Accessing the surgical area: Digitization is coming to the OR

Innovative medical technology is driving the digitization of healthcare institutions and is opening a world of possibilities. This is especially the case for minimally invasive robotic-assisted surgery.

The Da Vinci system is perhaps the most famous surgical robot. Since its introduction in 2000, more than 5,500 systems have been installed to date with the number of procedures performed worldwide by surgeons surpassing seven million. For the past two decades, complex systems like the Da Vinci have been introduced into the routine practice of various medical specialties to assist surgeons. The numbers are expected to increase since the surgical platform’s many advantages are obvious.

Robotic surgery uses a few small incisions, making treatment especially safe for patients as they experience significantly less pain, less blood loss, less scarring and a quicker recovery time along with shorter hospital stays.

Robotic-assisted surgery enhances the capabilities of the surgeon’s hands. The system delivers 3D high-definition views, giving the surgeon a clear view of the surgical area that is magnified up to ten times on the screen. Using a joystick to control the robot, the latter translates the surgeon's hand movements at the console in real time and eliminates tremors. This facilitates complex interventions in areas that are difficult to access, allows highly precise movements, gentler tissue manipulation, superhuman perception, and improved diagnosis and therapy by analyzing vast amounts of data. Thanks to a more efficient use of medical resources and staff, the application of robotic-assisted systems is also more cost-effective.

To maximize the potential of medical robotics, the systems must be adapted for their desired applications or must be newly developed. Tim-Lukas Habich is a research assistant at the Institute of Mechatronic Systems of the Leibniz University Hannover and focuses on the latter. His hydraulically actuated, snake-like robot for endoscopy is called HALEy and is designed to bridge the gap between the previous rigid and flexible designs. “Rigid endoscopes maintain high stiffness or rigidness but cannot reach target areas that are hidden or difficult to reach. For example, a gastroscopy requires a physician to look at the inside of the stomach. It would be impossible to accomplish this via your esophagus with a rigid endoscope,” says Habich. Instead, physicians use a flexible endoscope to warrant excellent maneuverability. However, the rigidity at the distal end is too low to enable tissue manipulation. As part of the HALEy project, the research assistant examines the principle of the hyper-redundant robot, which features discrete joints: providing a snake robot whose body can be fully controlled and delivers the desired rigidity.

Prof. Peter Pott is the Director of the Institute of Medical Device Technology at the University of Stuttgart. Along with his team, he is likewise working on a robot-assisted endoscope. His version is flexible and emphasizes different aspects. " Our focus is on developing actuation and sensor technologies that are small and powerful, yet cost-effective to also permit the robotic-assisted application of single-use endoscopes,” he explains. 

By now, Da Vinci has gotten some competition: In August of this year, the space-saving surgical robot system Avatera was introduced into everyday clinical practice in the Department of Urology at the University of Leipzig Medical Center (Universitätsklinikum Leipzig, UKL). The test phase will last several weeks with 25 scheduled interventions. Ten of which have already been performed, including several assisted surgeries for prostate cancer. The hospital reports no complications so far and the successful completion of all interventions. Avatera is a German proprietary development based in Jena. The system is designed to complement the existing portfolio of surgical robotic systems.

In August, a team led by Dr. Maximilian Kückelhaus and Prof. Tobias Hirsch from the Center for Musculoskeletal Medicine at the University of Münster (Westfälische Wilhelms-Universität, WWU) has carried out the first completely robot-supported microsurgical operations on humans. The scientists use an innovative operating method in which a new type of operations robot, designed especially for microsurgery, is networked with a robotic microscope, allowing the operating surgeon to be taken out of the operating area completely. The experts use the approach on patients with breast cancer who need complex breast reconstructions, or after accidents in which patients need tissue transplants. The system allows the surgeons to reconnect highly delicate anatomical structures such as blood vessels, nerves, or lymphatic vessels, which are often only 0.3 millimeters in diameter.