Limited role in aesthetic surgery

Aesthetic surgery, unlike other subspecialties of plastic surgery, did not lend itself to the robotic technology72. In fact, it is well known that in order to achieve successful and pleasing cosmesis, repetitive tactile assessments of the tissues being handled intraoperatively is an important requirement. This is performed using the surgeon’s hands for sensing contour deformities and irregularities. The sense of touch is also vital to minimise tissue injury during any kind of surgical procedures. It is also equally important to evaluate tissues and suture tension in aesthetic surgery. Suture tension in robotic surgery, for example, must be estimated by the degree of deformation of the respective tissues that is not translatable to aesthetic surgery. While working with a surgical robot, the surgeon relies solely on visual cues and not on tactile (haptic) feedback. Despite the fact that robotic instruments with force-feedback systems have been recently designed for integrating force-sensing capabilities, they have not been met with much enthusiasm because of the constraints in size, design, cost, compatibility, and ability to withstand conventional sterilisation procedures73. Even though imaging technologies based on virtual and augmented reality have evolved to provide real-time navigational guidance in hope to make up for this lack of haptic feedback74, they cannot fully replace the authentic sensing and feeling provided by the surgeon’s hands.

Conclusions

The advantages of minimally-invasive surgery are well known and much desired by surgeons and patients alike. Shorter hospital stays, decreased postoperative pain, rapid return to preoperative activity are among the benefits of minimally-invasive surgery. Surgical robotics is a new technology that holds significant promise in advancing the field of reconstructive surgery, an area where ultra-precision and minimal donor site morbidity are essential requirements for optimal results. The robot is not, however, without disadvantages. These include increased expenses, consumption of operating room resources, availability of skilled technical staff, complete elimination of tactile feedback, and the lack of an organised curriculum. The presence of the robotic systems in a limited number of centres reduces surgical training opportunities. Up to this point in time, the drive to develop and obtain robotic devices has been largely dictated by the market. There is no doubt that they will become an important tool in the armamentarium of reconstructive surgeons, as the extent of their use has been steadily evolving over the past few years. Graduate medical education and continuing medical education programmes are vital to address the surgical robotic learning needs of residents and practicing surgeons. The hope is that with a gradual decrease of robotic surgical system costs coupled with the development of new learning modules designed for plastic surgeons and their staff, a substantial change paradigm of surgical activity can be anticipated.