Robotic surgery systems provide an excellent platform through which to deliver additional real-time data to the surgeon to improve intraoperative decision making. The user interface is key to allowing surgeons to process additional information whilst maintaining surgeon comfort and without disrupting workflow. A number of robotic surgery systems have a distinct advantage over more traditional minimally invasive surgery imaging systems because of the immersive user interface provided to the surgeon. It was, therefore, exciting to see the advances in smart surgery reported at the symposium.

Robotic surgery is frequently used to allow tumor tissue to be excised, making the identification and visualization of tumor tissue very important. Prof. Marcu from UC Davis presented a paper entitled ‘Fluorescence Lifetime Imaging Augmented Reality in Trans-Oral Robotic Surgery: First-in-Human Study’. The technique is label free and is being developed for use with the da Vinci Surgical System. Importantly, the use of time-resolved spectroscopy allows the signals from different tissue fluorophores to be distinguished and the technique is showing potential in early clinical studies for being able to automatically distinguish, in real time, between tumor tissue and normal tissue. Clinical validation is ongoing. Other papers presented at the symposium reported the use of ultrasound, computed tomography and SPECT imaging for tumor visualization in conjunction with the da Vinci system. Confocal laser endomicroscopy systems are now available for use in surgery and Dr. Charalampaki from the Medical Centre Cologne presented on work demonstrating tumor classification in neurosurgery using the ability of the system to image at the cellular level. A next step would be to integrate the technique with robotics.

Improved identification of critical structures, such as nerves and blood vessels, would be a significant advancement in robotic surgery. Prof. Dr. Desjardins from University College London presented a paper entitled ‘Optical Ultrasound and Photoacoustic Imaging for Guiding Minimally Invasive Procedures’. These techniques are being applied initially to assist transseptal puncture in cardiac surgery and to improve needle guidance for administering nerve blocks in spinal procedures, but they offer the potential for use in many other procedures.

At Sagentia we continue to track the development of smart surgery systems and see great potential for applications in robotic surgery.

Rob Morgan