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Fellow contribution
The state of robotic surgery
Robotic surgery began in Australia in 2003, having commenced in the United States in 2002. Urology was the first surgical discipline to take up robotic surgery, mainly robotic radical prostatectomy. Since its introduction, there have been significant barriers to its adoption. These can be summarised in three points. First, scepticism about the perceived benefits of robotic surgery compared to traditional open and laparoscopic surgery; robotic enthusiasm was once described as ‘gizmo idolatary’. Second, the capital cost of the robot being around $4 million prevented installation of these machines in the financially constrained public hospital system, where registrar surgical training occurs. This meant that graduate Fellows of the College of Surgeons (FRACS) have to do a second expensive Fellowship to learn robotic surgery after graduation. Third, there is no validated curriculum for credentialing to proficiency in robotic surgery. Vendors have thus far provided the education and credentialing for robotic surgery. In Australia this means a brief online instructional video on how to drive the robot, called ‘buttonology’.Then a single porcine live animal surgery, followed by mentorship by another colleague in one or two early cases. As has often been the case in the digital age, the introduction of fancy new technology outstripped the ingenuity and ability of those destined
CMR Versius robotic system
We have recognised the true benefits of minimally invasive surgery since the introduction in the 1990s of laparoscopic surgery, which disseminated through many surgical disciplines. Minimally invasive surgery provides small incisions, reduced blood loss, reduced length of hospital stay and earlier return to normal activities. Robots added a third and fourth dimension to laparoscopy being threedimensional 10 times magnified view for the surgeon, and digitised telestrated intuitive hand movements, rather than the counterintuitive movements used in laparoscopy.
to challenge the existing monopoly. These machines will come with lower costs and enable provision of machines in the public system where Surgical Education and Training (SET) occurs. This second generation of robotic surgery will also embrace application of artificial intelligence in surgical procedures, and certain parts of operations such as suturing and wound closure may be automated. The cost of robotic machines is likely to reduce by about one third when competitive technologies are introduced. Robotic procedures will be undertaken in many more disciplines, including General Surgery with cholecystectomy, appendicectomy and hernia repair. Other disciplines to embrace robotics include bariatric, Colorectal, Ear Nose and Throat (ENT), gynaecology and Cardiothoracic Surgery.
We have just witnessed the end of the first generation of robotic surgery led by the Intuitive Surgical Company with the da Vinci machine from 2000-2021. In 2022, there will be at least three new robotic surgical machines available in Australia from three different providers: Medtronic, Cambridge Medical Robotics and Medicaroid Corporation (developer of the Japanese Kawasaki Hinotori machine). Intuitive Surgical Company’s da Vinci machine has proven to be the Rolls Royce in robotic surgical technology. It remains to be seen whether the new machines will be equivalent or at least good enough
In 2018, an independent commission, established by the Royal College of Surgeons of England, published a report on the ‘Future of Surgery’. This report describes how the surgeon’s role will change in the next 10 years. The surgeon of the future will have multiple skills. They will have to understand the language
to use it. Nowhere has this been more obvious than the introduction of telerobotic surgery. The manufacturers of the robot, mainly engineers not surgeons, developed a brilliant new technology.
Based on sales of $5.3 billion in 2019, Goldman Sachs has predicted that the worldwide robotic market will increase incrementally after the emergence of new competitors. The prediction is the market will be worth $14.1 billion in 2025, and $24 billion in 2030.
