Experiences with and Expectations of Robotic Surgical Systems: A Rapid Qualitative Review [Internet]

Excerpt

Robotic surgery (RS) involves a surgeon at a console operating remote-controlled robotic arms that facilitate the performance of laparoscopic procedures. The surgeon sits un-scrubbed at a console that provides them with a magnified pseudo 3-dimensional (3D) view of the surgical site. From the console, the surgeon is able to control the robot arms that hold the laparoscopic instruments inserted into the patient. Over the past 20 years, RS has emerged as an alternative minimally invasive surgical strategy. One system of surgical robots, da Vinci (Intuitive Surgical, California, USA), has been widely advertised and adopted by surgeons and hospitals since receiving approval from the United States Food and Drug Administration (FDA) in 2000. There has been rapid growth in the purchase of da Vinci robots and in the number of RS procedures performed annually in North America and worldwide. Other competing devices have been introduced to the market more recently (e.g., the Versius System or the Hugo System).

While RS is most commonly used in urology and gynecology, its use is expanding across other surgical specialties, such as ear nose and throat, colorectal, cardiology, pediatrics, and plastic and reconstructive surgery.^,, Surgical advantages have been reported with RS including improved dexterity and intuitive instrument handling, reduction/elimination of tremors, motion scaling, and superior visualization including three-dimensional imaging.^,, Systematic reviews and meta-analyses have found the clinical benefits of RS to include less blood loss compared to conventional laparoscopic surgery,^, shorter hospital stays as compared to open surgery and conventional laparoscopic surgery^, and evidence indicates RS holds potential for smaller incisions with minimal scarring and faster recovery than nonrobotic-assisted procedures. The CADTH Rapid Response report further outlines the clinical evidence on its Use in Gynecologic Oncology or Urologic Surgery. Overall, the evidence on RS as the superior surgical option is inconclusive and more trials are needed across surgical specialties.

RS has introduced new challenges and additional responsibilities for surgical teams in an already challenging and multifaceted work environment.^, Challenges with RS relate to the complex, highly technical equipment involved;^, patient positioning; the long duration of the procedure;^, and the separation of the primary surgeon from the patient. These challenges may alter the way that members of the surgical team interact, affecting patient safety and quality of perioperative care related to RS.^,– An understanding of the factors that patients value with regards to robotic surgery and surgical teams’ experiences with these robotic surgical systems is needed. This report summarizes the qualitative evidence of the patients’ and surgical teams’ experiences of robotic surgical systems.