Surgical procedures have existed for centuries—but not as we know them today. They are continually changing and evolving to enhance the surgeon’s precision and improve the patient’s outcomes.
The surgical buzzword of the modern day is minimally invasive surgeries, but what does include? There are two main types of minimally invasive surgeries: laparoscopic and robotic surgery. Let’s explore what each one involves.
The Advent of Minimally Invasive Surgeries
1. Brief on Traditional Surgeries
Open surgery has existed for centuries, dating as far back as 6,500 BCE. The traditional version of this procedure involves cutting the skin and tissue enough for the surgeon to clearly see and manipulate the affected organ or structure.
Because such an incision typically needs to be quite large, the healing times are usually lengthy. Not only does the external incision need weeks to properly heal, but the tissues and organs also need additional weeks—or months—to heal. This extended healing time, combined with a large surgical site, increases the risk of .
2. Enter Laparoscopic Surgery
The rise of minimally invasive surgeries began in the early 19th century when Phillip Bozzini created the first cystoscope, a tiny surgical tube. However, the term ‘laparoscopy’ wasn’t coined until about 100 years later, when Hans Christian Jacobaeus started using cystoscopes on animals.
It took almost another 100 years for laparoscopic surgery to resemble what it is today: a safe, minimally invasive surgical approach that utilizes several tiny incisions to insert thin tubes attached to surgical tools and cameras. By removing the need for a large incision, a laparoscopy allows for quicker healing times and reduced risks.
Deep Dive into Laparoscopic Surgery
1. The Technique Explained
During laparoscopic surgery, the surgeon makes several tiny incisions around the affected area, usually about half an inch long. They then insert tubes into those incisions and inflate the abdomen to allow for better visibility.
The surgeon then inserts small surgical instruments and a laparoscope through those tubes. The laparoscope is a thin fiber-optic instrument that includes a camera and light source and relays images back to a television monitor.
Instead of trying to create an incision large enough for the surgeon to see everything, they simply use the laparoscope and the enlarged image on the monitor to carry out the procedure.
2. Benefits of Laparoscopic Approaches
Even though the surgeons don’t have a direct view into the patient, the laparoscope allows for enhanced visibility. Plus, these small tools can often reach areas typically hidden during open surgeries, providing more accurate diagnoses and treatment.
The smaller incisions also allow for a quicker healing time—both internally and externally. Patients typically spend fewer days in the hospital compared to open surgery, and oftentimes they can go home on the same day. They also have minimal scarring, with a few tiny marks on the abdomen instead of a massive scar.
3. Limitations to Consider
Despite these benefits, there are a few drawbacks to consider. The primary issue is limited tactical feedback for the surgeon. Since the procedure is done based on a video feed and not actually feeling the tissue, it can be hard for the surgeon to judge the necessary force. Additionally, only a few incisions tiny incisions are made, giving the surgeon limited mobility within that given area.
The Rise of Robotic Surgery
1. Understanding Robotic-Assisted Surgeries
Compared to both open and laparoscopic surgery, robotic surgery is a brand-new approach. That said, it has existed since the late 1980s and has gained much popularity over the years.
Robotic surgery doesn’t mean that actual humanoid robots perform the surgery. Instead, it refers to robotic-assisted surgery, where the surgeon performs a laparoscopy but with much more advanced instruments. One of the most common robotic surgery instruments is the da Vinci Surgical System, which is a machine with four robotic arms. The surgeon manipulates the arms from a console or control center while viewing a 3D video feed. They no longer need to stand over the patient and manually manipulate laparoscopes or surgical instruments since the robotic machine does the manual work.
2. Robotic Surgeries Stand Out
The most significant draw of robotic surgery is the enhanced precision and visualization. With advanced technology and imagery, surgeons view magnified, high-quality images that can improve their precision during operations. Plus, the robotic arms have a greater range of motion than a human hand, which allows for better dexterity.
3. Potential Drawbacks
Understandably, one of the major concerns about robotic-assisted surgeries is mechanical failure. Nobody wants a machine to suddenly malfunction with a patient on the table. The good news is that malfunctions rarely occur. The few times that complications do arise, it’s usually upon equipment entry due to human error.
Other potential drawbacks include high costs and training requirements. However, as robotic-assisted surgeries become more commonplace, the costs will go down, and the required training will become standard.
Robotic vs. Laparoscopic: A Head-to-Head Comparison
1. Precision and Dexterity
Both procedures offer increased accuracy and dexterity, but robotic procedures come out ahead due to the 3D, high-definition vision system. The robotic arms also allow for advanced mobility and range of motion.
Even though both procedures involve a ‘hands-off’ approach, surgeons can create visual cues with the robotic-assisted approach that replace traditional tactile feedback. In some cases, these visual cues improve surgical quality compared to human touch.
2. Patient Recovery and Experience
Again, both approaches are fairly equal here. With only a few tiny incisions necessary, patients enjoy a quicker recovery, less post-op pain, and minimal scarring. The only reason that robotic surgery is more advantageous is because it presents the option of single-incision procedures.
While not appropriate for all surgical needs, single-incision procedures reduce the recovery time and scarring even more.
3. Cost and Accessibility
Robotic surgery is more expensive than laparoscopies because of the state-of-the-art instruments and higher operational costs. Those higher expenses for surgical centers mean higher costs for patients. Insurance companies might not cover as much of the surgery, leaving more out-of-pocket expenses.
4. Surgeon’s Perspective
Some surgeons may prefer the laparoscopic approach—or vice versa. The laparoscopic is more commonly taught and used, which might make surgeons more comfortable with that approach. However, with proper training, robotic surgeries may become the preference. Surgeons can sit down at a console rather than stay on their feet for hours, and the enhanced imagery can make any procedure simpler. It just comes down to receiving the right training.
Making the Choice: Factors for Patients to Consider
1. Surgeon’s Expertise
If a patient has the choice of procedure type, the main consideration should be the surgeon’s expertise. For example, a patient interested in robotic-assisted procedures should look for a surgeon with extensive training, many years of experience in that method, and a high success rate.
2. Nature of the Procedure
Minimally invasive procedures like laparoscopic and robotic-assisted surgeries are typically preferred over open surgery. However, patients must understand that they are not always an option.
It depends largely on the nature and complexity of the procedure and whether the surgeon can effectively reach the affected areas using a less invasive approach. In emergent and complex situations, open surgery is usually the safest option, despite its longer recovery time.
3. Personal Health Factors
Even though a minimally invasive procedure might be the most appealing, it’s not always feasible given the patient’s health. For example, robotic-assisted acid reflux surgery is an option for some surgeons. But if the patient also has underlying conditions—like a hiatal hernia—that complicate the situation, robotic surgery may no longer be an option.
Surgeons typically review a patient’s complete medical history and order pre-op tests to ensure that the preferred surgical method is, in fact, possible and safe.
The Future Trajectory: Where Are We Headed?
The future looks bright for minimally invasive procedures. According to a 2023 report, minimally invasive surgery has steadily increased in recent years, rising from 11.1% in 2017 to 11.2% in 2018. Likewise, robotic-assisted procedures rose from 2.5% to 2.9% in the same period—and these were only inpatient operating room procedures. The rate of minimally invasive procedures in ambulatory settings is much higher, increasing from 16.9% in 2016 to 18% in 2018.
As these procedures continue to become more popular, we can expect increased innovation and better techniques with both laparoscopic and robotic-assisted methods. For example, a 2022 report explored the next generation of robotic surgery tools and the possibility—or rather, probability—of integrating AI into robotic technology. AI can help identify patterns that surgeons can’t physically see, thereby improving predictions and diagnoses.
It’s exciting to see how much surgical approaches have changed, prioritizing efficacy and patient well-being. At the same time, though, it’s important to understand that minimally invasive approaches like laparoscopy and robotic-assisted surgeries are not the best time for every situation. Many situations still require open surgery, especially in emergencies.
Still, we can look forward to enhanced techniques in the future. And if you are able to seek medical assistance early, that can increase your probability of qualifying for a laparoscopic or robotic-assisted procedure.
If you have any medical concerns or think you might need surgery, consult with a specialist to see what procedure options are suitable for your situation. And make sure to stay up to date on the latest surgical innovations so you’re prepared for any procedure you may need in the future.
To find out if inguinal hernia repair surgery is right for you, Contact Orange County General Robotic Surgery at (714) 706-1257 for a consultation with Dr. Abtin H. Khosravi.