Since its emergence in the 1980s, minimally invasive surgeries (MIS) have been widely adopted across many surgical specialties. It is seen as a safe and effective technique over traditional open surgery, which requires larger incisions and a typically longer hospital stay.
The advent of MIS has seen further innovations in the field of robotic-assisted surgery (RAS). An advanced form of MIS, RAS has shown potential in achieving low complication rates and better patient outcomes. Current systems offer surgeons magnified, high-definition view, and greater dexterity and precision through the robotic arms and specialised instruments (such as surgical cameras, scalpels and forceps). Surgeons have acknowledged the benefits of RAS: as of 2020, more than 7.2 million robotic surgeries have been completed in 67 countries worldwide.
ITM: Seamless connection between the surgical table and robot
The popularity of RAS has driven expansion of its applications. One notable feature that has emerged is the ability to reposition the surgical table intraoperatively, i.e. Integrated Table Motion (ITM). ITM is a software which allows for point-to-point wireless communication (via infrared and radio frequency connections) between the surgical table and the surgical robot.
The connection allows the surgical table and robot to move in synchrony – the table’s positioning is relayed to the robot, which adjusts its arms and instruments to the optimal orientation to the patient’s body. The data feedback on table position allows surgery team to adjust the positioning as required. As a back-up, a wired cable connection is also provided for alternate connection.
Combining RAS and ITM to deliver better surgical performance
- Improved surgical outcome
RAS has enabled certain complex specialist procedures to be now carried out with less risk. An example is the lymph node clearance procedure for treating testicular cancer; the traditional open surgery approach would be extremely invasive, but minimally invasive robotic surgery could allow patients to return to recover fully within three weeks.
Enhanced Visibility and Access
The combination of ITM would further maximise access to the target surgical site for both surgeons and anaesthesiologists, providing them with an ideal working angle and the option for immediate repositioning during surgery. The solution leverages on gravity to expose the internal anatomy during robotic-assisted surgery. This also helps in locating unanticipated bleeding and critical structures to avoid. A 2020 study conducted by Suazio Consulting, which interviewed over 90 robotics surgeons and anaesthesia team members, reported that many surgeons appreciated how they do not have to ‘settle’ or ‘compromise’ on a preferred angle or view. As such, surgeons can work with more flexibility and autonomy, and patients can expect less scarring.
Improved Communication and Feedback
In addition, the real-time visual and data feedback on table positioning, such as the height and angle of tilt at each part of the body, is captured and presented on the surgeon console and touchscreen monitor. The ability to capture specific quantifiable data and numerical values allows for repeatable, precise positioning with predictive success – for instance, the table positioning values of a successful surgery can be referenced for future similar cases.
- Higher levels of patient safety
With the delicate precision offered by RAS, it is easier for surgeons to avoid surrounding nerves and organs. The use of RAS has been associated with less blood loss and less pain, which reduces the need for pain medicine post-surgery. The leveraging of gravity provides for less manipulation and trauma to the organs, minimising the risk of unintended injury.
There is also a reduced risk of infection with the use of sterilised robot systems and less movement from the surgery team, as well as lesser post-surgery complications, which contributes to improved recovery rates and reduced length of hospital stay.
- Workflow efficiency and time savings
With improved visualisation and dexterity, RAS hold potential for enhanced productivity and shorter procedure times.
One challenge that surgeons have faced with RAS was the time and effort needed to dock and undock the robotic platform during the procedure. For example, undocking may be needed mid-surgery, to adjust the bed for patient-supine relief during longer surgeries.
However, the coupled use of ITM would overcome this issue, as it allows for repositioning of the table while the robot is docked. The Suazio whitepaper found that eliminating undocking saved between 10 to 35 minutes per procedure. Surgeons raised that they also benefit from avoiding interruption of undocking, allowing them to maintain focus and concentration on the surgery.
One surgeon who found ITM useful was Professor Dr Yen-Chuan Ou, a urologist at Tungs’ Taichung Metro Harbor Hospital in Taiwan. “Integrated Table Motion can facilitate the process of making the procedure very simple and time efficient during radical prostatectomy, radical cystectomy and radical nephroureterectomy (surgical removal of prostate, bladder, and kidney/ureter respectively). Also, I can intra-operatively reposition my patients who experience excessive pleural pressure without undocking. According to my experience, I can save up to 20 minutes each case on average,” he said.
Future of robots in optimising surgical performance
Robotic surgeries signal a new era in how surgical procedures are conducted. However, rather than taking over the role of human surgeons, robots act as an aide to surgeons, providing them with support and confidence in addressing long and complex procedures – all towards the ultimate goal of improving patient outcomes and safety. With the numerous ongoing studies and research into future robotic surgery applications – such as autonomous robots and remote care enabled by 5G connections – the technology holds much promise in transforming the healthcare industry in the years to come.
Hillrom is a leading medical technology company on the edge of innovation. Its TS 7000dV Operating Table works with ITM to seamlessly link to robotic surgical systems for smooth, dynamic positioning of the patient. For more information, download the brochure here.