Robotics: Sci-Fi Surgery Made Real
New robotic technology allows surgeons to perform precise, delicate procedures that would be impossible with a hand-held scalpel.
From Robby the Robot to R2D2, people have always had a fascination with robots.
Now one of these mechanical marvels is helping surgeons perform operations with less scarring, less blood loss and quicker recovery times than traditional abdominal surgery.
This sophisticated robotic platform, called the da Vinci System, helps doctors take surgery beyond the limits of the human hand. It also offers minimally invasive options for many procedures that traditionally were exclusively performed through open surgery.
New Help for Prostate Cancer
Introduced about a decade ago, robotic surgery was first used by urologists performing radical prostatectomy operations for prostate cancer.
"It works very well when you're operating inside the pelvis because in open surgery, it's very difficult to see into this area of the body," according to Mills-Peninsula urologist Ori Melamud, M.D.
"Using the robot and its 3-D, high-definition cameras, we can see much better, operate more precisely and do complicated procedures we couldn't do before," he says.
The application of the robot has evolved over time. Now it is also used for kidney cancer and gynecologic operations, as well as gall bladder, colon and cardiac surgeries.
Expanding Surgeons' Capabilities
Dime-sized incisions are used to introduce miniaturized flexible instruments and a high-definition 3-D camera into the patient lying on an operating table. These instruments are attached to the "arms" of the robot.
A short distance away, seated at a control console, the surgeon looks through a binocular-shaped viewer watching a magnified, high-resolution 3-D image of the surgical site.
"One of the biggest misconceptions about robotic surgery is that people think there's a robot that stands in the operating room, we tell it what to do, it performs the surgery and then it takes a coffee break," kids Michael T. Margolis, M.D., a Mills-Peninsula urogynecologist.
"While the technology is fantastic, the robot cannot be programmed, make decisions or do anything unless the surgeon sitting behind the controls directs it," he emphasizes. "The robotic arms are literally just an extension of the surgeon's hands."
Manipulating a set of controls with his or her hands and feet - a combination of pedals, buttons and claw-like pinchers - the surgeon operates. Simultaneously, the robotic arms mimic the surgeon's hand movements, translating them into precise micro-movements of the instruments inside the patient's body.
"This allows the surgeon to tie knots, use needles, dissect and more, and the robot will basically reproduce those maneuvers inside the patient," Dr. Melamud says.
However, the robotic arms are engineered to do things that human hands cannot do. For example, the robot's instruments have a 360-degree range of motion. This gives the surgeons greatly increased access, dexterity and the opportunity to do extremely delicate, meticulous work.
Because surgeries can be performed with greater accuracy and effectiveness, patients typically experience less blood loss, scarring, pain and complications, and a shorter hospital stay and faster return to normal activity.
Surgeons undergo additional training to master this complex equipment. Afterwards, they also spend hours each week practicing on a robotic simulator - sort of a video game - to keep their skills sharp between operations, the same way a pilot might use a flight simulator.
"It's a joy to see how amazed my patients are at how well they feel so quickly after their operations, even though they've undergone a very complicated surgery," Dr. Melamud says. "I'm so grateful to have the ability and the technology to do this for them."
Not For Men Only
"In 2005, about 64 percent of hysterectomies were open surgeries, not even laparoscopic or vaginal surgeries," according to Claire Serrato, M.D., a Mills-Peninsula gynecologist and obstetrician.
Now, she says, most complex gynecological operations can be done robotically - hysterectomies, cancer surgery, removal of ovarian cysts and treatment of endometriosis.
"Laparoscopic instruments are straight, so when they are inserted inside the patient, there is little flexibility or leeway to move them around," she says. So, sometimes because of inaccessibility to the surgical site, surgeons are forced to cut into the patient.
"But the robot's instruments are better than a human wrist inside the patient and can articulate 360 degrees in any direction," she says. "So it allows us to go around intestine and blood vessels and see structures up close to make sure you're cutting what you want to cut and clearly avoiding structures you don't want to touch," she describes.
This dexterity, coupled with greatly enhanced visibility, allows the surgeon to clip blood vessels more precisely and remove tumors efficiently with less damage.
For example, in a myomectomy - removing a fibroid and then carefully suturing to close the uterus - the challenge is to leave the uterus intact so the woman has the option of a future pregnancy.
"Often we had to do these procedures with open surgery in order to provide a tight, secure closure," Dr. Serrato says. "Without tight closure, if the woman becomes pregnant, when her uterus stretches, that opening could possibly rupture.
"However, the problem with open surgeries is that they can cause terrible scarring, which can impair the fertility you are trying to protect."
With robotics, surgeons can perform the same myomectomy as in open surgery, but with minimally invasive techniques.
"This is a phenomenal advancement for women who get all the benefits of a tight closure of an open surgery, but without the scars, pain and long healing process," Dr. Serrato says. "And we can keep her uterus safe for future fertility."