NEW HORIZONS IN ROBOTIC SURGERY

Franca Melfi

Vice Chair of EACTS and Professor of Thoracic Surgery at the Medical School of the University of Pisa and Chair of Robotic Multidisciplinary Centre for Surgery – Thoracic MIS and Robotic surgery at the University Hospital of Pisa.

Robotic surgery is being transformed by the rise of new technologies like AI and 5G. Even though the technology has been around for more than 20 years, in many ways it has remained in the early stages of adoption. But now, with more companies entering the market and new technologies enabling better robotic systems, a transformation is taking place.

Robotic surgery is already well-established. Around the world more than 12 million patients have undergone robotic surgery procedures in all specialties. In Europe more than 900 robotic systems are in place in surgical theatres and more are being commissioned. Europe pioneered robotic surgery, although progress has stalled more recently because of regulatory hurdles.

Nonetheless, the advance of robotic surgery has been remarkable. To put this progress into context, in 2001 Prof Melfi was the first surgeon to perform a robotic lobectomy. This was considered an experimental procedure, with a team with no experience of robotic surgery, with no guidelines and using a platform with three surgical arms that was already old.

Today there is a substantial body of research to reassure patients over the safety of robotic surgery. We know that rates of long-term survival are higher for robotic surgery than for open surgery; recovery is quicker so people spend less time in hospital; and the risk of complications, such as blood clots is lower. Robotic surgery is better for patients because it is less intrusive. It is easy for surgeons to switch from open surgery to robotic surgery, using the same movements and techniques.

Now we are in a new phase of the development of robotic surgery. The robot is just one element in a vast system designed to assist the surgeon. Research is ongoing into augmented reality platforms for robot-assisted laparoscopic surgery; 3D deformable object tracking and extraction in medical imaging; AI for image processing; new surgical instruments; and new sensing devices.

The images now available to surgeons during procedures are remarkably clear and getting even better as the technology advances. The 3D virtual reconstructions are really helping surgery. When you apply the AI algorithm it gives you the opportunity to study and understand the shape of the tumour and the aortic arch. This manoeuvre can be performed in a safe way for the patient.

We are seeing many new platforms and new approaches, which can only be good for the future of robotic surgery. There are exciting advances in robotic navigation; for example, two robotic bronchoscopes have been approved by the FDA (Ion and Monarch).

We have new sensing devices, including sensors for surgical robotic tools to provide information to surgeons, and a new class of sensors to acquire vital chemical information from the field. There are new surgical instruments for telerobotic surgery, such as mechatronic design of tools with integrated sensors and control strategies to improve the surgeon’s sensorimotor skills.