AI and Microtechnology

Artificial intelligence and microtechnologies are improving at a rapid pace. Both will affect robot-assisted surgeries, as more companies enter the market and the range of surgeries possible with robotic instruments expands.

Intuitive Surgical’s da Vinci robotic surgery platform is the most widely used robotic system. However, a number of new players have entered the market since several of Intuitive’s patents expired in 2016.

Large vs. small platform

The da Vinci platform is for general surgery (some cardiac, colorectal, general, gynecology, head and neck, lung biopsy, thoracic, and urology). Medtronic is Intuitive’s largest competitor with a general surgery platform. However, the cost of large, multiuse systems like the da Vinci platform has led to the development of smaller, more compact, and more specialized platforms, like Zimmer Biomet’s ROSA and Stryker Corp.’s Mako, both of which are used to perform orthopedic surgeries.

At the same time, the movement has been toward smaller platforms that take up less space in often overcrowded operating rooms. There is an emerging trend toward modular systems, such as the Versius surgical robot from Cambridge Medical Robotics. Each Versius arm has its own cart, providing a smaller footprint and allowing carts to be added and removed as needed.1 These will be especially important for ambulatory surgery centers who have less space than hospitals and less need for large, general surgery systems.

Robotic surgical systems used to require multiple incisions, one for each instrument. In 2018, though, Intuitive introduced a single-port system with three instruments on one arm. Single-port systems are now the standard, but may still require a fairly large incision. Companies are working to make the instruments, and thus the incision, increasingly smaller.2 One new endoscopic robotic system, Virtuoso, uses concentric tube manipulators that allow instruments to be as thin as 1 mm.3

New technologies

New technologies are being added to improve the experience, ease of use, and efficacy of robot-assisted surgeries. Companies are adding haptics to give surgeons a more tactile experience, making it more like standard surgery. Voice commands and eye gaze can be incorporated into systems for moving tools rather than using hand controls.

Some are working to add artificial intelligence (AI) and new computer technologies to their systems. Augmented reality and artificial intelligence can be used to create accurate 3D models of a specific patient and predict surgical outcomes based on that patient’s history. Augmented reality also may allow layering of radiological imaging over the surgeon’s view of the patient.2

One of the most difficult pieces of the move to robot-assisted surgery is training new surgeons to use the machines. The expense of the systems often means hospitals only have one or a few systems. They are often in use, leaving little time for surgeons to practice with the machines. Augmented and virtual reality can be harnessed to aid in training, giving surgeons a feeling for the experience without endangering patients. They can be useful in reviewing video of surgeries and critiquing surgeons’ techniques, as well.

Effect on sterile processing

What does all this mean for sterile processing? The biggest challenges will be in the development of more flexible and snakelike arms that can enter blood vessels and microsurgery tools that will allow for smaller incisions, as well as attach to these smaller, flexible arms.4

These microsurgical instruments and narrow, flexible arms will require irrigation for proper cleaning. Many washer-disinfectors and ultrasonic cleaners already handle da Vinci instruments because they have been the major player in the market for 20 years. However, adjustments will have to be made to accommodate smaller, more delicate instruments. Even brushes used in manual cleaning will need to be resized for narrower openings.

Robotic surgery has been in use for more than 25 years. Intuitive Surgical has had the field largely to itself until recently. New companies’ and systems’ entry into the market has increased the pace of development and change. To keep patients safe, sterile processing departments need to prepare for these changes.

 

References
  1. Nikhil Mayor, Andrew SJ Coppola, and Ben Challacombe, “Past, present and future of surgical robotics,” Trends in Urology & Men’s Health, 13: No. 1, January/February 2022, pp 7–10, https://doi.org/10.1002/tre.834.
  2. Joe Batley, “Robot-assisted surgical trends in 2023 and beyond,” Springboard, 14 December 2022, accessed 17 November 2023, https://www.springboard.pro/robot-assisted-surgical-trends-in-2023-and-beyond/.
  3. Ma Runzhuo, MD, and Andrew J. Hung, MD, “AUA2023 Take Home Messages: Innovation in Robotic Surgery,” AUA News, 30 August 2023, accessed 17 November 2023, https://auanews.net/issues/articles/2023/august-extra-2023/aua2023-take-home-messages-innovation-in-robotic-surgery.
  4. Jim McCartney, “Robotic Surgery Is Here to Stay—and So Are Surgeons,” American College of Surgeons Bulletin, 108, no. 5, May 2023, https://www.facs.org/for-medical-professionals/news-publications/news-and-articles/bulletin/2023/may-2023-volume-108-issue-5/robotic-surgery-is-here-to-stay-and-so-are-surgeons/.