Surgical Robot and its Impact on Health-Care Services
Rajendra B. Nerli, Shridhar C. Ghagane, Dayananda Melanahalli · Journal of the Scientific Society · 2023
Robots are increasingly being adopted in health care to carry out various tasks that enhance patient care. Technological advancements have enabled robots to conduct increasingly varied and complex roles in health care. For instance, precision tasks such as improving dexterity following a stroke or assisting with percutaneous coronary intervention.[1] The advent of the COVID-19 pandemic led to the health-care industry being flooded with novel technologies to assist the delivery of care in unprecedented circumstances.[2,3] Robotic systems have long been known to be able to alleviate workforce pressures, not least in health care.[4] Such systems can include remote presence robots for virtual consultations or transportation robots for automated delivery of equipment within hospitals. In addition to supporting hospitals, robotic systems can offer the ability to support clinical practice in a variety of specialties. Examples include exoskeletons that assist stroke patients in mobilization and surgical robots that allow surgeons to perform operations. It is important also to understand the landscape of roles that robots have in health care to inform the research and development of the future.[1] Morgan etal.[1] searched the following databases, namely CINAHL, Cochrane Library, Embase, MEDLINE, and Scopus, using medical subject headings that included robots and extracted 1123 publications that were eligible for inclusion in the review. Eighty-nine percent of the manuscripts focused on adult populations, with only 7% that included the pediatric population. The specialties with the most publications were stroke (n = 194, 21%), urology (n = 149, 16%), and general surgery (n = 137, 15%). The clinical settings included the surgical theatre (n = 498), the rehabilitation unit (n = 353), catheterization labs (n = 17), pharmacies (n = 16), and general wards (n = 10) [Figure 1].Figure 1: Number of publications on robotRobots and their Roles in Health Care One hundred and seventy-one named robots have been identified. The da Vinci Surgical System [Intuitive Surgical, USA, Figure 2] was most frequently studied (n = 291); the Lokomat® (Hocoma, Switzerland) (n = 72) and hybrid assistive limb (Cyberdyne, Japan) (n = 46) being the next commonly used. The identified robots were categorized by their role, leading to the formation of 10 different groups. These groups represent the 10 overarching roles that robots have been found to have within health care, namely surgical, telepresence, pharmacy, socially assistive, interventional, imaging assistance, disinfection, radiotherapy, delivery, and transport.Figure 2: Da Vinci surgical robotSurgical Robots Surgical robots are presently used to assist in performing surgical procedures.[5] Their specific roles within surgery are varied, ranging from instrument (endoscope) control to automated surgical table movement. This is a well-explored role, with 19 named robots presently being identified. Most studies within this category are observational in nature (90%). The da Vinci Surgical System is the predominant robot in use and thus has the largest literature base behind it.[5] The system provides instruments that can be controlled by a surgeon through a console to perform minimally invasive surgery. It can be used in procedures including cholecystectomy, pancreatectomy, and prostatectomy. Other robotic systems that are being used include the ROBO-DOC® Surgical System (Curexo Technology, USA), which is used in orthopedics to plan and carry out total knee arthroplasties,[6] and Robotized Stereotactic Assistant (ROSA®) (Zimmer Biomet, France) which can assist with neurosurgical procedures such as intracranial electrode implantation.[7] Some robots can also assist with biopsies. For example, the iSR’obot™ Mona Lisa (Biobot Surgical, Singapore) can assist with visualization and robotic needle guidance in prostate biopsy.[8] Factors Associated with Hospital Decisions to Purchase Robotic Surgical Systems Robotic surgical systems are expensive to own and operate, and the purchase of such technology is an important decision for hospital administrators. Most of the literature focuses on the comparison of clinical outcomes between robotic surgery and other laparoscopic or open surgery. There appears to be a huge knowledge gap as to what drives hospitals to purchase robotic systems.[9] Shen etal.[9] reported on factors associated with a hospital’s decision to acquire advanced robotic surgical systems. They used the 2002–2011 data from the State of California Office of State-wide Health Planning and Development to examine the robotic surgical system purchase decisions of 476 hospitals. Hospitals with a high volume of surgical procedures (>50,000 surgeries) were more likely to purchase robotic systems. They concluded that potential market demand and the available resources were a strong driver for hospital purchase of robotic surgical systems. The market competition did not significantly increase the adoption of new, expensive surgical technologies. Decisions on large capital expenditures, such as robotic surgical system purchases, are important for the financial health of hospitals. The acquisition of a robotic system can cost up to $2 million, and additional consumables and annual maintenance fees contribute to ongoing costs. It is largely unknown how acquisitions of robotic surgical systems affect the market share of hospitals. Future studies are necessary to further examine the relationship between the acquisitions of a robotic system and the financial health and performance of hospitals. Effect of Regional Hospital Competition Robotic-assisted surgery has diffused rapidly into clinical practice as of today. Marketing to physicians, hospitals, and patients has been widespread, but how this marketing contributed to the diffusion of the technology remains unknown. Wright etal.[10] examined the effect of regional hospital competition and hospital financial status on the use of robotic-assisted surgery for five commonly performed procedures. A cohort study of 22,1637 patients who underwent radical prostatectomy, total nephrectomy, partial nephrectomy, hysterectomy, or oophorectomy at 1370 hospitals in the United States from January 1, 2010, to December 31, 2011, was conducted. The use of robotic-assisted surgery increased for each procedure from January 2010 to December 2011. For all five operations, increased market competition (as measured by the Herfindahl–Hirschman Index) was associated with increased use of robotic-assisted surgery. The authors concluded that patients undergoing surgery in a hospital in a competitive regional market were more likely to undergo a robotic-assisted procedure. It is well known that patient characteristics are associated with the use of robotic-assisted surgery; however, studies have shown that regional market forces also influence care. Although patients treated at hospitals located in competitive regional markets are more likely to undergo robotic-assisted surgery, the hospital’s financial status appears to have a more limited association with the use of robotic-assisted surgery. Impacts of Robotic-assisted Surgery on Hospital’s Strategic Plan The modern hospital environment is highly connected to technology and engineering. A vast number of technological equipment is widespread in a hospital, from laboratories to intensive care and from short-term care to operating theater. The technological equipment is of key importance regarding the strategic plan of the hospital in various aspects as well as the economic view. Platis and Zoulias[11] reported that although, for some cases, robotic surgery proved not to be cost-effective, in total and taking into account all aspects that were involved in a hospital, robotic surgery was worth implementing. Benefits of Robotic Surgery Robotic surgery offers many benefits to patients compared to open surgery, including shorter hospitalization, reduced pain and discomfort, faster recovery time and return to normal activities, smaller incisions, resulting in reduced risk of infection, Reduced blood loss and transfusions, and minimal scarring.[12] At the same time, robotic surgery offers the operating surgeon several advantages that include: greater visualization, enhanced dexterity, and greater precision.