Robotic-Assisted Surgery

Robotic-assisted surgery is a minimally invasive (small-incision) surgical technique in which a surgeon controls a set of robotic arms to perform precise operations inside the body through tiny cuts.

The surgeon sits at a console — a workstation with a magnified 3-D screen — a short distance from the operating table. From there, they move hand controls that translate directly into movements of the robotic instruments inside the patient. The robot does not act on its own; every movement comes from the surgeon. The robotic arms can rotate and bend in ways that human hands cannot, allowing them to reach tight spaces with great steadiness and precision.

Robotic-assisted surgery is not a treatment for one specific disease; it is a platform used across many specialties whenever a surgeon needs exceptional precision in a confined space and wants to avoid a large open incision. Common conditions and procedures it is used for include:

• Prostate cancer — robotic prostatectomy (removal of the prostate gland) is one of the most common uses worldwide.
• Kidney cancer or kidney disease — partial or total removal of the kidney, or kidney donation surgery.
• Gynaecological conditions — fibroids (non-cancerous growths in the uterus), endometriosis (tissue growing outside the uterus), cervical or uterine cancer, and hysterectomy (removal of the uterus).
• Colorectal conditions — rectal cancer, bowel resection (removal of a diseased section of the bowel), and repair of complex hernias.
• Heart surgery — repair of heart valves in some specialised centres.
• Thoracic (chest) surgery — removal of part of the lung or mediastinal (chest cavity) tumours.
• Bariatric (weight-loss) surgery — such as gastric bypass or sleeve gastrectomy (stomach reduction).
• Urological conditions — bladder reconstruction, repair of the ureter (the tube connecting kidney to bladder), and pyeloplasty (repair of the kidney drainage system).

Robotic-assisted surgery is not always the right choice. A doctor may recommend a conventional open operation or standard laparoscopy (keyhole surgery) instead when:

• The patient has had many previous abdominal surgeries causing heavy scar tissue (adhesions) that make robotic access unsafe.
• The tumour or affected organ is so large that small incisions are not practical.
• The patient cannot safely tolerate the specialised body positions or the longer anaesthesia time sometimes needed.
• Robotic equipment is not available or appropriate for the specific anatomy involved.
• An emergency situation requires the fastest possible access to the abdomen or chest.

Like any surgical procedure, robotic-assisted surgery carries risks, though the small incisions often mean less bleeding and a lower chance of wound infection compared with open surgery. Recognised risks include:

• Pain and discomfort at the incision sites after the operation.
• Temporary shoulder or back pain caused by the gas used to inflate the abdomen during surgery (this usually fades within a day or two).
• Bleeding that may require a blood transfusion or, rarely, conversion to open surgery.
• Infection at the incision sites or internally, which is treated with antibiotics.
• Injury to nearby structures — such as blood vessels, nerves, or neighbouring organs — during the procedure.
• Blood clots (deep vein thrombosis) in the legs, which can occasionally travel to the lungs (pulmonary embolism).
• Adverse reactions to anaesthesia (the medication used to keep you unconscious and pain-free during surgery).
• Conversion to open surgery if the robotic approach becomes unsafe at any point — this is a safety measure, not a failure.
• Risks specific to the organ being operated on, which your surgical team will explain in detail during the consent process.

Preparation for robotic-assisted surgery usually begins several days before the procedure. Your surgical team will give you personalised instructions, but the following gives a general idea of what to expect.

Before the day of surgery, your team will typically ask you to:

• Stop eating and drinking (including water) for a set number of hours beforehand — usually from midnight the night before. Your anaesthetist will confirm the exact fasting window.
• Pause certain medications, such as blood thinners or anti-inflammatory drugs, for several days before the operation. Your doctor will advise which ones and for how long.
• Stop smoking as early as possible, as smoking affects healing and anaesthesia. Most teams recommend stopping at least a few weeks before surgery.
• Avoid alcohol for at least several days before the procedure.
• Complete a bowel preparation (drinking a special liquid to clear the intestine) if the operation involves the bowel or lower abdomen.
• Arrange for someone to accompany you home, as you will not be able to drive after anaesthesia.

Before giving the final go-ahead, the surgical team usually orders a set of pre-operative (pre-surgery) tests to check that you are safe for anaesthesia and surgery. These commonly include:

• Blood tests to check for anaemia (low blood count), clotting ability, kidney and liver function, and blood group.
• An ECG (electrocardiogram — a recording of the heart's electrical activity) to screen for heart rhythm problems.
• A chest X-ray to assess the lungs and heart size.
• CT (computed tomography) or MRI (magnetic resonance imaging) scans if detailed images of the target area are needed.
• A urine test if a urological or gynaecological procedure is planned.
• A consultation with the anaesthetist to review your full medical history and any allergies.

On the day of surgery, the procedure itself generally follows these steps, though the exact sequence and duration vary by organ and hospital:

• 1. You change into a hospital gown and an intravenous (IV) line is placed in your arm to deliver fluids and medication.
• 2. You are taken to the operating room and positioned on the table. For abdominal procedures, the table is often tilted so that gravity moves organs away from the surgical site.
• 3. The anaesthetist administers general anaesthesia so that you are completely unconscious and feel no pain throughout.
• 4. The surgical team cleans and drapes the skin around the operation area.
• 5. The surgeon makes several small incisions, usually between half a centimetre and about one centimetre wide, depending on the instruments needed.
• 6. A trocar (a thin hollow tube) is inserted through each incision. Through one trocar, carbon dioxide gas is pumped in to inflate the body cavity and create working space. Through the others, the robotic arms and a camera are introduced.
• 7. The surgeon moves to the console and uses the hand and foot controls to operate the robotic instruments under the live magnified 3-D view from the camera inside you.
• 8. An assistant surgeon stands beside the table throughout to pass additional instruments, manage suction, and monitor.
• 9. Once the surgical task is complete, the instruments are withdrawn, the gas is released, and the incisions are closed with stitches or surgical glue.
• 10. You are transferred to the recovery room where the anaesthesia wears off under close nursing observation.

Recovery after robotic-assisted surgery is usually faster than after open surgery because the incisions are small, but the pace of recovery still depends on which organ was operated on and your overall health. Your team will monitor you closely in the hours immediately after surgery before deciding when it is safe to move you to a regular ward or discharge you.

• Monitoring: You will spend time in the post-anaesthesia care unit (recovery room) until you are awake, breathing well, and your vital signs are stable. Depending on the procedure, you may then go to a standard ward, a high-dependency unit, or, in rare complex cases, the ICU.
• Hospital stay: Many robotic procedures allow discharge within one to a few days. More complex operations — such as bowel resection or heart valve repair — may require a longer stay. Your surgeon will advise.
• Pain management: Some pain and bloating at the incision sites is normal. The team will manage this with appropriate pain relief. The referred shoulder pain from the surgical gas usually settles on its own within a day or two.
• Diet: You will typically start with clear fluids and progress to solid food as your bowel function returns. This timeline varies by procedure.
• Movement: Gentle walking is usually encouraged from the first day after surgery to reduce the risk of blood clots. Strenuous activity, heavy lifting, and driving are restricted for a period your surgeon will specify.
• Wound care: The small incision sites need to be kept clean and dry. Your team will advise on dressing changes and when you may shower. Report any redness, swelling, discharge, or fever to your medical team promptly.
• Medications: You may be sent home with pain relief, antibiotics, or blood-thinning medication, depending on the procedure. Follow the prescription your doctor provides.
• Follow-up appointments: A review appointment is usually scheduled within a few weeks of discharge to check wound healing, review any pathology (laboratory) results, and plan any further treatment such as cancer therapy if relevant.
• Lifestyle: Returning to full daily activities, work, and exercise happens gradually. Your surgeon will give a personalised timeline. Smoking cessation and a healthy diet support healing regardless of the type of surgery.