Michelle Gillis
While laparoscopic surgery has been performed in hospitals for many years, new robotic technology has completely transformed the entire surgical experience.
The Da Vinci Xi robotic surgery system, developed by Intuitive, has been implemented in Wheeling Hospital systems to improve the surgical experience for patients and surgeons.
Wheeling Hospital has been using robotic technology in surgeries for about five years and just recently installed its third robot.
“We’re using a newer system, the da Vinci Xi system,” said Wayne Myers, MD, a general surgeon at Wheeling Hospital, “and it’s being used for a variety of procedures.”
Myers said robotic technology became popular in urology and obstetrics and gynecology about 10 to 15 years ago as it gave surgeons a clearer view into the tight spaces inside the pelvis.
However, today it is used for hernia repair, hiatal and inguinal hernia repair, sleeve gastrectomy, etc. It is becoming very popular in the field of bariatric care, as well as in gynecological surgery.
“I use it a lot,” Myers said, “Almost all of my hernia surgeries are done robotically, and I also do bariatric surgery, so I use it whenever I do a sleeve gastrectomy.”
Surgeon Rami Abraham, MD, joined Reynolds Memorial Hospital with five years of robotic surgery experience, but there was no robotics program at the time, so he was excited to share his knowledge and help launch an all-new robotics program with the Da Vinci Xi at his new workplace.
Currently, Reynolds has just one Da Vinci Xi, but Abraham said they plan to add more once the program gets going, possibly in two or three years.
“I thought this would be a good opportunity to use my experience to help start a program somewhere else,” said Abraham, who performed about 875 robotic surgeries between his time in medical school and his time at Forbes Regional Hospital in Pittsburgh. “There’s a lot of excitement in that, right? So I think it’s important for me in the long run.”
To help Reynolds’ surgeons and staff use the robot, Intuitive assembled a team to train the surgeons and operating room staff, and also sent surgeons for physical training on using the robot on cadavers and pigs.
“These courses allow you to actually operate it, use it, get familiar with joystick movements and how it works,” Abraham said. “You learn how to use the foot pedals, operate the equipment, how to be fluid with your movements.”
Before a surgeon is legally authorized to perform robotic surgery, they must complete three supervised surgeries, and their supervisor will either advise them on areas to improve or decide they are OK to perform the procedure.
While some patients may balk or resist when robotic surgery is suggested, Myers and Abraham explained that the Da Vinci Xi is simply a tool to improve the precision of the procedure for patients.
“I think that’s a misconception,” Myers says. “Everyone hears robots and thinks, ‘Oh, I don’t want a robot to operate on me,’ but a robot is just a tool.”
The surgeon has full control over the robotic arm.
Myers said they make ports or small holes in the abdomen, similar to laparoscopic surgery. “The nice thing about the robot is that the joints on the instruments move a lot better,” he said. “You sit at the console, you look at the screen, and there’s a place to move your hand and your fingers, and in real time, your wrist joints move in the same way that the instruments on the robot do. You can have up to four different arms with the robot that you can manipulate and use.”
During surgery, the surgeon and console are in the operating room with the patient.
“You dock the robot, attach the instruments you want to use, sit at the console, and you can control all four arms and the camera,” Myers says, “and in real time, the wrist joints move in the same way as the instruments on the robot. It’s really helpful for the surgeon to be able to control all the arms, because sometimes you have a really good assistant, and sometimes you have a brand new assistant and they don’t know how to help. So it’s nice to control it yourself, but it’s visualization that’s key.”
The Da Vinci Xi robot’s cameras provide 3D visualization capabilities, allowing surgeons to see inside a patient’s abdomen in greater detail than ever before.
“The images are fantastic, so we can see better and get into smaller, tighter areas of the abdomen,” Myers said. Abraham agreed that the 3-D cameras would be extremely helpful.
“When you put your head into the console, you get a 10x magnification of the three-dimensional image,” Abraham says. “If you stand up and put the thing you’re working on right in front of your face, it’s almost as if you’re working at arm’s length. You can see it much closer, but you’re still working at arm’s length.”
The main advantage of robotic technology in surgery is faster recovery time for patients.
“Robots reduce pain,” Myers says. “There’s always a salesman trying to sell you everything. I’ve always been skeptical — it can’t possibly reduce pain. My perspective isn’t that different. But studies have shown that robotic surgery results in shorter hospital stays, less blood loss, and a lower risk of infection compared to other surgeries. All of these things translate into a faster recovery.”
Myers said one reason it’s less painful is because the robot is so precise that it causes less trauma to the abdomen.
“The advantage of robotic surgery is that it’s less painful, you can see more, you can see a lot more clearly,” Myers said, “and with robotic surgery you can go deeper and see better, so you can operate deeper. You can operate in tighter spaces, and the big advantage is that you have instruments that have the same dexterity and rotation as your wrist.”
Abraham said using the robot is like using your own hands.
“It’s like having your hand inside the abdomen, literally,” Abraham says. “The tip of the instrument controls the movement and does the suturing and stuff. Stitching inside the abdomen is very difficult with straight instruments like in traditional laparoscopy, because you have to move your whole arm in a circular motion, like you would when putting in a suture.”
Abraham said the robots allow surgeons to perform fine movements more efficiently and precisely, allowing them to operate without causing trauma to internal tissue, resulting in less post-operative trauma and inflammation for patients. Less inflammation means less pain.
Reduced pain also reduces the need for patients to be prescribed narcotics after surgery, which is a major benefit of scheduling this type of surgery.
Another benefit of robotic technology in the operating room is the Da Vinci Xi’s on-board sensors: for example, the system can detect tissue thickness and recommend the appropriate stapler size, reducing the risk of bleeding and leaks.
“The technology that Da Vinci has put into this machine is incredible,” Myers says, “because it can tell you, ‘This tissue is too thin, you’d better staple it,’ or, ‘This tissue is too thick, you’d better staple it.'”
Myers said surgeons and operating room staff shouldn’t worry about losing their jobs: The robots used in surgery are just tools, and there will always be people to operate the robots, hand them tools, and all the other jobs needed to perform a successful operation.
Abraham said the robot has many safety features, and will not move at all if the surgeon leaves the console.
Abraham acknowledged that some experienced surgeons may resist change because of cost and other factors.
“In the long term, when you calculate the potential costs of readmissions, conversions to open surgery and complications over a number of years, using the robot translates into cost savings,” Abraham said.
Both surgeons acknowledged that there are times, especially in emergency situations, when the robot can’t be used and they have to open up the patient and perform surgery the old-fashioned way.
Sponsored content provided by WVU Medicine.
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