In is even possible to perform cardiac hybrid

               In 1983the first computer-assisted surgery took place in Canada using a robotic systemcalled “Arthrobot”1.Since then the use of robotics in surgical procedures has become more and morecommon in the medical world with the da Vinci System, a robotic system used formitral valve repair, being used for 48,000 procedures in 20062.

Computer assisted surgical devices have had a very positive effect since theirintroduction. Patients who have surgery performed with the assistance ofrobotic techniques have much shorter hospital stays and recovery times thanwhen they undergo traditional surgery3.This is due to the minimally invasive nature of robotic procedures; cardiacbypass procedures, for example, no longer need the thoracic cavity to be fullyexposed4.It is even possible to perform cardiac hybrid revascularisations withoutopening up the chest cavity and can be done while the heart is still beating asthe ‘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 insidethe patient without opening up large areas of the body and allow them to enterthe body from more accessible places6.Due to of these smaller incisions there is a reduced risk of infection and lesspain 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 acancerous kidney which resulted in his death7.The surgeon was inexperienced in the operation of the complicated and expensivemachines.  However, as the use of roboticsurgical machines become more commonplace; surgeons will gain experience and errorswill become less likely.Within the Maastricht UniversityMedical Centre, the next step forward in surgical robotics was taken in October2017. The device was created by Microsure, a company from Eindhoven, and wasthe first robotic device to be used in a super-microsurgical procedure.

TheMicrosure device was used to connect lymphatic vessels to blood vessels toassist with the movement of lymphatic fluid and reduce swelling for the patient,who was suffering from lymphedema. This is a very difficult procedure to pulloff due to the tiny size of the vessels involved, a mere 0.3mm in diameter, andas a result, only a handful of surgeons are skilled enough to perform theprocedure by hand. The machine works by translating the hand movements of thesurgeon 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. Lymphedema is an incurablecondition that causes much pain to the sufferer mainly due to the pressure ofthe fluid build up on skeletal structures.

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Lymphedema’s main cause is by damageto the lymphatic vessels, but the condition can also be inherited. It affectsaround 140 million people worldwide and can also be caused by cancer treatmentssuch as radiation therapy. The most common treatment of lymphedema is manualcompression, or compression by the use of dressings, on the affected area to presson the swelling and move the fluid build up away from the area. These treatmentsare very far from long term cures and must be carried out daily to have apositive effect. Therefore, it can be said that such a condition has a huge anddirect 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 effectivelytreat Lymphedema in the long term, allowing people to return to a more normalway of life. The swelling will drain more readily after the connection of the variouslymphatic vessels to blood vessels. The Microsure device allows the lifechanging surgery to be more readily available to people around the world as itsimplifies the procedure. This enables less skilled surgeons to be moreconfident in carrying out the operation and lessens surgical complications.

Ithas also been stated that surgery carried out by the Microsure device willrequire less post-operation treatment. Due to the modern and technical natureof the machine it is quite expensive to use and upkeep. However, the cost reductionit creates in other areas, such as by increasing patient turn over and freeing upsurgeon time, makes it a cost effective investment. The maintenanceof such a machine will create more jobs for the hospital but the cost ofrunning them is still cheaper due to the increased risk involved withtraditional methods. These include heightened risk of infection and longer bedstays.

Therefore, the Microsure machine will free up hospital beds and surgeryrooms during a period of huge strain on medical services such as with the NHSdue to the decrease in post-surgery treatment and complications. While usingthe Microsure machine the surgeon can sit down. This decreases the effect offatigue on the surgeon, meaning that his work can be more accurate and so bemore successful.  TheMicrosure robotic surgical device has clearly shown the direction in whichsurgical innovation is going.

Over the 35 years of computer assisted surgerythere has been great advancements of the equipment and techniques used,allowing for the treatment of more and more complicated conditions. With theincrease of surgeon experience on machines such as the one built by Microsurethere will be less and less reason complications during surgical treatment. Itis hoped that in the future the Microsure device will be used in the treatmentof other tricky operations that, without it, are often considered too difficultordangerous for most surgeons to attempt. The next proposed step for thesuper-microsurgical machine is the reconstruction of tissues after the removalof a tumour. Eventually machines like the Microsure device will become morereadily available greatly reducing the complications and risks of even the mostcomplicated surgeries.

   1 Cohen, B (2016) All About Robotic Surgery, Available at: http://www.allaboutroboticsurgery.com/roboticsurgeryhistory.html (Accessed: 13January 2018).2Cohen, B (2016) All About Robotic Surgery, Available at: http://www.allaboutroboticsurgery.com/roboticsurgeryhistory.

html (Accessed: 13January 2018).3Cohen, B (2016) All About Robotic Surgery, Available at: http://www.allaboutroboticsurgery.com/roboticsurgeryhistory.html (Accessed: 13January 2018).4Cohen, B (2016) All About Robotic Surgery, Available at: http://www.allaboutroboticsurgery.

com/roboticsurgeryhistory.html (Accessed: 13January 2018).5Cohen, B (2016) All About Robotic Surgery, Available at: http://www.allaboutroboticsurgery.com/roboticsurgeryhistory.html (Accessed: 13January 2018).

6Braumann, C. Diseases of the Colon and Rectum. December 2005. Volume 48, Number9, pp1820-1827.7 Cohen, B (2016) All About Robotic Surgery, Available at: http://www.allaboutroboticsurgery.com/roboticsurgeryhistory.html (Accessed: 13January 2018).