The beginnings of robotic surgery began with the prostate. Or more accurately it began with the advent of PSA screening. Before PSA screenings, prostate cancer was often not picked up until the symptomatic stage, in other words — it was too late to fight it (prostate cancer at its most curable stage is completely invisible).
PSA changed that, and as a result the diagnosis of prostate cancer spiked. However, early diagnosis presented its own set of problems — how to treat the prostate?
Dr Daniel Moon, Urologist, Australian Urology Associates and Director of Robotic Surgery, Epworth Healthcare said that ‘prostate surgery is a delicate, complex procedure, very difficult to perform by hand, and the complications arising from surgery can be significant. Bladder damage, incontinency and death are all risk factors.’
As Dr Moon acknowledged, clinicians in this field recognised that ‘there was a need for surgery with better vision and less complications for patients.’
Around the same time, the US department of defence and NASA were collaborating on a robotic device that would allow a military surgeon to perform procedures remotely to soldiers on the battlefield. While the technology couldn’t be adequately adapted for the intended purpose, the very sophisticated interface was ideal for keyhole surgery.
What are the applications of robotic surgery?
In the decades that have followed the surgery has been adapted to a wide range of surgeries. For example, with tumours on the kidney. Previously the surgeon would have to remove the entire organ, now the robotic system can carefully take out the tumour and it’s possible to leave the kidney intact.
Dr Moon was also enthusiastic about its applications to head and neck surgery particularly on how the technology can get to laryngeal tumours (which occur at the base of the tongue).
‘Previously to get that far back, you’d have to break the jaw, or treat with radiation. Now with robotics you can scurry down the back of the throat to the tumour.'
Robotic surgery is also starting to have a significant impact on gynecology, cardiac surgery and thyroid surgery.
The challenges of robotic surgery
However, while there have been incredible leaps forward, Dr Moon admits that there are still challenges that the industry faces. One of the biggest issues, he suggests, is that the technology is to be found predominately in the private sector.
Another issue has been the learning curve the technology has presented to surgeons, and the issues around how to best educate and train them. Because it’s such a new area, Dr Moon and his team have had to be very proactive in keeping up-to-date in creating best practices.
5 things that helped create a successful robotics culture
To that end Dr Moon shared the five key lessons he learnt in implementing and working with robotics technology:
1. Having the right team is vital
At every level, from the theatre team, to the techs you need to make sure the entire operation is compatible and working towards the same aim, because a weak link will dominate the outcomes.
2. Keep up with training and best practices
Dr Moon states, ‘ because we started from scratch, we have to make sure that we have a good auditing system, while allowing technology progress to be made.’
Collaboration is a key factor to the success of the technology. Dr Moon says to ‘[collaborate] between cities, between surgeons, between hospitals and between industries. Put databases together, swap articles and constantly strive to learn from each other.'
4. Know your outcomes
You don’t want your outcomes to be a marketing tool, you want to demonstrate that you’re making a difference. For example, Dr Moon’s team have looked at over 5,000 prostatectomies, and can clearly demonstrate the improvements on factors like, incontinence recovery, patient wellbeing.
5. Push the boundaries
Dr Moon finished off by saying that:
"We’ve just had a 10 year celebration of robotic surgery. We can now watch surgeries on screen and real-time. We recently had a team in LA perform surgery while we watched at a conference at the MCG. Amazing. I think in the next ten years we’ll start to see the technology become more cost-effective which will raise the bar in terms of surgical outcomes. We’re just at the start and I am really looking forward to see what the technology is going to bring us in the next decade."