Invasive Techniques For Robotic Surgery

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Robotic surgery is increasingly being implemented to overcome drawbacks associated with the use of conventional techniques such as laparoscopy, especially in complex procedures. However, despite holding significant promise, robotic surgery is associated with some clear disadvantages and robust evidence base supporting robotic assistance remains lacking[1].
The introduction of minimally invasive techniques to general surgery has been described as “the most dramatic change in surgery since the introduction of anaesthesia”[2]. This has led to many procedures being performed exclusively via the laparoscopic approach, such as a cholecystectomy. Reasons include reduced blood loss and post-operative pain, reduced risk of infection, reduced length of hospital stay and faster return to daily activities[3]. However, these superior results are only when the initial learning curve has been taken into account.
Laparoscopic surgery is associated with several challenges. Disadvantages and complications have been well documented[4]. Long, rigid instruments amplify tremor, reduce range of motion and degrees of freedom. This is exacerbated by the fulcrum effect whereby instrument tips move in a direction opposite to those of surgeon’s hands[5]. Loss of 3-dimentional (3D) vision and having to view a 2-dimentional image, not directly under the control of surgeon, enhances these difficulties by leading to loss of traditional eye-hand target axis[6]. The laparoscopic technique is
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