Courtesy of the Times
Is it a science fiction movie? It looks like the future, a robot operating on a human being with movements so precise they rival a surgeon’s.
The future is now, it’s not science fiction, and the robot has a name. But despite appearances, a robot isn’t actually doing the surgery.
“There’s a misconception about that," says Dr. John Taylor, obstetrician and gynecologist at IU Health La Porte. “The da Vinci robot is not doing the surgery -- it’s just a tool, like any other instrument. The arms of the robot are guided by the physician.” The robot can’t be programmed nor make any decisions on its own.
The da Vinci does allow the surgeon to guide precise movements for delicate procedures, and doctors are enthusiastic. “I love it. It’s the difference between a hammer and an electric drill,” says Dr. Tyler Emley, who has a private practice at Urologic Specialists of Northwest Indiana and is affiliated with Methodist Hospital’s Northlake Campus in Gary. “Robotics is now a more common approach to surgeries. Well over 80 percent of prostate surgeries are done with robotics.”
A small incision is made through which the instruments are guided -- so what makes the da Vinci so different from a laparoscopic surgery? Dr. Nabil Shabeeb, director of robotic surgeries at Community Hospital in Munster, Ind., explains: ”The robotic arm has much more mobility and maneuverability, with better range of motion. And the da Vinci view is three-dimensional; laparoscopic is one-dimensional, with a flat screen like a TV.” The latest version of the da Vinci allows all the instruments, including the 3-D camera, to be passed through a single, one-fifth-inch incision, while laparoscopic requires three to five incisions. “The first single-site surgery was in San Diego, Calif., in 2012; I was the first to do it in Indiana,” says Shabeeb. “(Single-site incision) is much more advanced, and they’re coming out with new improvements all the time.”
Once the incision is made, says Taylor, a tubular structure called a trocar goes through the incision and is attached to the robot. “It’s like passing a straw through to the abdomen, then passing a smaller one through the straw.” With the camera in place and showing crisp images, the surgeon guides the instruments with his or her fingers. Three-D, magnified imagery gives natural depth of field, allowing the surgeon to perform delicate tissue dissection and precise suturing.
Taylor, at IU Health La Porte since 1995, has been performing robotic surgery since 2010, primarily in gynecological surgeries. Now, he says, robotic surgeries are being performed by general surgeons, cardiovascular surgeons and ear, nose and throat specialists.
The advantages are impressive. “Suturing is much faster and more precise,” says Shabeeb.
Emley, who has been using the da Vinci since 2005, after studying robotics in 2003, says compared to conventional surgery, there is less pain, less blood loss, decreased hospital stay and quicker return to activity. ”Feedback from patients and their relatives is more positive,” he says.
There are several training locations across the country. Each requires initial reading of material and studying a video, and spending an entire day at the facility practicing using the robotic arms and sewing stitches. When beginning to work with the da Vinci robot with patients, surgeons’ first few cases are monitored by experienced staff.
The miniaturized surgical instruments attached at the wrists help surgeons perform more precise maneuvers than would be possible with their own hands
“It’s very exciting,” says Shabeeb. “Medicine has been the beneficiary of modern technology, with MRIs, etc., and now we’re already in the third generation of robotics." Noting the recent development allowing a single-site incision and better optics. With all improvements requiring FDA approval, “The risk is pretty much the same as with open surgery." Though the risk of infection is less than with larger incisions, Shabeeb says.
“When the arms of the robot move, they pivot around a focal point, so there’s not as much pain and there’s less blood loss,” explains Taylor. “Most of the surgeries I do, which are hysterectomies, the patient can go home the next day. A sedentary worker can be back at work in two weeks.”
The da Vinci sounds great -- but there is a cost. In fact, “Cost is an issue,” says Emley. “It’s much higher than an open surgery. With open surgeries you have standard equipment that lasts. The da Vinci has parts that have to be replaced, some parts are disposable. There are also the upgrades. But the important thing is that it’s much more precise.”
And using the da Vinci, the surgeon is more ergonomically comfortable, and that may lengthen a surgeon’s career, says Emley, who adds that it’s beneficial to society to have physicians extending their careers, and for patients who experience less pain, fewer infections and more rapid recovery.