Republic of the Philippines

Isabela State University- Main Campus

San Fabian, Echague, Isabela

College of Arts and Sciences

Bachelor of Science in Psychology

A Case Study on the Use of Technology in Medicine:

Robotic Surgery

Submitted by: John Mark Emata Ria Celine Versoza

Edlyn Mar Custodio Jonabel Domingo

Dan Heaven Guerrero Shaira Mae Macalintal

Desiree Jane Agor Jelie Lean Cabansi

Cherry Belle Carag Jessa Mae Mateo

Marvin Gaspar Alyanna Abejo

Submitted to: Mr. Darios B. Alado

Living in the Information Technology Era Professor
A Case Study on the Use of Technology in Medicine: Robotic Surgery

Rationale
1
Robotic-Assisted Laparoscopic Surgery or commonly known as Robotic
Surgery has become one of much widely used technology in the field of
medicine, especially in Urology. It is a form of laparoscopic or minimally invasive
surgery in which computer-controlled robots will assist the surgeon or doctors
with an increased level of dexterity and allows them to operate in small spaces
inside the body that would otherwise require open surgery.

Instead of using traditional open surgery, they invented this robotic

surgery because it results in just some smaller incisions, which can reduce pain
and also scarring. It can also lessen the time that we will be spending on the
surgery procedures, especially when it comes to the recovery time. Robotic
Surgery is faster than traditional one.
2
Robotic surgery was initially developed by the USA forces as a medical
tool to perform procedures in warzones without endangering and hurting every
surgeon and doctor. The first-ever trial on Robotic-Assisted Laparoscopic
Surgery was performed by the Cardiac Surgeon followed by the other surgeons
in different specialties like nose, ear, throat, and gynecology.

Different Urological procedures are being performed robotically such as

Radical Prostatectomy, Radical Cystectomy, Renal Procedures like Partial
Nephrectomy and Pyeloplasty as well as Ureteric re-implantation
and Adrenalectomy.

Robotic Surgery is very important and helpful, not just in every patient but
also in every surgeon or doctor. The particular reason for this circumstance is
that Robotic Surgery will allow the surgeons and doctors to perform very delicate
and complex surgical procedures that have been very difficult or even impossible
to happen without the help and did of the robot.

1
https://www.frontiersin.org/articles/10.3389/fsurg.2016.00026/full?fbclid=IwAR0KtZtMrspYm0RcXtInj3F
1KfGhsJ5iyYl1I7bKEYzmt2-ELVGRFLgIqvw
2
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4780976/?fbclid=IwAR0oprxHvvoOk6zMbCXkB7hgONvf
WHJjtYDHJwtJa2KiDpso8ayIw0NH57k

Roboti c Surgery |1
 3
The first-ever documented use of a robot-assisted surgical procedure
occurred in 1985 when PUMA 560 robotic surgical arm was used in a delicate
neurosurgical biopsy, a non-laparoscopic surgery. Integration of machine
learning with a large database could guide surgeons by allowing a step-by-step
or short video to pop up. Such integration between robotic systems, operating
rooms, and databases of trainers and videos would help overcome a surgeons'
initial learning period.

Functionalities of Robotic Surgery

4
Robotic-assisted surgery embodies the latest in technological
advancement and is being applied to the operative management of patients. The
current concept of robotic surgery involves the performance of surgical
procedures by using small wristed instruments attached to a robotic arm. Its
extension to otolaryngology is only natural, because it allows for precise surgery
through anatomic orifices, often allowing for the preservation of critical anatomic
structures and functions. Transoral robotic surgery is an effective and safe tool
for head and neck surgeons. Its speed of recent growth and the imminent
addition of innovative technology could signal the advent of a new era in surgery.
Robotic surgery, or robot-assisted surgery, allows doctors to perform many types
of complex procedures with more precision, flexibility, and control than is
possible with conventional techniques. Robotic surgery is usually associated with
minimally invasive surgery procedures performed through tiny incisions. It is also
sometimes used in certain traditional open surgical procedures.
5
Robotic surgery, or robot-assisted surgery, enables doctors to perform
many types of different procedures with more accuracy, flexibility, and control
than is possible with traditional methods. A camera and the use of very small
surgical tools attached to robotic arms are the most commonly used systems
today. The robotic arms are controlled by a specially trained surgeon via a
viewing screen, which is usually located in the same room as the operating table.
The viewing screen, on the other hand, could be placed far away, allowing
surgeons to perform telesurgery from afar. The screen is part of a console, which
allows surgeons to perform procedures while seated and viewing a magnified
three-dimensional view of the patient's surgical site.

Robotic surgery is not performed by robots, contrary to popular belief.

Rather, the surgeon maintains full control over the robotic arms at all times. The

3
https://link.springer.com/article/10.1007/s00464-016-4752-
x?fbclid=IwAR1LxO7a98XQ6O_iM2w5CDK_BjFhtS4yd09K8ycJQZaCZ0K_P9_TEPVUktE
4
https://pubmed.ncbi.nlm.nih.gov/32838968/
5
https://www.mayoclinic.org/tests-procedures/robotic-surgery/about/pac-20394974

Roboti c Surgery |2
robot acts as a tool and can be thought of as a sort of assistant to the surgeon,
hence the term robotic-assisted surgery.

Via small incisions controlled by the physician, a teleoperated surgical

robot provides superior instrumentation and flexible motion. Usually, in a
visualization environment, the surgeon manipulates an ergonomic master input
unit, and these inputs are converted into motion by a 3D vision system
and wristed laparoscopic surgical instruments. Overall, master and slave surgical
robots are popular because they combine the accuracy and precision of a robot
with the ability to retain overall control by the surgeon who is skilled in performing
those specific surgical tasks.

Discussions
6
Over the years pass technology was very useful in this decade in the
different fields. In the fields of medicine, robotic surgery or also known as robotic-
assisted surgery was one of the technologies used today. Robotic surgery has
been becoming more and more common as the technology offers many benefits
including being less scary and quicker recovery time. Procedures that were once
only able to be performed through large incisions and with large instruments are
now being done with microscopic precision with the aid of much smaller incisions
and much tinier instruments.
7
Before robotic surgery, laparoscopic surgery was performed using
smaller instrumentation and smaller incisions it also incorporated the use of
miniature cameras to view the operating field. 8Today, Robotic surgery expanded
on this technique through the addition of robotic arms that could mimic the
dexterity of a surgeon’s hands but in a smaller operating area. 9Robotic surgery
was a medical technology that allows a doctor or a surgeon to perform a very
wide variety of complicated procedures with greater accuracy, versatility, and
control than conventional techniques provide. Currently, one of the most
advanced robots in use today is the da Vinci Surgical System. It is an extremely
precise tool that has been in use for over ten years. The advantages of surgeries
performed using this technology are often shorter recovery times and less
discomfort for the patient.

6
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5956578/
7
https://medlineplus.gov/ency/article/007339.htm
8
https://hcghospitals.in/Hospital/hcg-cancer-center-ahmedabad/1
9
https://www.uclahealth.org/robotic-surgery/what-is-robotic-surgery

Roboti c Surgery |3
 10
Robotic surgery is a kind of minimally invasive surgery done through tiny
incisions. In terms of the procedure, it gives the surgeon-enhanced visuals of the
body and the organs, better control where the surgeon controls the robotic arm
with a computer that can bend and rotate at complicated angles and make
precise movements. The movements are rendered more precise as the robot
eliminates unwanted fine tremors of hands and uneconomical movements with
added extraordinary maneuverability afforded by the specially designed
instrumentation. Due to the magnified 3D view, a surgeon can see what he is
cutting in all angles and therefore can reach such areas where angels fear to
trade. A surgeon, working on the console, places himself/herself close to the
patient and makes precise movements from inside the console, mimicked by the
robotic equipment. These are also programmed with protectors that prevent any
sudden movements. This, results in better surgical performance, especially in
complex cases. Furthermore, in one robotic surgery by an Indian surgeon
demoed in Miami, one of the delegates asked him if the live surgery was real or
on a cadaver because he was seen cutting very close to major vessels where a
tiny nick could prove disastrous.

Finally, with the extraordinary maneuverability afforded by the robot, it is

possible to conduct complex procedures in 3D view not routinely possible in
laparoscopic surgery. It has a great role in cancer surgery where precision and
good clearance of lymph nodes make the difference to the long-term outcome.

Overall, robotic surgery provides a much-improved visualization of the

anatomy with high definition screens and specific cameras. It also provides smart
tools and instrumentation that will mimic a human hand inside the body and in
tight locations and uncomfortable angles where surgery needs to be conducted.
In those conditions where robotic surgery can be conducted, it may
decrease intra-operative blood loss, decrease the rate of complications, provide
more precise treatment choices and decrease post-operative pain and recovery
time.

Positive Impact of the Technology

In Society

10
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1356187/

Roboti c Surgery |4
  Robotic surgery removes the awkward and unnatural movements
required during laparoscopy and the surgeon can sit down comfortably at the
console so that the surgeons may help the needs of society.

 11Robotic surgery helps to reduce the amount of human error that occurs
during a procedure - making complications less likely. Robotic surgery has
always played an essential role in human work, progress, and advancement of
society.

 Robotic surgery is a complex intervention, by which we mean that it is an

intervention aimed at producing a change in the delivery and organization of
healthcare services and which comprises several separate components that may
act both independently and interdependently. These components are not only
technological but also organizational and social, and they can all impact the
extent to which the technology is successfully introduced, as well as subsequent
process and patient outcomes.

In people

 12For many patients, recovering from surgery is tougher than undergoing

the surgery itself. The smaller incisions needed by robotic surgery generally
mean patients feel less pain and discomfort following their procedure. For
example, using undergoing robotic surgery instead of traditional open surgery for
a chest procedure can mean you’ll need an uncomfortable chest tube for a
shorter period.

 A human hand can only move so much. But the robotic instrument
exceeds the dexterity and range of motion of the human hand. The arms can
rotate a full 360 degrees. This allows your surgeon to operate in a way that would
be impossible without the robot.

 Most people, however, can resume normal activities, including working,

within several weeks after robotic-assisted surgery. With a potentially shorter
recovery time, you'll save on the typically high costs that come with an inpatient
hospital stay and get back to normal life more quickly. Because there is less

11
https://www.adena.org/blog/detail.dT/5-benefits-of-robotic-surgery?fbclid=IwAR0YkUymddLnZ_c-
_zGQh1OlYJfEIIrklKiU83HnIyl29MdyqMvhuHgDhvw
12
https://www.medstarfranklinsquare.org/our-services/surgical-services/treatments/robotic-
surgery/benefits-of-robotic-
surgery/?fbclid=IwAR2XFWPmtT8zN0xIQ_hd3KQAuV_yyYINJfZ0qyLMjg2Wei5jzt0eBhng248

Roboti c Surgery |5
trauma to the body, you'll also experience less scarring as you recover. The
potential for scarring is less due to the smaller size of the incisions.13

In environment

 Sustainable healthcare has only recently entered the medical

vocabulary. The surgeons proposed that monitoring and then reducing the
environmental effects of healthcare should be seen as an extension of enhancing
the overall healthcare quality of Robotic surgery.

 Surgical care is a foundation of any healthcare system with both elective

and emergency operations contributing to the health services of the population.
Operating rooms can be high-risk areas for transmission given the urgency in
management, involvement of multiple teams, and high-risk activities.

 As a result of the substantial threat to surgeons, several surgical

societies have published safety guidelines during procedures. To effectively
reduce pathogen spread, robots can be integrated at several sections of the
sequence, which each surgical patient traverses during a hospital stay.14

Negative Impact of Technology

In Society

 Despite being modernized and fast process of doing robotic surgery we

cannot hide the fact that this technology isn't beneficial for all, especially for the
middle and lower class of society. It's because the surgery wasn't pocket-friendly
for it cost a lot of money. Due to the technological advancement, we will need an
additional budget to acquire this surgery which will result in a higher bill payment
in which the middle and lower class cannot afford.

 The cost of the operation or the high cost of a robotic surgery system will
make a surgical procedure more costly. Besides, mechanical failure extends the
time it takes for the surgeon's orders to be carried out, making it impossible for
surgeons to respond rapidly to issues that arise during the procedure. Surgery is
an expensive proposition at the best of times. The high cost of installing a robotic
surgery system can increase the cost of a surgical procedure. Surgical robots are

13
https://www.trihealth.com/dailyhealthwire/health-topics/robotics/4-advantages-of-robotic-surgery
14
https://journals.lww.com/annalsofsurgery/fulltext/2013/01000/The_Impact_of_Robotic_Surgery_for_
Mid_and_Low.14.aspx

Roboti c Surgery |6
costly to maintain, and their operation requires additional training, which is also
expensive.

In people

 With robot-assisted surgery, there is not only the risk of human error
when operating the robotic system, but also the potential for mechanical failure.
For instance, system components such as robotic arms, cameras, robotic towers,
binocular lenses, and instruments can fail. In other cases, the electrical current in
the robotic instrument can leave the robotic arm and be misapplied to
surrounding tissues, resulting in accidental burn injuries. Likewise, robot-assisted
surgery can cause nerve palsies due to extreme body positioning or direct nerve
compression that may occur when using robots. It also takes longer to perform
robotic surgery than non-robotic surgery in surgical centers with lower robotic
volume or by less experienced surgeons.

 As a doctor and nurses, this technology has a huge negative impact to

their profession because of this technology only minimum doctor or nurses must
be in an operation while using robotic surgery. Only the doctor who knows how to
operate this technology will be there. And as have a professional there’s a
tendency that you don’t have work. While in terms of us patient, we are not truly
sure that we are 100 percent safe if we undergo an operation with the use of
robotic surgery. We are not truly sure because there’s a tendency that might the
materials used in this technology must be having a damaged.

 There will be a significant job loss, and many workers will have less
economic value. Workers may also experience financial challenges as a result.

 Most complications, if any, stem from a doctor’s lack of experience

performing da Vinci robotic surgeries. If you decide to have a procedure
done robotically, one of the most important things is to make sure your doctor
has ample experience.

In environment

 As for my own opinion, the possible negative impact of robotic surgery in

our environment is that maybe it leads our environment to power shortage.
Numbers of patients are undergoing surgery from time to time imagine how much

Roboti c Surgery |7
power will it use if every day there's robotic surgery happens. A current or power
shortage will be a possible negative impact on our environment.

 CO2 is a greenhouse gas that contributes between 9% and 26% of the

greenhouse effect, mainly due to the use of fossil fuels, implicating it in the
ongoing global warming trend since the industrial revolution of the twentieth
century. The combustion of fossil fuels is responsible for three-quarters of global
CO2 emissions, with the remainder due to deforestation, land use, and other
factors.

Summary
15
Robotic surgery was a medical technology that allows a doctor or a
surgeon to perform a wide variety of complicated procedures. The advantages of
surgeries performed using this technology are often shorter recovery times and
less discomfort for the patient. One of the most advanced robots in use today is
the da Vinci Surgical System. Based on the findings, Robotic surgery has always
played an essential role in human work, progress, and advancement of society.
Robotic surgery is a complex intervention. It comprises some separate
components that may act both independently and interdependently. Robotic
surgery allows for smaller incisions and less trauma to the body. The potential for
scarring is less due to the smaller size of the incisions. Most people can resume
normal activities, including working, within several weeks. Surgical care is the
foundation of any healthcare system. Surgical care contributes to the health
services of the population. Operating rooms can be high-risk areas for
transmission. To effectively reduce pathogen spread, robots can be integrated.
Robotic surgery isn't pocket-friendly for the middle and lower class of society.
The high cost of installing a robotic surgery system can increase the cost of a
surgical procedure. Surgical robots are costly to maintain and their operation
requires additional training. With robot-assisted surgery, there is not only the risk
of human error when operating the robotic system, but also the potential for
mechanical failure. Most complications, if any, stem from a doctor's lack of
experience performing da Vinci robotic surgeries. If you decide to have a
procedure done robotically, one of the most important things is to make sure your
doctor has ample experience. Robotic surgery may lead to power shortage,
which could harm the environment. CO2 is a greenhouse gas that contributes
between 9% and 26% of the greenhouse effect. Fossil fuels are responsible for
three-quarters of global CO2 emissions.

15
https://www.verywellhealth.com/robotic-surgery-4843262

Roboti c Surgery |8
Conclusion

Robotic-Assisted Laparoscopic Surgery also known as Robotic Surgery is

a type of technology that is widely used in the field of medicine. Instead of
performing traditional surgery, they invented this robotic surgery for the reason
that it only has some smaller incisions that can reduce pain and scarring, and
also it is faster than the traditional one. Also, a Robotic-Assisted Surgeries’
current concept is to involve the performance of surgical procedures by using
small wristed instruments attached to the robot's arm. It allows surgeons to
perform many types of complex procedures with more precision, flexibility, and
control than is possible with conventional techniques.

It is usually associated with minimally invasive surgery procedures

performed through tiny incisions. Sometimes it also uses in traditional surgery. A
Robotic Surgery is not performed by robots the surgeon maintains full control of
the robots' arm at all times, the robot act as a tool that assists the surgeons. It is
programmed with protectors to avoid any sudden movements for the better result
of the surgical performance, especially in complex cases. It also provides much-
improved visualization of the anatomy with high definition screens and specific
cameras.

Robotic Surgery smart tools that simulate a human hand inside a body in
tight locations and uncomfortable angles where surgery needs to be conducted.
In this way it may decrease blood loss, rate of implications, provide more precise
treatment choices and decrease postoperative and recovery time. Using a
systematic approach, detailed credentialing criteria for robotic surgery were
defined. Implementation of these criteria uniformly across institutions will promote
proficiency of robotic surgeons and has the potential to positively impact patient
outcomes.

Recommendations

Given that robotic surgery revealed the effectiveness in open surgery in

the medical field of technology thus, the following recommendations are hereby
presented.

Since robotics surgery has been proven effective, health professionals

must not worry about losing their job. Robotic surgery sustainability maintains
safe surgery for the patients and helps them trust the robotics surgery.

Implementation of robotics surgery as a Medical technology should be

encouraged by administrations and embraced by health professionals to
continually improve safety and low-cost surgery.

Roboti c Surgery |9
 The field of Robotic surgery continues to rapidly evolve. Presently, there
remains a great need for additional trials to objectively compare clinical outcomes
and the cost-effectiveness of robotic compared to traditional laparoscopic and
open procedures, including expanding roles in bariatric populations. Novel
techniques and refinements in existing methods, such as single-site robotic-
assisted surgery, are continually emerging. The full scope
of telesurgery and telemetering in global access to health care
remains undefined.

R o b o t i c S u r g e r y | 10