Do Not Be Afraid of the Robot

Minimally invasive surgery is one of the areas of greatest development in surgical specialties in several parts of the world, and Colombia has not been the exception. In urology, as in all specialties, the evolution in technology has optimized the diagnosis and the treatment of most of the pathologies. The purpose has always been that the patients who undergo surgery have a pleasant, less stressful experience, without compromising the perioperative and postoperative results.

In this search, 9 years ago, the Clínica de Marly was the first site to bring the Da Vinci (Minimally Invasive Surgery Group, Laparoscopy and Robotics, Urologic Team, Clínica de Marly, Hospital de San José, Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia) robot. Since then, both in our institution and in others located in Bogotá, which later acquired this same technology, a large number of surgical interventions have been successfully carried out. The great motivation for this is supported by the fact that the robotic approach allows surgeons to increase the level of precision of their interventions, and as the experience of the operative team increases, procedures are performed with greater safety and fewer complications, with successful oncological and functional results comparable with what is achieved with techniques such as open or laparoscopic, always clarifying that any operative technique should be performed by expert surgeons.

Robotic surgery allows surgeons to increase the level of precision of their interventions, achieving, with a lower learning curve, the same oncological and functional results achieved by open and laparoscopic surgeons who handle large surgical volumes. However, the human factor is still essential in obtaining good results in robotic surgery: good robotic surgeons with more experience will probably have better results.

We must consider that open surgery has already reached its maximum development. In its beginnings, robotic surgery in urology has achieved the same results as open surgery, which makes us wonder how far can robotic surgery go. However, in robotic surgery, there is constant development that will take this technology to unsuspected levels. Examples of this are magnified vision, high definition, the possibility of practicing microscopic approaches, being able to see beyond what is seen (indocyanine green immunofluorescence), image fusioning during surgery, development of tactile sensations, equipment miniaturization, and new software, among others, are some of the expected developments.

However, the current robot has clear disadvantages that must be handled so they can be corrected in the future. One of them is the bulky size of the equipment, requiring large operating rooms. In addition, the robot requires a large number of delicate connections inside the surgery room that can cause accidents.

The main disadvantage at present is undoubtedly the high costs of the equipment and its operation fee; this is due to the fact of the monopoly that exists at the moment by the manufacturing company, which has caused many groups to question the cost-efficiency of the treatments. With the arrival of new robots in the market, these costs will probably decrease and surgery will become more affordable and cost-effective.

• Related readings

• 1 Giedelman C, Abdul-Muhsin H. El impacto de la cirugía robótica en Urología. Actas Urol Esp. 2013; 37 (10) 652-657
• 2 US Food and Drug Administration Home Page, Caution When Using Robotically-Assisted Surgical Devices in Women's Health including Mastectomy and Other Cancer-Related Surgeries: FDA Safety Communication, February 28, 2019, https://www.fda.gov
• 3 Ramirez P, Frumovitz M. Minimally Invasive versus Abdominal Radical Hysterectomy for Cervical Cancer. N Engl J Med 2018; 379: 1895-1904 . November 15, 2018
• 4 Rassweiler J, Autorino R. Future of robotic surgery in urology. BJU Int 2017; 120: 822-841