IssueJune 22Opinion

Enhancing Surgeon’s Skills

With robotic surgery’s advanced technology Surgeon skills are enhanced whilst surgeon errors are negated. An insight by Dr Prasanna Venkatesh, Sr Paediatric Urologist, Robotic Urologist & MD, NU Hospitals, Bengaluru

Laparoscopic surgery has certain limitations, such as two – dimensional imaging, restricted range of motion of the instruments, and poor ergonomic positioning of the surgeon. The robotic surgery system was introduced as a solution to minimise the shortcomings of laparoscopy. Improved visualisation and greater dexterity are two major
features of robotic-assisted laparoscopic surgery. This emerging method provides undoubted technical advantages over conventional laparoscopy. Robotic systems have 3D imaging, tremor filters and articulated instruments.

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With this advanced equipment, robotic surgery is superior  to conventional laparoscopic surgery due to its
significant improvements in visibility and manipulation. Improvements in the efficiency and usability of robotic
systems are increasingly being explored. Robotic surgery offers many benefits to patients compared to open surgery, including:

Shorter hospitalisation
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
Minimal scarring

Advantages

The Versius system has a small form factor, versatility and portability, and is designed to support surgeons to
deliver the benefits of minimal access surgery to patients around the world. The form factor and modular design
include individually cart-mounted arms, allowing it to move between operating rooms and even hospitals/clinics, giving the surgical team access to patients at all times. By bio-mimicking the human arm, Versius gives surgeons the freedom of port placement, but with the benefits of small fully wristed instruments. The system also includes 3D HD vision, easy-to-adopt instrument control and achoice of ergonomic working positions, aimed to reduce stress and fatigue to help extend the careers of surgeons.

With Versius one can ‘Think Laparoscopically, Operate Robotically’. A surgical robotic system that fits into virtually any operating room (OR) and works around your existing set-up. Robotic surgery safety With traditional surgical techniques, the errors that could be made by the surgeons get passed on to the patient. With robotic surgery’s advanced technology surgeon skills are enhanced whilst surgeon errors are negated.

Surgical challenges such as trembling of the hands and restriction with hand movements can cost or save a life in an OR. These aspects are protected by the advanced technology used in the Versius surgical robot. Besides less blood loss and less pain to the patient, robotic surgery with Versius adds another component to the safety
of the patient via the surgeon’s comfort and by enhancing their skills.

Hand controllers of the Versius system

The Versius Console consists of just two hand controllers that are used to control all the bedside units. These hand controllers allow the surgeon to move the instruments in directions and angles that a surgeon’s hand physically and biologically cannot. The surgeons can rotate the instruments up to 720 degrees. With the incredible learning curve on Versius, surgeons can think laparoscopically and operate robotically.

Higher dexterity leads to better navigation during surgery. Surgeons can reach areas, rotate and navigate in ways they never could before. Versius gives the surgeons the support they need to overcome the restrictions surgeons have faced over the last decade or more. Versius can be defined as the next-generation surgical robot that has focussed on the challenges Surgeons have faced with robotic surgery in the past. It was designed and built purely to make robotic-assisted minimally invasive surgery better for the surgeons in the form of surgeon comfort, higher precision, clearer vision and surgical modularity. These components put together into a single system with a smaller learning curve leading to better patient outcomes is what makes Versius the next-generation surgical robot.

• Versius has been designed to bring all the benefits of robotics, whilst lowering the barrier of adoption to minimal
access surgery. Versius has fully wristed instruments, natural instrument control, and full HD 3D vision, to help improve the surgeon’s dexterity, precision and control within the abdomen and pelvis.

• Being small, Versius doesn’t dominate the OR. Its modular and portable design enables you to move it between ORs, and only use the number of arms that you need for any given procedure

• Placing a wrist at the end of the robotic arm, enables greater freedom of setup making the Versius system suitable across a range of different specialities. This helps each setup to be tailored to the patient, while the wrist on the instruments gives the surgeon greater dexterity inside the patient.

The console has been designed to minimise physical strain on the operating surgeon by giving them the option to either sit or stand whilst operating, all in an ergonomic pose. This potentially allows them to keep operating at peak performance for longer and prolong their surgical careers.

• The open console design provides a clear line of sight to facilitate verbal and non-verbal communication  between the surgeon and the bedside surgical team.

Versius is designed to give the surgical team access to the patient at all times, due to its small form factor
and ‘collaborative arm technology’.This allows the teams to reposition the arms and move the elbows out of the
way without  interrupting the surgicalprocedure, enabling easy access to the patient at all times.

We have added the CMR Versius Robotic System to our armamentarium. Robotic surgery is very useful for urological pelvic surgeries, prostate cancer, cancer of the kidneys and reconstruction of major congenital paediatric urological anomalies. Worldwide, almost 40-50 per cent of robotic surgeries are done in the urology space, while 10-15 per cent of usage is in gynaecology and then for the rest of the specialities such as onco-
surgery, gastro-surgery, cardiac surgery etc.

We operate in a niche space of the three specialities of Nephrology, Urology and Fertility care and also their sub-
specialities. So, we firmly believe that wherever services are not available, that is where we plan to expand and
grow whether in India or abroad. We do have plans to penetrate deeper into far-off areas to cover the neglected populace, but those plans have been temporarily put on hold because of the pandemic. Probably, we would roll out those projects in the coming six months or a year depending on the pandemic situation. I also believe that NU Hospitals has been able to achieve so much because of the excellent Medical and Non-Medical team that we have in our NABH accredited hospitals. We have recently been bestowed “The Great Place to Work” certification – with only a few hospitals receiving this in India – it is a true testimony to the great team that we have.”

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