In is even possible to perform cardiac hybrid


              In 1983
the first computer-assisted surgery took place in Canada using a robotic system
called “Arthrobot”1.
Since then the use of robotics in surgical procedures has become more and more
common in the medical world with the da Vinci System, a robotic system used for
mitral valve repair, being used for 48,000 procedures in 20062.
Computer assisted surgical devices have had a very positive effect since their
introduction. Patients who have surgery performed with the assistance of
robotic techniques have much shorter hospital stays and recovery times than
when they undergo traditional surgery3.
This is due to the minimally invasive nature of robotic procedures; cardiac
bypass procedures, for example, no longer need the thoracic cavity to be fully
It is even possible to perform cardiac hybrid revascularisations without
opening up the chest cavity and can be done while the heart is still beating as
the ‘robotic hands’ move up and down in the same rhythm of the heartbeat5.
Cameras on the end of these ‘robotic hands’ enable the surgeons to see inside
the patient without opening up large areas of the body and allow them to enter
the body from more accessible places6.
Due to of these smaller incisions there is a reduced risk of infection and less
pain caused to the patient, decreasing hospital stays. The procedures are,
contrary to the belief of many, less costly than the traditional surgery. Conversely,
the systems aren’t perfect as was proved in December 2003 when a patients’
abdominal aorta and inferior vena cava were cut during the removal of a
cancerous kidney which resulted in his death7.
The surgeon was inexperienced in the operation of the complicated and expensive
machines.  However, as the use of robotic
surgical machines become more commonplace; surgeons will gain experience and errors
will become less likely.

Within the Maastricht University
Medical Centre, the next step forward in surgical robotics was taken in October
2017. The device was created by Microsure, a company from Eindhoven, and was
the first robotic device to be used in a super-microsurgical procedure. The
Microsure device was used to connect lymphatic vessels to blood vessels to
assist with the movement of lymphatic fluid and reduce swelling for the patient,
who was suffering from lymphedema. This is a very difficult procedure to pull
off due to the tiny size of the vessels involved, a mere 0.3mm in diameter, and
as a result, only a handful of surgeons are skilled enough to perform the
procedure by hand. The machine works by translating the hand movements of the
surgeon into smaller movements which are then executed by the ‘robotic hands’
on the patient, while also removing any shaking affect from the surgeons’
hands. All of this enables the suturing of very small vessels.

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Lymphedema is an incurable
condition that causes much pain to the sufferer mainly due to the pressure of
the fluid build up on skeletal structures. Lymphedema’s main cause is by damage
to the lymphatic vessels, but the condition can also be inherited. It affects
around 140 million people worldwide and can also be caused by cancer treatments
such as radiation therapy. The most common treatment of lymphedema is manual
compression, or compression by the use of dressings, on the affected area to press
on the swelling and move the fluid build up away from the area. These treatments
are very far from long term cures and must be carried out daily to have a
positive effect. Therefore, it can be said that such a condition has a huge and
direct impact on the patient’s quality of life. The invention of the Microsure,
therefore, is a great medical advancement.

 The use of the Microsure machine can more effectively
treat Lymphedema in the long term, allowing people to return to a more normal
way of life. The swelling will drain more readily after the connection of the various
lymphatic vessels to blood vessels. The Microsure device allows the life
changing surgery to be more readily available to people around the world as it
simplifies the procedure. This enables less skilled surgeons to be more
confident in carrying out the operation and lessens surgical complications. It
has also been stated that surgery carried out by the Microsure device will
require less post-operation treatment. Due to the modern and technical nature
of the machine it is quite expensive to use and upkeep. However, the cost reduction
it creates in other areas, such as by increasing patient turn over and freeing up
surgeon time, makes it a cost effective investment. The maintenance
of such a machine will create more jobs for the hospital but the cost of
running them is still cheaper due to the increased risk involved with
traditional methods. These include heightened risk of infection and longer bed
stays. Therefore, the Microsure machine will free up hospital beds and surgery
rooms during a period of huge strain on medical services such as with the NHS
due to the decrease in post-surgery treatment and complications. While using
the Microsure machine the surgeon can sit down. This decreases the effect of
fatigue on the surgeon, meaning that his work can be more accurate and so be
more successful. 

Microsure robotic surgical device has clearly shown the direction in which
surgical innovation is going. Over the 35 years of computer assisted surgery
there has been great advancements of the equipment and techniques used,
allowing for the treatment of more and more complicated conditions. With the
increase of surgeon experience on machines such as the one built by Microsure
there will be less and less reason complications during surgical treatment. It
is hoped that in the future the Microsure device will be used in the treatment
of other tricky operations that, without it, are often considered too difficultor
dangerous for most surgeons to attempt. The next proposed step for the
super-microsurgical machine is the reconstruction of tissues after the removal
of a tumour. Eventually machines like the Microsure device will become more
readily available greatly reducing the complications and risks of even the most
complicated surgeries.




1 Cohen, B (2016) All About Robotic Surgery, Available at: (Accessed: 13
January 2018).

Cohen, B (2016) All About Robotic Surgery, Available at: (Accessed: 13
January 2018).

Cohen, B (2016) All About Robotic Surgery, Available at: (Accessed: 13
January 2018).

Cohen, B (2016) All About Robotic Surgery, Available at: (Accessed: 13
January 2018).

Cohen, B (2016) All About Robotic Surgery, Available at: (Accessed: 13
January 2018).

Braumann, C. Diseases of the Colon and Rectum. December 2005. Volume 48, Number
9, pp1820-1827.

7 Cohen, B (2016) All About Robotic Surgery, Available at: (Accessed: 13
January 2018).