Surgeon-Powered Robotics in Thoracic Surgery; An Era of Surgical Innovation and Its Benefits for the Patient and Beyond

Abstract

Following its introduction in 1992, the growth of minimally invasive thoracic surgery was initially hampered by the lack of specialized instruments, impeded visualization and stapling. However, in subsequent years these challenges were somewhat overcome and video-assisted thoracoscopic surgery (VATS) became the preferred modality of many centers. More recently, robotic surgery has come to the fore. Whilst it offers outstanding precision via robotic wristed instruments, robotic surgery is expensive and has safety implications as the surgeon is away from the patient's side. Wristed VATS instruments offer a new, exciting alternative. By placing the robotic-like wristed instruments in the hands of the surgeon, a concept we call surgeon-powered robotics, the benefits of robotic surgery can be achieved by the patient's side. We describe our experience of the ArtiSential® wristed instruments and discuss the benefits and challenges of this technology. By combining wristed instruments with the latest surgeon-controlled 3D camera technology, surgeon-powered robotics is an affordable reality.

ArtiSential® Articulated Wrist-Like Instruments and Their First Application in Pediatric Minimally Invasive Surgery: Case Reports and Literature Review of the Most Commonly Available Robot-Inspired Devices

“…The shaft diameter is 10 mm [11,12] The ArtiSential ® (Figure 3E) is an 8 mm diameter pistol-handle instrument. It has zero ben radius when deflected; its wrist function is guaranteed by two joints at the end effector that couples their movements with the ones of the handle [13][14][15][16][17][18].…”

Cardiac patch transplantation instruments for robotic minimally invasive cardiac surgery: initial proof-of-concept designs and surgery in a porcine cadaver [preprint]

“…Fully autonomous systems have also been developed, although human surgeon supervision may still be needed (22). Fully autonomous unsupervised robotic systems for surgery would need to overcome safety concerns (13). For example, it is foreseeable that a component or power malfunction…”

“…Otherwise, it could be hard to justify a traditional open surgical operation, not least because the risk/benefit threshold may be harder to meet (13). For example, conventional open surgeries, splitting the sternum (median sternotomy) or via the ribcage (thoracotomy), have been associated with a longer initial recovery and higher incidence of overall complications/adverse events than minimally invasive approaches (14,15).…”

“…With the advancement of minimally invasive robotic cardiothoracic surgery (16,17), it is increasingly pertinent to develop feasible, cost-effective, synergistic instrument-control systems (13). Current surgical robots established in clinical use, including da Vinci® Surgical Systems (Intuitive Surgical Inc., Sunnyvale, CA, USA), have shown that a master-slave (semi-automated) robotic system can perform robotic surgery on humans, resulting in new ways to perform challenging cardiac surgery (17) and potentially improving established operations (16).…”

Cardiac Patch Transplantation Instruments for Robotic Minimally Invasive Cardiac Surgery: Initial Proof-of-concept Designs and Surgery in a Porcine Cadaver

“…Furthermore, if patch-based myocardial repair is to realize its paradigm-shifting therapeutic potential (for example, as a standalone procedure and/or an adjunct for a patient already undergoing surgery for some other reason), it should be compatible with minimally invasive (keyhole) robotic surgical approaches ( Roche et al, 2021b ). Otherwise, it could be hard to justify a traditional open surgical operation, not least because the risk/benefit threshold may be harder to meet ( Trevis et al, 2020 ). For example, conventional open surgeries, splitting the sternum (median sternotomy) or via the ribcage (thoracotomy), have been associated with a longer initial recovery and higher incidence of overall complications/adverse events than minimally invasive approaches ( Lim et al, 2021 ; Moscarelli et al, 2021 ).…”