For decades, surgery was guided by a simple belief: the bigger the incision, the better the result. This idea has now been put to rest. Advances in surgical science have shown that well-performed minimally invasive surgery (MIS) can provide results equal to and often better than traditional open procedures, while causing far less trauma to the patient. This change has prompted the gradual evolution of surgery from large open incisions to laparoscopy, which uses small incisions, cameras and delicate instruments to reduce pain, shorten hospital stays and speed recovery. Today, robotic surgery represents the next step forward, building on minimally invasive principles while incorporating technology that enhances the surgeon’s vision and dexterity.
The journey of robotic surgery began decades ago. In the late 1980s, Imperial College London developed PROBOT for prostate surgery. This was followed by the AESOP (voice controlled camera holder) and ZEUS (for telesurgery) systems, which allowed surgeons to control instruments remotely.
In 1985, the first robot-assisted procedure used the PUMA 200 robotic arm for a brain biopsy. In the UK, Professor Prokar Dasgupta, Professor of Robotic Surgery and Urological Innovation at King’s College London, pioneered robotic urological procedures. Today, the da Vinci system, which was approved in 2000, leads the field and has become synonymous with robotic surgery worldwide.
Surgeon friendly
Dr Raghunath SK, urological oncologist and robotic surgeon, explains that robotic surgery enables the surgeon to operate from a main console located a short distance from the patient. Every movement of the hand translates into precise and vibration-free actions of the instrument.
The surgeon is provided with a real-time, magnified, high-definition three-dimensional view of the surgical field. Robotic instruments mimic the natural movements of the wrist, offering seven degrees of freedom, which allows safe and precise surgery in narrow and complex anatomical areas that are difficult or impossible to access using open or conventional laparoscopic techniques. Moreover, this approach significantly reduces surgeon fatigue during long procedures and, in turn, helps extend the surgeon’s operative career.
Faster healing
Precision is especially valuable in major cancer surgeries, where major blood vessels and vital nerves must be carefully navigated. Robotic instruments help minimize tissue damage, reduce blood loss, and improve nerve preservation. These advantages lead to faster recovery and earlier discharge. According to Professor Dasgupta, precision can also make robotic surgery cost-effective by reducing complications and the need for prolonged post-operative care. Importantly, the basic surgical principles, especially in the treatment of cancer, remain unchanged whether the operation is performed open, laparoscopically or robotically.
Patients experience clear benefits. Minimally invasive robotic procedures cause less disruption to the immune system, allowing for earlier initiation of chemotherapy, immunotherapy or radiotherapy. In urological operations, complications such as urinary incontinence and sexual dysfunction are less common. Tumors can be removed through small incisions, with excellent sample quality and reduced risk of infection and postoperative pain. Short-term results, including a faster return of bowel function and motility, are superior to those of open surgery, and long-term cancer control continues to show encouraging results.
Artificial intelligence
Artificial intelligence is increasingly integrated into surgical systems, but experts emphasize that the technology assists, not replaces, the surgeon. “The machine and the man behind the machine are both important,” says Dr Raghunath. Professor Dasgupta highlights innovations such as combining robotic surgery with 3D printing. Creating a 3D model of a patient’s cancerous prostate allows surgeons to see and even feel the tumor before surgery. “The model restores the sense of touch and takes the guesswork out,” he notes. This approach, pioneered at Guy’s and St Thomas’ hospitals in London, has personalized robotic surgery for individual patients.
Despite these advances, open and laparoscopic surgeries remain essential. Trauma cases often require open surgery. In India, where access to advanced technology is uneven and costs remain high, traditional techniques continue to play a vital role.
Cost remains a significant barrier to the widespread adoption of robotic surgery. However, increased usage and competition in the market are expected to lower prices. India’s indigenous robotic system offers a more affordable alternative, pointing to a future where advanced surgical care becomes accessible to a wider population. With the expansion of 5G networks, remote telesurgery, allowing surgeons to operate remotely across the country, may soon become a reality.
(Dr Jagannath Dixit is a senior robotic surgeon in Bengaluru. Dr Praveen Kumar Kaudlay is a consultant haemato-oncologist with a special interest in stem cell transplantation at Royal Wolverhampton NHS Trust, UK. He can be contacted at praveen.kaudlay1@nhs.net.)
