Robotic Surgery in Singapore

• Patients requiring surgery in specialties where robotic assistance offers clear benefits
• Individuals with conditions amenable to minimally invasive approaches
• Patients who are medically fit for general anaesthesia
• Those seeking faster recovery times compared to open surgery
• Individuals with body habitus suitable for laparoscopic positioning
• Patients without extensive adhesions from previous surgeries in the operative area
• Those who understand and accept both benefits and limitations of robotic surgery

• Severe cardiopulmonary disease preventing safe positioning for robotic surgery
• Inability to tolerate general anaesthesia or pneumoperitoneum (CO2 insufflation)
• Extensive intra-abdominal adhesions that prevent safe access
• Emergency surgical situations requiring immediate open intervention
• Certain anatomical variations that make robotic access unsafe
• Active infections at proposed port sites
• Uncorrected coagulopathy or bleeding disorders

The suitability for DaVinci robotic surgery depends on multiple factors including the specific procedure needed, anatomical considerations, and overall health status. A thorough evaluation by your surgeon will determine whether this approach offers advantages over traditional surgical methods for your particular condition. Not all procedures or patients benefit equally from robotic assistance, making individualised assessment essential.

Preparation for DaVinci robotic surgery begins with comprehensive pre-operative assessment including blood tests, imaging studies, and cardiac evaluation when indicated. Patients typically undergo bowel preparation for abdominal procedures, starting 1-2 days before surgery. Fasting guidelines require no solid food for 8 hours and clear liquids until 2 hours before the procedure. Anti-embolic stockings are fitted to prevent blood clots.

Medication adjustments may include stopping blood thinners, with specific timing determined by your surgeon and anaesthesiologist. Pre-operative antibiotics are administered to reduce infection risk. Patients receive detailed instructions about post-operative care, expected recovery timeline, and necessary home preparations. Consent discussions cover the specific procedure, potential conversion to open surgery if needed, and alternative treatment options.

The procedure begins with general anaesthesia administration and patient positioning, which varies based on the surgical site. For pelvic procedures, patients are placed in a steep Trendelenburg position (head down). The surgical team creates small incisions and establishes pneumoperitoneum using CO2 gas to create working space. Trocars (hollow tubes) are inserted through the incisions to allow robotic arm docking.

Once the robotic system is positioned and calibrated, the surgeon moves to the console while the bedside team remains with the patient. The surgeon controls the camera and instruments through hand controls, performing the procedure with magnified 3D visualisation. The bedside assistant helps with instrument exchanges, specimen retrieval, and any additional tasks. Procedure duration varies significantly based on complexity, typically ranging from 1-4 hours.

Following surgery completion, the robotic system is undocked, instruments removed, and CO2 gas evacuated. The small incisions are closed with sutures or skin adhesive. Patients are transferred to the recovery room where vital signs are monitored closely. Pain management begins immediately with multimodal approaches including regional blocks when appropriate. Most patients experience mild to moderate discomfort rather than severe pain.

Initial recovery focuses on respiratory function, particularly clearing residual anaesthetic effects. Patients are encouraged to take deep breaths and use incentive spirometry. Nausea prevention and management are priorities. Urinary catheter management depends on the procedure type. Discharge timing varies from same-day for simple procedures to 1-3 days for complex operations, contingent on meeting specific recovery milestones.

Temporary effects experienced by many patients include mild incision discomfort lasting 1-2 weeks, managed effectively with oral pain medications. Bloating and shoulder pain from CO2 gas typically resolve within 48 hours. Mild nausea from anaesthesia affects some patients but responds well to anti-nausea medications. Temporary changes in bowel or bladder function may occur depending on the procedure location.

Fatigue is common during the first week as the body heals, though generally less pronounced than after open surgery. Minor incision bruising or swelling is normal and resolves spontaneously. Some patients experience temporary voice changes from intubation. These common effects are anticipated and manageable with appropriate supportive care.

While uncommon, potential complications include bleeding requiring transfusion or return to surgery, occurring in less than 2% of cases. Infection at port sites or internally requires antibiotic treatment. Injury to surrounding organs or structures may necessitate repair, though the magnified view often reduces this risk compared to traditional surgery. Conversion to open surgery occurs in 1-5% of cases due to technical difficulties or unexpected findings.

Anaesthesia-related complications, while rare, include allergic reactions or cardiovascular events. Deep vein thrombosis or pulmonary embolism risk is minimised through preventive measures. Hernia formation at port sites is a delayed complication seen occasionally. Robotic system malfunction, though extremely rare, may require conversion to traditional laparoscopic or open approach.

These risks are minimised through careful patient selection, meticulous surgical technique, and the enhanced visualisation provided by the robotic system. The experience of both the surgical and anaesthesia teams plays a crucial role in preventing and managing any complications that may arise.