Chapter 16: Perioperative care
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Robotic surgery
Robotic surgery has now been established for some time (the Da Vinci system was licensed in 2000). Robotic surgery is another type of minimally invasive surgery; it uses miniaturized surgical instruments and a series of 5 or 8 mm incisions.
Related theory
Robotic arms have for some time been used to replace surgical assistants holding retractors, and more advanced devices are now in use. Telemanipulation systems exist, by which the surgeon's hand movements are accurately reproduced within the patient's body. The surgeon controls these instruments and the camera from a console located in the operating room. The surgeon controls all four arms of the robot simultaneously.
The Da Vinci Surgical System (Figure 16.22) is able to manipulate instruments through 360°, which is something that even the most talented and dextrous surgeon cannot do. Its endo‐wrist allows better manipulation of the tissue retraction or dissection, in areas that are hard to reach compared to in laparoscopic or conventional open surgery. As with regular laparoscopic surgery, those patients having robotic surgery will have a shorter recovery time in hospital compared to those having open surgery for the same procedure.
Figure 16.22 Da Vinci surgical robotic operating theatre.
Clinical governance
Competencies
Staff involved with robotic surgery must have additional special training in order to set up and assist with robotic procedures (Figure 16.23). Robotic equipment requires a skilled practitioner who has the technical knowledge to operate the device competently. This is achieved through comprehensive technical training, which must be completed before a practitioner can assist in a robotic procedure (Figure 16.24)
Figure 16.23 Specialist staff using Da Vinci robotic equipment.
Figure 16.24 Robotic surgical team. Source: Reproduced with permission of Intuitive Medical, Inc. © 2014 Intuitive Surgical, Inc.
