Robotics-assisted surgery offers a wide range of advantages, including shorter hospitalization, decreased pain and discomfort, faster recovery times, smaller incisions, reduced blood loss, and minimal scarring. The use of robotics in surgery enables enhanced control, improved visualization, and greater precision.
Technology continues to evolve and simplify processes across various industries. Healthcare is not an exception.
The use of robotic surgery is on the rise. Sheetz et al. reported in their study that the use of robotics-assisted surgery for general surgery procedures increased from 1.8% in 2012 to 15.1% in 2018, representing a significant improvement.
This article will focus on robotics-assisted surgeries in diabetes-related procedures.
Importance of Robot-Assisted Surgeries for Patients with Diabetes
Performing surgeries on patients with diabetes is an incredibly challenging task. Diabetes paves the way to a multitude of complications, including infection after the surgery (particularly at the surgical site), problems with fluid, electrolytes, and kidneys, and slow wound healing. At the same time, the number of people with diabetes in need of surgery is increasing due to the micro- and macrovascular complications of this chronic condition.
Bearing in mind the growing need for surgery and the potential complications that may occur, it is crucial to develop approaches that improve patients’ safety. Robot-assisted procedures could be beneficial for patients with diabetes. The use of robotics and artificial intelligence presents numerous opportunities for healthcare providers. The algorithms can analyze medical imaging and detect diseases such as diabetic retinopathy in the early stages.
Robot-assisted procedures are designed with great precision in mind, which is why systems such as da Vinci Surgical System can perform eye surgery, especially those targeting the retina.
Since patients with diabetes experience problems such as wound healing, it is of enormous importance to focus on techniques that allow for better outcomes. That is precisely the primary advantage of robot-assisted surgery – it allows for a faster recovery. Moreover, robotic-assisted procedure experience is associated with fewer complications, and they also involve scars that are smaller and less noticeable compared to scars from other surgeries. A smaller scar implies the incision site is also smaller, meaning it may become easier for a wound to heal.
Pancreas transplant is a common therapeutic approach for patients with type 1 diabetes. The doctor may recommend a pancreas transplant when standard treatment for type 1 diabetes doesn’t work. People with frequent insulin reactions, severe kidney damage, and persistently poor blood sugar control may need pancreas transplants as well. In some cases, a patient with type 2 diabetes may need a pancreas transplant. This is necessary when they have both insulin resistance and low production of insulin.
There are different types of pancreas transplant, including pancreatic islet cell transplant, which is performed by obtaining insulin-producing islet cells from a deceased donor’s pancreas and injecting them into the blood vessel that takes blood to the liver.
The use of robotics-assisted surgery can lead to the successful completion of a pancreas transplant. In their case report from Medicine Journal, Yeh et al. found that a robotic pancreas transplant is a feasible approach for patients with morbid obesity. They described a case of a 34-year-old male with type 1 diabetes and class III obesity. The robotic pancreas after kidney transplantation was successful, and the patient was quickly discharged without suffering complications. A little reminder; the pancreas after a kidney transplant indicates a person who previously had a kidney transplant may be a candidate for a pancreas transplant. For people who are waiting for a transplant of both kidney and pancreas, it may be advised to undergo a kidney transplant first.
Researchers Yeh and colleagues observed improved metabolic control. Before the transplant, the patient's hemoglobin A1c level was 9%. By day 120 following the transplant, the hemoglobin A1c level had reduced to 4.4%. Even at one-year follow-up, the patient remained in a non-diabetic state.
Speaking of pancreas transplant, M. Spaggiari et al. revealed in their single-center retrospective study that robotic pancreas transfer is both safe and effective in obese patients with diabetes. Robotic-assisted surgery is without the added risk of wound complications.
A common complication of diabetes is weight gain. Excess weight and diabetes have a bidirectional relationship; one can contribute to the development and progression of the other. Bariatric surgery is common among patients with diabetes, and it’s not just about weight loss. Bariatric surgery can support the treatment of diabetes by helping the body produce and use insulin more efficiently.
The use of robotic-assisted surgery in bariatric procedures isn’t uncommon. Dimou et al. investigated factors associated with robotic surgery and found that the presence of diabetes or conditions such as GERD and COPD was associated with Roux-en-Y gastric bypass. Of 76,805 patients who underwent Roux-en-Y gastric bypass, 7.9% had robotic surgery. The prevalence of robotic surgery for weight loss increased over time.
Zhengchen et al. explored the effectiveness of robot-assisted sleeve gastrectomy. They begin their paper by confirming that obesity and diabetes are closely related chronic diseases that can endanger human health. Compared to standard laparoscopic approaches, robotic surgery can significantly shorten the learning curve. For example, laparoscopic sleeve gastrectomy typically requires 68 procedures for proficiency; the robotic-assisted approach only requires 20 operations to complete the learning curve.
Robotic-assisted bariatric surgery can benefit children or adolescents with diabetes, too. Cag et al. published a case report and review of the literature on this subject. Their case report is, in fact, the world’s first case of robotic-assisted mini-gastric bypass in a 15-year-old boy with a BMI of 58.6 and type 2 diabetes.
The patient didn’t experience any complications during the 105-minute surgery and was even able to start walking six hours later.
Blood glucose levels were within the normal range on the first day post-surgery. No perturbation of blood glucose level was observed after one month of follow-up. Cag and colleagues concluded that a robotic-assisted mini-gastric bypass is a feasible approach for children with diabetes. The most significant benefits of this procedure include reduced pain and a faster recovery.