What is Robotic Surgery? Its Applications in General Surgery

Put simply, robotic surgery is the most advanced technological stage of minimally invasive surgery, where the surgeon manages the operation from a special console rather than standing directly over the patient. By providing high precision in narrow anatomical regions that the human hand cannot reach, this system both increases the success of the surgery and significantly accelerates the patient's recovery process.

In Brief

• The robot does not perform the surgery on its own; all movements are controlled by an expert surgeon from a console.
• The robotic arms, which mimic the human wrist, offer a 540-degree range of motion.
• Because the incisions are millimetric, post-operative pain and the risk of infection are minimised.
• It makes a massive contribution to the preservation of nerves and blood vessels, particularly in cancer surgery.
• The length of hospital stay is shortened, allowing patients to return to their normal daily lives much faster.

What is Robotic Surgery?

This revolutionary technology in the medical world is the product of a project originally designed to provide remote medical intervention for astronauts in space. Over time, it was developed and made available to civilian medicine. The Da Vinci robotic surgery system basically consists of three main components: the control console where the surgeon sits, the patient cart with the robotic arms located at the patient's bedside, and finally the vision cart that provides high-resolution imaging. Through the console, the surgeon sees the surgical field in three dimensions and highly magnified.

Thanks to special sensors attached to the surgeon's fingers, even the slightest hand movements are simultaneously transmitted to the millimetric robotic arms inside the patient. Contrary to popular belief, the surgery is completely performed by the surgeon, not the robot. The robotic system filters out any hand tremors, reducing them to zero, and offers a freedom of movement that exceeds the anatomical limits of the human hand. This makes it possible to make incisions or place stitches extremely safely, even in the narrowest and most complex areas.

Which Conditions is Robotic Surgery Used for in General Surgery?

Due to the complex structure of intra-abdominal organs, the general surgery branch is one of the fields where this technology is used most efficiently. Particularly in robotic surgery for colon cancer, it achieves great success in preserving the nerves that directly affect the patient's quality of life. In the removal of tumours located in a narrow space within the pelvis, such as rectal cancer, the manoeuvrability provided by the robotic arms offers the surgeon an unparalleled field of vision and movement.

In addition, robotic surgery is frequently preferred in general surgery for the precise removal of cancerous tissue in stomach and oesophageal cancers. In bariatric (obesity) surgery, operations that become difficult due to the thickness of the abdominal wall, especially in patients with high body weight, are completed much more comfortably with the robotic system. Furthermore, this advanced technology is safely used in the surgical treatment of complex abdominal wall hernias, gallbladder operations, and spleen diseases.

What are the Advantages of Robotic Surgery?

This innovative method offers numerous benefits for both the patient and the surgeon. Among the most notable advantages of robotic surgery for patients is that the operation is performed through a few millimetric holes instead of large incisions as in open surgery. This significantly reduces post-operative pain and lowers the risk of surgical site infection. With blood loss kept to a minimum, the patient's recovery process is accelerated, reducing the hospital stay to just a few days.

From the surgeon's perspective, the greatest gain is ergonomics and flawless vision. While in traditional laparoscopic surgeries the surgeon works standing up and looking at a two-dimensional screen, in the robotic system, they manage the operation sitting comfortably in a chair. Thanks to the three-dimensional, depth-perceiving image that can be magnified up to ten times more than normal, the boundaries between tissues are distinguished much more clearly. This reduces the surgeon's fatigue during long, challenging cancer surgeries and allows them to work with the same high concentration from the beginning to the end of the operation.

Pre-operative Preparation Process

When a robotic operation is planned, a detailed evaluation of the patient's general health status is essential. In the first step, standard tests such as blood tests, chest X-rays, and an ECG are performed. At this stage, the patient's chronic diseases are reviewed; for example, conditions such as high cholesterol, diabetes, or hypertension are meticulously examined by the anaesthesiologist. When deemed necessary, approval is requested from physicians in related branches.

At least one week before the surgery, the use of blood thinners, herbal supplements, and vitamins should be stopped under a physician's supervision. For patients scheduled for bowel surgery, bowel preparation (enema) with special solutions may be required the day before the operation. Since the patient's stomach must be completely empty on the day of surgery, all food and fluid intake, including water, must be stopped at least eight hours before the operation time. Full compliance with the preparation process is a critical step for the safety and success of the surgery.

During the Surgery and Post-operative Recovery Process

The operation begins with the patient being put completely to sleep under general anaesthesia. Thin tubes called trocars are inserted through small holes opened in the abdominal area, and the inside of the abdomen is inflated with a harmless gas to create a working space. Then, the robotic arms are advanced through these tubes, and the surgeon takes their place at the console to perform the surgery. Once the procedure is complete, the arms are removed, the gas is evacuated, and the incision sites are closed with aesthetic stitches.

After the surgery, the patient is monitored in the recovery room until the effects of the anaesthesia wear off, and is then taken to their room in the ward. It is normal to feel mild pain and nausea within the first few hours; these complaints are kept under control with intravenous medications. It is highly valuable for the patient to get up and walk in the early period, either on the evening of the operation or the next morning, to start bowel movements and prevent blood clot formation. Generally, after a hospital stay of two to four days, discharged patients can return to their normal lives within a few weeks, provided they avoid heavy physical activities.

Risks and Who is Not Suitable?

As with any surgical intervention, this method has certain risks and limitations. Since it is fundamentally a type of minimally invasive surgery, risks related to general anaesthesia, as well as the possibility of bleeding or infection, are present, albeit at low rates. In very rare cases, if a technical difficulty is encountered during the surgery or severe bleeding occurs, the surgeon may decide to convert the operation to open surgery for the patient's safety.

This technology may not be a suitable option for every patient. This method is not preferred for patients with advanced heart or lung failure, for whom receiving general anaesthesia is considered risky. Also, in patients who have severe adhesions inside the abdomen due to numerous previous open abdominal surgeries, there may not be enough safe space for the robotic arms to move. The patient's anatomical structure or the tumour being excessively large can also be an obstacle to the application.

When to Seek Medical Attention?

During the recovery process at home after discharge, you must carefully monitor the signals your body gives. Although most patients get through the process without any problems, early detection of possible complications is life-saving. If you experience any of the following symptoms, you should immediately call the 112 emergency call centre or go to the nearest emergency department without wasting time:

• A high fever exceeding 38 degrees that cannot be brought down.
• Pain in the abdominal area that starts suddenly, gradually worsens, and does not go away with painkillers.
• Increasing redness, swelling, a feeling of heat, or foul-smelling, purulent discharge at the incision sites.
• Persistent nausea, vomiting, and an inability to consume fluids.
• Difficulty breathing, chest pain, or sudden swelling in the legs.

The Process at BHT CLINIC

The BHT CLINIC İstanbul Tema Hastanesi General Surgery Clinic provides services with an experienced team of physicians in the fields of digestive system, breast, thyroid, hernia, and bariatric surgery. In our hospital, treatment processes are meticulously planned by multidisciplinary boards where different specialties come together. In our JCI-accredited institution, patient safety and comfort are prioritised at every step, from pre-operative preparation to the follow-up process after discharge. For unexpected situations, our 24/7 emergency department and fully equipped intensive care units are always ready. To get detailed information and consult with our specialist physicians, you can book an appointment via our website.

Frequently Asked Questions

How long does robotic surgery take?

The duration of the surgery varies depending on the organ to be operated on and the complexity of the disease. It generally takes a similar amount of time to standard laparoscopic surgeries, usually being completed in an average of one to four hours.

Does the robot perform the surgery?

No, the robot does not perform the surgery on its own. The system is completely under the control of an expert surgeon; the robotic arms merely transfer the surgeon's hand movements exactly and much more precisely into the patient's body.

What is the difference between laparoscopic surgery and robotic surgery?

Both are minimally invasive methods, but the robotic system provides the surgeon with a three-dimensional and high-resolution view. Additionally, the fact that the robotic arms have a much greater range of motion than the human wrist makes it easier to place stitches and separate tissues in narrow spaces.

Will there be scars after robotic surgery?

Since the procedure is performed through small incisions of only a few millimetres, large and prominent scars do not form after the surgery. Over time, these small incision scars will fade and reach a level where they are not aesthetically bothersome.

Can robotic surgery be applied to every patient?

While this technology is suitable for many patients, it may not be applied to those with advanced heart and lung diseases, or those with severe intra-abdominal adhesions due to previous surgeries. The decision on suitability is made as a result of a detailed medical examination.

This article is for informational purposes only; please consult your physician for diagnosis and treatment.