Robotic surgery has shown great promise across a broad range of surgical disciplines. Read some of the more recent applications in this Frost & Sullivan analysis.
Robots have become increasingly important in the field of surgical interventions due to the growing complexity of procedures for difficult diseases and greater demand for minimally invasive surgery. Surgical robots are computer-assisted electromechanical devices that can perform tasks with great geometric accuracy and precision, guided by computer algorithms through the sensor systems. They can work through tiny incisions without any tremor even in difficult-to-reach anatomical areas, reducing procedural time and blood loss and eliminating the need for extensive suturing. Surgical robots can be used for a range of orthopedic, gastrointestinal, and obstetric/gynecological surgeries, and for delicate and precise neurosurgery and ocular microsurgery. Some of these application areas are discussed below.
Precision Orthopedic Surgery
Since the introduction of the ROBODOC surgical system in 1992, robotic technology has been used in orthopedic surgery for total hip replacement. With its high precision, robot-assisted surgery helps in accurate implant positioning and reduces the risk of injury to adjacent tissues. Patients benefit from less bleeding and post-operative pain, and fewer hospital readmissions. Robotic technology also is used for partial knee and hip replacements.
Another robotic surgery system for orthopedics is the MAKOplasty® System by MAKO Surgical Corp., a Stryker company. It utilizes a RIO® robotic arm system to achieve a higher level of precision when resurfacing the diseased part of a patient’s bone. Accurate alignment and positioning of hip implants are important factors affecting surgical outcomes and the implant lifespan. This system offers a higher level of patient–specific implant alignment and positioning, to accurately reproduce the surgical plan—an aspect that is not consistently achieved in manual techniques.
Omnibotics by Massachusetts-based OmniGuide allows surgeons to perform patient-specific total knee surgery using the patented Bone Morphing™ technology that quickly builds and displays a real-time three-dimensional anatomical model of the surgical site for guidance and navigation. It is the only U.S. Food and Drug Administration (FDA)-cleared orthopedic robotic navigation solution for primary total knee replacement.
The Swanson School of Engineering at the University of Pittsburgh is developing a portable, low-maintenance, six-axis test robot—MJT Model FRS2010—that uses position and force feedback technology to examine knee, glenohumeral and acromioclavicular joint, spine, elbow, hip, and ankle functions with the aim of preventing degenerative joint disease by improving diagnostics, repair, and rehabilitation for musculoskeletal injuries. This system is in the early stages of research.
The biggest challenge in brain and spine surgery is the delicate neural structures that are approached through narrow surgical corridors. The benefits of robot-assisted neurosurgery are the ability to perform surgery on a smaller scale (microsurgery), increased accuracy and precision (stereotactic surgery), access to small corridors (minimally invasive surgery), reducing surgeon’s physiological tremor, ability to process large amounts of data (image-guided surgery) and enabling telesurgery. Robotic spinal procedures include spinal fusion surgery, kyphoplasty or vertebroplasty for a spine fracture, and scoliosis correction. Robotic brain surgery includes tumor removal, deep brain simulation, and biopsies.
The most commonly used robotic system for neurosurgery is the FDA-approved and CE-marked Renaissance™, Mazor Robotics’ surgical guidance system that allows surgeons to plan spine surgery in a three-dimensional field and guides them during the procedure.
ROSA Spine Surgery Robot by Medtech S.A. of France (now a part of Zimmer Biotech Holdings, Inc.), is a dexterous robotic system with six degrees of freedom and advanced haptic capability. Its flexibility allows for biopsies, implantations of electrodes for functional procedures such as cerebral cortex and deep brain stimulation, and open-skull procedures using navigation, ventricular and transnasal endoscopy and other keyhole procedures. It received 510K FDA clearance in 2014.
Obstetric and Gynecological Surgery
Robotic systems can be used for hysterectomies, myomectomies, lymph node removal in those with gynecologic cancers, and vaginal prolapse surgeries.
The da Vinci robotic surgical system by Intuitive Surgical of Sunnyvale, Calif., was cleared for use in the United States in 2005, and is the first FDA-approved robotic system for gynecological surgery. The advantages of using da Vinci technology over conventional laparoscopy include wristed instrumentation, clear 3-D optics, better ergonomics, and independence of camera control.
Titan Medical Inc. of Toronto, Ontario, is developing a surgeon-controlled robotic platform with a 3-D vision system that can perform minimally invasive abdominal, gynecological, and urological procedures through an incision of 25 mm. The SPORT™ Surgical System is expected to have multi-articulating, interactive, snake-like instruments that are reusable. Development of a pre-production prototype is underway.
Precise Tumor Removal
Robot-assisted surgery is common for prostate cancer. Its precision removal of cancerous tissues reduces the possibility of relapse, and the less-invasive technique allows for quicker healing and minimal scarring and risk of infection. In a robotic prostatectomy, improved visualization, precision, and dexterity prevent damage to the prostatic nerves that control the bladder and sexual functions. Robotic surgery is also used to remove the thyroid gland and tumors in the head, neck, rectum, and kidney. A robotic resection can treat benign prostatic hyperplasia.
Currently, the widely used robotic surgical system is the da Vinci robot. Another product is the Flex Robotic System, a highly articulated robotic system by Medrobotics Corp. of Reynham, Mass., a Carnegie Mellon University spin-off. The minimally invasive system can access tumors that once would have required open surgery or been impossible to reach, such as in the jaw or neck. It is CE-marked and FDA-cleared for transoral surgeries.
The AquaBeam System by Procept BioRobotics of Redwood City, Calif., uses real-time image-based ultrasonic guidance and robotics for a controlled resection of the prostate through aquablation—heat-free, high-velocity waterjet technology. The product is in Phase III clinical trials in the United States.
Robotic surgery has shown great promise across a broad range of surgical disciplines. Rapid advances in micro- and nanoelectromechanical systems have led to smaller, lower-cost, and more flexible robots. The innovation ecosystem is a collaborative conglomeration of companies, universities, research institutes, and governmental organizations. Major challenges in the industry include high installation costs; a larger footprint that makes integration into operating rooms difficult; and the risk of malfunction, which can endanger a patient’s life. Researchers are trying to address these limitations through improved instrumentation, better sensors and visualization, miniaturization, and increased flexibility.
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