Robot-assisted surgery safe for gallbladder removal, reviewers find

Using robots as assistants during keyhole surgery to remove gallbladders is as safe and effective as using a human assistant, a review has found.

In Wednesday's issue of the Cochrane Reviews, researchers found no differences in illnesses, operating time or length of stay in hospital in five randomized trials of 453 patients who had keyhole gallbladder removal with robots or human assistants.

It's estimated that between 10 and 15 per cent of the adult Western population develop gallstones. In the U.S. each year, more than 500,000 people have their gallbladder removed, and gallstones are the most common reason for removing a patient’s gallbladder.

In keyhole surgery, a surgeon makes a one-centimetre abdominal cut and uses a long camera to look inside while surgical instruments are introduced through other small cuts.

In the trials studied, the assistant —  whether a human or robot —  moved the camera, which acts as surgeon's eyes.

The results showed a small but not statistical decrease in the number of gallstones that burst during robot-assisted keyhole surgery, known as a cholecystectomy.

"We need more trials that see whether the success rates using robotic assistants increase once surgeons have more experience using them," said lead researcher Kurinchi Gurusamy, who works at the University Department of Surgery at the Royal Free Hospital in London.

One of the aims of using robots is to allow emergency operations to be performed before a human assistant becomes available.

"Robotic assistants seem to be an exciting possibility, but we are not yet at the stage that they should be used as replacements for human assistants," Gurusamy said.

Dr. Christopher Schlachta, medical director of CSTAR at London Health Sciences Centre, said he agreed with the reviewers' conclusions.

Schlachta uses the Da Vinci robot system, which also operates instruments under the surgeon's command, to do laproscopic gallbladder surgery as well as more complex surgery on the bile duct.

"Laparoscopy, in my opinion, is just a transition phase," Schlachta said.

"Computer-assisted surgery is the way we will eventually be doing all surgery, because the computer allows the surgeons to extend their range of capabilities beyond human limitations. 

"You can tie a thread the size of a human hair, but you can do it with the comfort as if you were tying your shoelaces. It allows you do things in small spaces that you couldn't fit your hand into."

Virtual reality training for surgeons

In a related study appearing in the same issue, researchers concluded that training surgeons using virtual reality simulators helps them to learn techniques faster and with greater accuracy than using additional video training.

The research aims to reduce the time and cost of training surgeons in laparoscopic or keyhole surgery.

Gurusamy and his colleagues analyzed 23 randomized trials involving 612 participants that compared virtual reality training with other methods of training.

"In the participants with limited laparoscopic experience, virtual reality training reduced operating time, improved accuracy and decreased unnecessary movements better than standard laparoscopic training," the reviewers said in a summary.

The reviewers called for better quality studies that use outcomes that are more relevant to patients.  

Virtual reality techniques may help fulfill the need to allow surgeons to develop new skills while working within time limits set by European legislation, Gurusamy said.