What is Da Vinci Robotic Surgical System?

The Da Vinci robotic surgical system is an automated system that accomplishes all laparoscopy related surgical procedures through the use of a robot with four arms. The system is developed around the fact that technology can be used to add precision, comfort, accuracy and pain-less to minimally invasive surgery.

The Da Vinci robotic surgical system is conducted by specially trained surgeons who have the necessary skills to handle the robot and control the surgery using it. As a result, when compared to general laparoscopic technique, the Da Vinci robotic surgical system completes the process faster and with more efficiency.

Why is it called Da Vinci Surgical System?

The robotic surgical system is called the Da Vinci surgical system because Leonardo Da Vinci is the first man who invented robots. His works of art are developed on detailed anatomical study and analysis of humans and creatures around him. Since, the robotic system provides an opportunity for surgeons to experience the details of the surgery through three-dimensional images, which are complete in anatomical details; the system has been named as the Da Vinci robotic surgical system.

How does Da Vinci System work?

The Da Vinci system works in a systematic manner using the following four parts:

  1. Surgeon’s console: This is the part of the system that is two or three feet away from the patient cart. The surgeon is required to sit at the console and control the movements of the robotic arms at the patient side end. The screen allows the surgeon to see the internal organs clearly in a 3D view and lets him see every minute detail. The master controls in the console helps the surgeon feed in direct input regarding instrument manipulation, most of which is done by translation of the surgeon’s wrist, finger, and hand movements.
  2. Patient Cart: This is the operating table where the patient is required to lie down for the operation in semi or fully unconscious state. The robotic arms at this end of the machine operate on the target organ by using minimally invasive technology. As the surgeon controls and monitors the activities of the robotic arms, the speed and accuracy of the process become higher than general laparoscopic techniques. The Da Vinci robot has four arms out of which one holds the three-dimensional camera and the other three are used to hold and operate instruments.
  3. High Definition Visual Technology: The three-dimensional technology used in the Da Vinci robotic system captures detailed images at the operation site and therefore, gives the surgeon a real picture of  the interiors of the target body part.
  4. Endowrist Instruments: Known to have diameters that go to a minimum of only eight centimetres, the Endowrist instruments are patented instruments created by the makers of Da Vinci robotic systems, Intuitive Surgical. These perform laparoscopic and surgical operations with accuracy and speed.

Where is Da Vinci system in being used in India/ Delhi?

The Da Vinci robotic surgery system is available in many parts of India. The All India Institute of Medical Sciences, Delhi was amongst the first government institutions to receive a Da Vinci robot.

Other hospitals in India which have the Da Vinci robot in its surgical labs are – Indraprastha Apollo Hospital, Delhi; Apollo Hospitals Delhi, Chennai, Hyderabad; Apollo Gleneagles Hospital, Kolkata; Wockhardt Hospital Bangalore, Hyderabad, Mumbai; Fortis Hospital, Delhi, Mohali, Noida; Escorts Heart Institute Hospital, Delhi; Narayana HruDayalaya Heart Hospital, Bangalore; Artemis Hospital, Gurgaon ( Delhi); Max Devki Devi Heart and Vascular  hospital,  Delhi; and BGS Global Hospital Bangalore, Chennai, Hyderabad, India.

Procedures for which the Da Vinci robot is being used in India include the following:

  1. Gastro-intestinal and general surgery
  2. Bariatric surgery
  3. Thoracic surgery
  4. Urology
  5. Gynecology
  6. Cardiac surgery and head and neck surgeries

Who is a Da Vinci Surgeon?

The Da vinci surgeon is one who along with knowing the essentials of laparoscopic techniques also knows how to handle the robotic equipment and perform the surgery. In most cases, these surgeons have a certified document of training that authorizes them to use the system. Many online courses and real-time in-hospital courses conducted by the manufacturers of the Da Vinci robotic system – Intuitive Surgical, equip surgeons through a continual learning process.

This ultimately wins them the certificate for eligibility to undertake complete case series of robotic surgery on new cases. In-hospital training is usually imparted to teams of surgeons involved in laparoscopic surgery, who learn different aspects of using the Da Vinci robot and while the main surgeon controls the operation at the console, the others help in monitoring the patient and replacing the Endowrist instruments at the robotic arms according to the surgeon’s instructions.

Advantages of Da Vinci Robot?

The main advantages of using the Da Vinci robot are as follows:

  1. Greater details: The three-dimensional visual system offers excellent internal details to the surgeon. Often termed as an operation conducted through virtual reality, the three-dimensional screen further helps the surgeon seated at the console to discern the surgery as it proceeds. It also helps him/her locate secondary problems like clots, nerve damage and infection and administer suitable measures to counter the conditions.
  2. Fine automation: From drilling to completing sutures, the robotic arms take care of every aspect of laparoscopy that might have been difficult for even an experienced surgeon. The entire process runs in an automated manner and the surgeon and the patient experience minimal hassle during the surgery.
  3. Precision: The precision of the robotic arms is appreciably large. The endowrist technology allows holding of laparoscopic instruments at angles which are often difficult for humans to accomplish. The movement of the arms and the translation of the surgeon’s hand movements are extremely fine tuned, allowing the surgeon to finish the surgery with high precision, something that is highly important in minimally invasive as well as open surgery.
  4. Time Saving: Due to the high precision automation, the robotic surgery system completes all the processes swiftly and other than the default time required to replace the instruments, there is no major time loss during the separate steps of the surgical process. Robotic surgeries have been used to accomplish complicated laparoscopy procedures wherein access to the target organ is difficult, and would take a lot of time through general laparoscopy. Such procedures have also been completed in much less time than that required for straightforward laparoscopic procedures conducted manually.
  5. Low Pain: Due to minimal invasion and high precision, patient experiences less pain when compared to open surgery and general laparoscopic processes. The post operative pain is also low and therefore, patients are not required to take heavy pain killers or sedatives during recovery.
  6. Low Recovery Period: The recovery period is similar to other minimally invasive surgical processes and is very low. Patients are able to resume normal movement and daily activities like walking and sitting within 48 to 72 hours after the operation. Unless any complications arise, a little diet control and regular dressing at the incision point is enough to render them fit to move around till the sutures are removed.
  7. Reduced Bleeding: The main advantage of all minimally invasive processes is the minimised bleeding that occurs during the operation. This keeps the patient healthy and although it is important to have a blood transfusion in place during robotic surgery, minimised bleeding at the incision point renders it unused unless severe complications arise where there is excessive bleeding in the patient.

Risks of using Da Vinci Robot?

There are a couple of risks involved in using the Da Vinci robot. These are as follows:

  1. Instrument Movement and flexibility: While the present models of the Da Vinci robot have proven to be useful in terms of instrument precision, the options available in manipulating swift movements during emergencies are limited. Therefore, in case of complications, it is unwise to rely on the Da Vinci robot for manipulation of instruments at the surgery field because the speed and flexibility may not be as accurately timed as human surgeon’s hands.
  2. Excessive bleeding: Due to larger instrument diameter, there might be incidents of excessive bleeding in hypersensitive patients, which has to be controlled manually.
  3. Technical snag: Although not seen commonly, the chances of the Da Vinci robot suffering from technical snags is a huge risk factor in these processes since any such incident can put the lie of the patient at peril.

FDA Approval?

The Da Vinci robotic surgery system has received approval and clearance from the U.S. Food and Drug Administration and is being used in a large number of hospitals worldwide.

Cost of Da Vinci Surgery?

The Da Vinci surgery costs one-third more than general laparoscopic procedures. In case of complex surgeries wherein extra time and specialised skills are required in completing the process, the cost might be higher. The robotic surgery system is a one-off costly process which will neither be repeated nor required. In ninety percent of the cases, patients have gotten better with no complaints about pain or bleeding. Cases where complications arise during or after the operation have to be treated by extensive medication or an open surgery schedule at a later date.

Alternative names?

The Da Vinci robotic system is also known as the Da Vinci surgery, robotic surgery, roboticlaparoscopy, Da Vinci system robotic surgery, or simply Da Vinci robotic surgery.

Image courtesy – wikipedia