A new surgical robot allows surgeons to “feel” their way through a procedure with a haptic feedback system. According to scientists at Deakin University and Harvard University, the HeroSurg system provides both tactile sensation and HD-quality 3D imaging for greater confidence and accuracy than is possible with current robotic laparoscopic systems.

Laparoscopic, or “key hole” surgeries, are significantly less invasive than “open” surgeries, requiring just a few small incisions and providing shorter recovery times, but the procedures do limit a surgeon’s field of vision and ability to feel differences in tissues while operating. Suren Krishnan, who in 2008 was the first surgeon to perform an ears, nose, and throat (ENT) operation with Intuitive’s Da Vinci surgical robot, assisted in the design of HeroSurg and stated that the “lack of tactile sensation” was the primary drawback to current robotic laparoscopic systems.

“Tactile feedback allows a surgeon to differentiate between tissues and to ‘feel’ delicate tissues weakened by infection or inflammation and dissect them more carefully,” said Krishnan in a press release. “Tactile feedback will allow us to use finer and more delicate sutures in microsurgery.” Because surgeons would be able to “feel” relative differences and stiffness of tissues, Krishnan added that surgeons using HeroSurg could identify cancerous tissue more easily than working with imaging alone.

The HeroSurg system was developed at the Deakin Institute for Intelligent Systems Research and Innovation (ISSRI) with input from scientists at Harvard University, and was recently introduced at the Australasian Simulation Congress in Victoria, Australia. In their demonstration, the researchers showed how sensors embedded into the instruments measured forces applied by surgeons, and then relayed sensory information, via vibrations, to the surgeons’ hands, reported New Atlas.

In addition to haptic feedback, the HeroSurg system offers collision avoidance capability, high-resolution 3D imaging, automatic patient/bed adjustment, and a more ergonomic workspace. Mohsen Moradi Dalvand, lead researcher on the project, stated that the system’s features offer greater confidence and safety to robotic surgery, and could allow surgeons to perform more complicated surgeries using less invasive methods.

Simulation Australasia CEO John Stewart said the technology would “change the way medicine was done,” and was impressed by the system’s potential for remote operation. “The best surgeons will be able to operate on patients on the other side of the world and the advancements in haptic technology mean they’re no longer just relying on sight,” said Stewart.

Several startups have launched surgical robots over the past few years, and large medtechs — such as Medtronic, Stryker, Smith & Nephew, and J&J’s Ethicon — have made sizeable investments in the technology. Johnson & Johnson recently launched Verb Surgical, a joint robotics surgery venture, with Verily. Medtronic recently partnered with Mazor Robotics and projects surgical robot revenue by 2019.

The Lancet recently published results from the first clinical trial comparing robotic surgery to traditional surgical procedures for patients with localized prostate cancer, though it showed “no statistical difference” in patient outcomes 12 weeks post-surgery. Trial participants will be followed for an additional two years to assess long-term outcomes.

In a new study published in the American Journal of Obstetrics & Gynecology, researchers from The University of North Carolina at Chapel Hill compared the relative risks of laparoscopic hysterectomy (with morcellation) with abdominal surgery for hysterectomy in premenopausal women undergoing surgery for presumed uterine fibroids. Examining short- and long-term complications, quality of life, and overall mortality, they found that abdominal surgery carries a higher risk of complications, decreased quality of life, and death.

Hysterectomy is the most common gynecologic procedure performed on non-pregnant women in the United States, and a diagnosis of fibroids (leiomyomata) accounts for many of these procedures. Minimally invasive surgery is being used more frequently because of its many advantages, including less pain and shorter length of hospital stay. But in some cases, the uterus cannot be removed without morcellation, or cutting it into pieces to fit through small incisions. However, morcellation has come under scrutiny because of concerns that if an undetected malignancy (leiomyosarcoma) is present, it may be dispersed into the pelvis and abdomen, resulting in the spread of cancer and increased mortality. This concern resulted in an FDA notification that discouraged morcellation during hysterectomy.

Given the rarity of leiomyosarcoma, a randomized trial comparing mortality after different types of hysterectomy is not feasible. Consequently, the UNC researchers used decision-tree analysis, which can compare the morbidity and mortality outcomes from a choice of surgical approaches, in this case laparoscopic versus abdominal surgery. The model evaluates outcomes according to the probability of complications specific to laparoscopic and abdominal surgery. Researchers used results from published studies, selecting inputs from the highest quality and most recent studies to reflect advances in surgical practice. Ten studies were used to estimate the incidence of malignant leiomyosarcoma in women undergoing surgery for presumed fibroids.

The aim of this meta–analysis and systematic review was to compare the “early postoperative complication rate i.e. within 30–days” reported from randomized control trials (RCTs) comparing these two procedures. This meta–analysis and systematic review of RCTs suggests that fewer early major and minor complications are associated with LVSG compared with LRYGB procedure. However, this does not translate into higher readmission rate, reoperation rate, or 30–day mortality for either procedure.
Methods

RCTs comparing the early complication rates following LVSG and LRYGB between 2000 and 2015 were selected from PubMed, Medline, Embase, Science Citation Index, Current Contents, and the Cochrane database.
The outcome variables analyzed included 30-day mortality, major and minor complications and interventions required for their management, length of hospital stay, readmission rates, operating time, and conversions from laparoscopic to open procedures.
Results

Six RCTs involving a total of 695 patients (LVSG n = 347, LRYGB n = 348) reported on early major complications.
A statistically significant reduction in relative odds of early major complications favoring the LVSG procedure was noted (p = 0.05).
Five RCTs representing 633 patients (LVSG n = 317, LRYGB n = 316) reported early minor complications.
A non-statically significant reduction in relative odds of 29 % favoring the LVSG procedure was observed for early minor complications (p = 0.4).
However, other outcomes directly related to complications which included reoperation rates, readmission rate, and 30-day mortality rate showed comparable effect size for both surgical procedures.