Robotic-assisted laparoscopic surgery has become the next major stage of advancement for a range of operations. The field of surgery has long worked to improve skills and tools to minimize the invasiveness of operations and to overcome the limitations of human surgical dexterity and access. It has done so while dealing with the challenges of visualizing internal structures and controlling the variability inherent in even the best human hand-eye-brain decisions and coordination. Robotic surgery is helping to surmount these factors.
Since launching its robotics program, Our Lady of Lourdes Medical Center has gained a depth of experience in delivering robotic surgery. This is important because a surgeon must be fully trained and prepared to use such advanced systems. And, a large volume of patients is important within a program to gaining and maintaining the competence required with this technology.
Movements Safely Transformed and Viewed Up Close
The da Vinci® technology used at Lourdes gives the medical center’s surgical teams an advanced minimally invasive tool with unparalleled precision and flexibility in performing delicate procedures. Our Lady of Lourdes Medical Center is among select hospitals nationwide to possess the da Vinci® S™ Robotic Surgical System, the most advanced, minimally invasive surgical tool, and one that allows surgeons to treat patients with even less blood loss and pain, and quicker recovery, than conventional laparoscopy. Robotic surgery has found its greatest application in urology and gynecology. More recently its use has expanded in general surgery and now in thoracic and cardiothoracic operations as well.
|The da Vinci® features three-dimensional imaging of the operating field and intuitive controller-hand movement — as well as other major improvements over previous minimally invasive surgical systems.|
Representing the next step in the evolution of laparoscopy—and making this form of surgery available to more types of patients—the robotic approach offers and enhances all the advantages of laparoscopy when compared to traditional open surgery, including:
- smaller incisions and thus less trauma to the abdominal or pelvic wall and to organs and tissue near the structure targeted for surgery;
- less blood loss (with transfusions rarely necessary);
- reduced risk of infection;
- shortened hospital stay;
- decreased postoperative pain (with less use of pain medications necessary);
- faster return of patients to regular activities;
- less scaring, for better cosmetic result;
- less time needed between surgery and follow-on treatments;
- better outcomes and patient satisfaction, in many cases.
Movements Safely Transformed and Viewed Up Close
For robotic surgery, the surgeon sits at a console close by the patient, with his or her hands around sophisticated, fitted control devices that transfer human hand movements to robotic system and thus to the robotic instruments inserted inside the patient through puncture holes in the abdomen or pelvis. The system converts hand movements to a micro-scale. It also overrides any gross accidental movements—hands jerked by a sneeze or bump, for example. (For safety, robotic instruments do not accept such motion, cancelling out sudden or unsteady hand movement.)
At the console, the surgeon sees the surgery as a magnified, three-dimensional high-definition image, thereby getting a tight-in view of the surgical area via the small endoscopic camera system inserted into the abdomen. The image is visible as well on screens in the operating room. The surgeon can reposition, zoom and rotate this view of the operative field. The system gives the surgeon natural depth perception, as he or she would have in traditional open surgery; but, it retains the immediacy of a laparoscopic view, as if the surgeon views the site closely from within the incision. This permits the surgeon to perform delicate tissue dissection and reconstruction with precision, using the system’s highly programmed hand controls and foot petals.
“Wristed” movement of the pincers at the end of the small robot arms duplicate, on a smaller scale, the movements made by the surgeon’s hands. But this robotic “endowrist” tool provides even more freedom of movement than the human hand, which is comparatively limited (and, of course, much larger). This, for instance, makes such steps as internal laparoscopic suturing easier and is an improvement over rigid laparoscopic instruments, which offer a limited range of motion.
The surgeon’s fingers grasp the master controls below the display, with his or her hands and wrists naturally positioned relative to his or her eyes. The system smoothly and seamlessly translates the surgeon’s hand, wrist, finger and foot-control movements to surgical instruments inside the patient.
Finally, the approach also results in much less tool movement at the location of the incision, as no turning or twisting of the tool at the entry site of the body, and no movement of the patient, is required. This further reduces postoperative soreness in and around the surgical area.
If the surgical team should encounter difficulties with the robotic approach during a procedure, it can convert to an open procedure in the operating room. This step, referred to as a conversion surgery, provides an important back-up option.
Makes Surgery Better, and Easier to Undergo
Thus, the robotic system does not, of course, “do” the surgery, and does not replace the surgeon. Instead, the skills of the surgeon controlling the robotic “hands”, and conducting and performing the procedure, make the surgery possible as the robotic system makes the operation better. The system enhances the surgeon’s ability to perform delicate procedures through tiny surgical openings. It bears repeating that very maneuver is directly controlled by the surgeon. The system cannot be set up to make decisions or take actions on its own.
The da Vinci® is the first robotic surgical system to provide the surgeon with nearly all of the natural movements of the human wrist and then some. It also eliminates natural hand tremor and improves dexterity to enable surgeons to do ever-finer surgery in a more controlled manner.
The system allows surgeons to use the same techniques that they use for open surgery, but without large incisions. Instead of placing their hands into a large incision, they put their hands into the console and perform the same maneuvers using robotic instruments.
Because the robotic instruments are inserted into small, keyhole-sized incisions in the abdomen, the minimally invasive procedures allow quicker recovery. Even more so than with conventional laparoscopic surgery, patients are active again quickly. Patients are often up and walking around the next day after, which decreases the chance of blood clots, pneumonia and delayed return of function. They often resume activities in days, saving them the weeks or months of painful recovery typically necessitated by traditional open surgery.
Minimally Invasive Surgery Accessible to More Patients
The robotic system also makes laparoscopic-type minimally invasive surgery an option for patients with more kinds of medical situations, including those who:
- have adhesions or scar tissue from prior surgery, including multiple abdominal surgeries. In the past, these patients would have always had to undergo open surgery, the first step of which often had to remove much of the scar tissue to clear a path for the new procedure.
- are obese or elderly.
- or are on anticoagulent therapy. These patients are at greater risk for bleeding from any type of surgery. In robotic operations, however, they typically lose a tiny fraction of the blood they would lose from an open procedure, making it rare that even these patients would need a transfusion as a result of the procedure.
Many among these types of patients would have been ineligible even for conventional minimally invasive surgery. Now advanced surgical staffs like that at Lourdes have the experience and skills to perform to perform operations for both simple and complicated cases with the assistance of the robot—including for cases that would have been considered extremely challenging just a few years ago.
|Since its program began, Lourdes surgeons have performed thousands of procedures performed with the da Vinci system.|
What’s more, the approach is not just for challenging cases. At centers such as Lourdes today, many if not most patients eligible for an open procedure can potentially undergo a robotic procedure instead.
(Note: The staff, of course, continues to use conventional laparoscopic surgery as well. And this approach is often the choice for operations that do not require reconstruction.)
Surgeons use superlatives for the combination of control and visualization provided by the new state-of-the-science robotic systems. Our Lady of Lourdes Medical Center has some of the most extensive experience in robotic surgery in its region, an important factor for safety and effectiveness in these procedures.
Patient Education Video
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For more information about robotic-assisted surgeries at Lourdes, call 1-888-LOURDES (568-7337).