Enabling more MAS: why modularity matters

To understand why modularity really matters in robotics, you first have to address a bigger question. Why, after 30 years of laparoscopy, are 50% of patients still getting open surgery?

At its very simplest, we know manual laparoscopy is highly complex to perform, especially in advanced procedures. There is a steep learning curve to become confident in this approach. While surgical robotics can often make laparoscopy easier to learn (by bringing open surgery style manoeuvres into the laparoscopic approach) it would be wrong to say surgical robotics comes without its own set of unique challenges.

 There are some key barriers preventing robotics being more widespread today. This is particularly true in multiquadrant or hybrid procedures. It is arguable that many of these barriers can be overcome by modular systems instead of a single monolithic structure. By separating the robotic arms, it can be a better fit for not only surgeons, but also hospitals, operating rooms (ORs) and their surgical teams.

 By adopting modular robots, it is believed we could help shift the dial to enable more minimal access surgery(MAS) to be performed, potentially benefiting millions of patients across the globe. Here’s why...

 1. Utilisation – When a hospital invests in a surgical robot, it’s essential for them to be able to “sweat the asset” i.e. keep it busy all day. While monolithic robots can be too big for some ORs, once it is in there, the size often means that it cannot be easily moved. If a hospital can’t move its robot from say a gynaecology OR in the morning to a colorectal OR in the afternoon, it is unlikely that the robot is going to be working at its maximum capacity all day. This low utilisation may be a barrier to MASuptake, and it can also be a major issue for hospitals financially.

 2. Port placement – The architecture of non-modular robots often dictates where a surgeon must put their ports which is often different from their know port positions for a laparoscopic case. Not only dosurgeons working with monolithic robots need to learn a new system, they must also learn a whole new surgical approach.  So, wouldn’t you want a system that has the flexibility to allow the ports to go where a surgeon wants them, and where they already know how to do the procedure from? 

 3. Hybrid procedures – Some procedures can never be done laparoscopically, by hand or by robot. This is particularly true if the pathology is too big. Likewise, some procedures should only be done by manual laparoscopy because they are quick and simple. But in various complex cases such as colectomies, anterior resections and gastrectomies, it can be a great benefit to do some of it by manual laparoscopy and some robotically. However, this only makes sense if the port positions can be used for both manual laparoscopic instruments and the robot without the need for additional ports. 

 4. Collaboration – Surgery is a team sport. And the surgeon being tucked away in a console can be a deterrent for the rest of the OR team. The surgical teams want a robot with an open console where the surgeon can communicate with them. They want a robot that has small, moveable arms, and thus make it easy to collaborate as a team working towards the same goal. 

 5. Size matters – Not all modularity is equal. The modular nature of the system has to allow it to get easily around the patient while still allowing clear access for the bedside team and anaesthetist. This only works if the modules are small, lightweight and compact. Having multiple massive arms crowding out the patient or the bedside staff defeats the point. The size makes the robot portable, as it can be moved between ORs or between sites. When it’s not being used it can then be easily stored, not taking up valuable OR space. 

 What does this mean? All in all, to see a wider uptake of MAS, we need a surgical robot that works around the surgeon, surgical team and the OR and not the other way around.  Small form modularity can help with this.

 Small modular robots can be designed to fit into virtually any OR, so that no matter where in a hospital a patient seeks the best MAS healthcare, the robot can be moved there easily. 

 A small modular robot can be positioned wherever a surgeon can stand around the patient, so that ports can be placed in manual laparoscopic positions that are extremely familiar. The design enables the bedside team toeasily work among the arms – and this helps to make hybrid procedures a reality. 

While monolithic (or huge modular) robots can feel like they get in the way, dominating an OR, small modular robots give the benefit that the surgeon has a clear view of not just the patient, but also the staff working at the bedside. This allows for clear verbal and non-verbal communication – critical for both the surgeon and team.

All in all, the change from manual laparoscopy is much less dramatic with small modular robots: they allow surgeons to think laparoscopically and act robotically. Small form modularity matters because it has the real potential to allow many more patients to benefit from MAS.