and shoulder surgical procedure and will launch as early as next year. (The medical doctors interviewed for this text are usually not selling or endorsing any merchandise talked about.) 

In the meantime, synthetic intelligence, or AI, is letting researchers and builders make robots extra autonomous, able to performing surgical subtasks and even complete surgical procedures.

“It’s an thrilling time,” mentioned Michael Yip, PhD, an affiliate professor {of electrical} and laptop engineering, and director of the Superior Robotics and Controls Laboratory, on the College of California San Diego. “The variety of robotic applied sciences is de facto widening exponentially.”

Advantages for Sufferers

Information reveals that robotic surgical procedure might help scale back bleeding, scarring, and restoration time, and it permits for shorter hospital stays, in comparison with conventional surgical procedure. 

Probably the most hanging advantages: Many sufferers, like Pollack, don’t want opioids – or any painkillers, for that matter. That’s exceptional when you think about the norm. 

For kidney transplant, “it’s 100% narcotic use after an open transplant,” mentioned Thomas Pshak, MD, a robotic kidney and liver transplant surgeon at UCHealth College of Colorado Hospital. Open surgical procedure sufferers go dwelling with as a lot as a week’s supply of opioids, and generally want morphine or oxycodone in an IV after surgical procedure.

Robotic surgical procedure sufferers heal a lot sooner, returning to work and regular actions inside just a few weeks, vs. the recommended 8 weeks after open kidney transplant. 

“A painless kidney transplant looks as if science fiction, however right here we’re,” Pshak mentioned.

He makes use of a da Vinci surgical robotic system with 4 slender arms, every concerning the measurement of a pencil, that maintain surgical devices and a high-definition digicam. Throughout surgical procedure, he sits at a pc console just a few toes away, trying by means of binoculars that present a extremely magnified 3D view of the operation web site. With each fingers on joystick-type controls, he guides the arms into the cuts to carry out “delicate, exact actions,” similar to suturing the brand new kidney to blood vessels. Foot pedals have interaction and disengage the robotic arms. 

photo of doctor with robot

Pshak carried out UCHealths first robotic kidney transplant in 2021 and has performed greater than a dozen since then, and much more donor kidney removals, utilizing the robotic. With robotic kidney transplant, “the most important incision is about 2 inches, close to the bellybutton,” he mentioned. For context, a conventional open kidney transplant entails a 10- to 12-inch lower.

Robotics could enhance entry to surgical procedure as properly. One-third of sufferers ready for a donated kidney have physique mass indexes over 35. The upper BMI can imply longer, deeper cuts, growing the chance of issues and adverse outcomes. The much less invasive robotic process may make kidney transplant doable for these patients.

Advantages for Medical doctors

In a way, robotics give surgeons superhuman abilities. The robotic can right for any tremor within the surgeons hand and lets a surgeon view hard-to-see creases, shifting the digicam and small instruments into locations the human hand can’t attain.

“I can set the [robot] arm actions to maneuver at one-tenth of my regular hand motion,” Pshak mentioned. “That simply permits for some insane accuracy.”

In spinal surgical procedure, robotics reduce the misplacement of a screw. Meaning “a decrease revision price – having to return and take away and substitute a misplaced screw,” mentioned Mohamad Bydon, MD, a neurosurgeon and clinician-scientist on the Mayo Clinic in Rochester, MN, the place they’ve been performing robotic neurosurgeries since 2018.

Bydon was the lead creator of a study in Mayo Clinic Proceedings that reported that out of 402 screws positioned in 77 sufferers who had robot-assisted spinal surgical procedure, none needed to be redone after surgical procedure.

Different benefits, Bydon famous, embrace the power to map out the surgical procedure prematurely, and sub-millimeter accuracy round a affected person’s nerves and spinal wire. “It preserves muscle mass, tendons, and ligaments,” he mentioned.

Corey Walker, MD, is a neurosurgeon at Cedars-Sinai in Los Angeles who carried out minimally invasive robotic again surgical procedure on a highschool soccer participant final yr after the participant fractured his backbone in three spots. The robots gather information that’s fed again into AI algorithms to enhance planning and accuracy. “The robotic is not only giving us a technical benefit,” Walker famous, “but in addition an information benefit.”

After surgical procedure, the soccer participant was again to regular actions and coaching once more inside weeks as a substitute of the traditional 6 months.

With youthful sufferers, Walker mentioned, it’s essential to protect their longevity and keep away from harm to the muscle mass surrounding the backbone. Robotic procedures “depart as little of a footprint on the construction of the backbone as doable.”

Robotic Surgical procedure: What Sufferers and Medical doctors Ought to Know

In america, educational medical institutions and hospitals have developed their very own credentialing paths. Many robotic surgeons prepare in typical surgical strategies and later transfer into robotic procedures, taking web-based and in-person programs with gear producers, training on pattern tissues, in digital actuality simulations, and on inanimate objects (like choosing up small objects or peeling tape from a floor). 

Some surgeons and medical facilities supply robotic coaching for these outdoors their establishment. On the Ohio State University College of Medicine, surgeons from around the globe can go to, observing current and rising robotic procedures for $500 a day. 

“The most important problem with robotics is that it’s so automated, it generally takes away from the residents’ skill to be taught the anatomy,” Walker mentioned. “Our problem is to nonetheless be capable of train residents the anatomy and to not change into reliant on the expertise.”

Sufferers ought to look right into a hospital’s historical past with robotics and ask what number of procedures their establishment and surgeon have carried out, as Pollack did earlier than her surgical procedure. Not all surgical procedures are appropriate for robotics; sufferers and surgeons ought to talk about professionals and cons.


Robotic surgical procedure isn’t with out controversy. A 2021 review of 50 randomized trials evaluating robot-assisted surgical procedures with laparoscopy and/or open surgical procedure for stomach or pelvic surgical procedure discovered little distinction in outcomes. 

Some older research counsel dangers or probably worse outcomes for some procedures. In 2018, a New England Journal of Medicine multicenter study led by MD Anderson Most cancers Heart researchers reported that, in girls with early cervical most cancers, laparoscopic or robotic minimally invasive radical hysterectomy was linked to decrease charges of disease-free survival and general survival, when in comparison with open belly radical hysterectomy. And in 2021, the FDA cautioned in opposition to robotically assisted surgical system use for mastectomy.

Nonetheless, scores of different latest research again up robot-assisted surgical procedure’s advantages.

One downside: It’s not accessible in every single place. “You need to be at a spot that’s keen to put money into it and that believes in it as a expertise,” Walker mentioned. 

For sure specialties, the excessive value (the da Vinci’s price ticket is reported to be $2 million) could not outweigh the return on funding, Yip mentioned , stalling development.

In line with Francis Sutter, DO, chief of cardiac surgical procedure at Lankenau Medical Center, a part of Fundamental Line Well being, and a longtime robotic surgeon, the variety of robotic coronary heart surgical procedures has fallen previously 10 years. 

“There’s not a marketplace for it,” he mentioned. “I hope there can be extra curiosity from cardiac surgeons within the years forward.”

What’s Subsequent?

Semi-autonomous gadgets that carry out surgical duties – like holding a clamp in place or eradicating broken tissues – may begin to emerge clinically within the subsequent 10 years, Yip mentioned. 

Like a self-driving automobile, they use sensors to localize with respect to anatomy and map the setting.

Sometime, we may even see absolutely autonomous robots able to performing a whole process. At Johns Hopkins final yr, surgeons examined a new robotic technology referred to as Sensible Tissue Autonomous Robotic (STAR) that visualizes and plans its subsequent surgical transfer virtually in actual time. They efficiently practiced with it in 4 experiments, stitching collectively pig intestines, tissue that’s smooth, pliable, and troublesome to function on.

For hemorrhage management, Yip mentioned, “the pc acknowledges blood and can instantly attempt to suck up the blood, discover the supply, and clamp it.” Such robots could possibly be airdropped throughout, say, pure disasters to stabilize injured individuals. The expertise may additionally open the door to remote “telesurgery.”

Nonetheless, fears that robots will substitute surgeons altogether are inflated, consultants say. For the foreseeable future, robots will improve the work of the surgeon, not substitute it, Bydon, of the Mayo Clinic, mentioned.