Advances with Robotic Surgery

Greater precision and recovery for patients in Northern Virginia

“You’ll need to have surgery,” the doctor says. In the past, those words would have sent an already worried patient into a stressed, maybe even panicked mode. The word “surgery” brings to mind ideas of deep cuts, scars on the body, pain, long recovery times, and possibly addictive medication. But advances in medical technology that led to the less-invasive laparoscopy surgery have now brought the minimally invasive robotic surgery.

Though it is still a relatively new option – it was just in 2000 when the U.S. Food and Drug Administration approved the da Vinci Surgery System as the first robotic system for laparoscopic surgery – and not offered widely, those people who work in robotic surgery can’t praise its benefits enough.

Jennifer Young, MD, is one of those advocates. As the director of robotic surgery at StoneSprings Hospital in Dulles, Virginia, she has seen how the method has revolutionized some surgical procedures.

“What we used 20 years ago when you had prostate or kidney cancer or needed your bladder removed, for example,” she says, “would mean we’d have to do a big incision, take things out, and do reconstruction, and you had a risk of needing a blood transfusion.” Patient recovery could be long, too, Dr. Young says. “If you had an upper kidney tumor, we would need to take out a rib, and you would have to not be active for eight weeks from the open surgery,” she says.

“Along came laparoscopy, where we use a port through small incisions and insert long thin sticks with tools. The next evolution was robotic surgery, also with a small incision (so less scarring) and little ports carrying tiny instruments. But now these tools can be connected to a robot,” Dr. Young says.

The use of the robot enables greater capabilities than a doctor would have with traditional open surgery. Controlling the miniaturized surgical instruments that fit through a tiny incision – usually just a quarter-inch long – allows the doctors a greater range of motion and precision.

But it is the doctor who is still doing the work, Young adds. If the words “robotic surgery” conjures images from a science fiction film of robots gone rogue, fear not: the robot is just a tool, one of many that doctors can use.

“The robot is just a tool. It’s not doing the surgery itself. It’s not controlling it – it’s just helping us to guide the instruments differently,” Dr. Young says. In robotic surgery, the doctor is not bedside, but sitting at a console in the surgical room, guiding the robot.

From this console in the patient’s operating room, the surgeon controls these instruments and the camera. The surgeon can operate all four arms of the da Vinci simultaneously while looking at a high-definition monitor to get a full view inside the patient. Robotic surgeons say it’s like being inside the patient with greater control – the robot is just an extension of the surgeon.

“We’re using the newest robot. We have two da Vinci Xi robots,” Dr. Young says, “which provide even better visualization, high definition, a bigger field of vision, and more adjustment.” The robot gives surgeons 10- to 15-fold more magnification, more depth perception, and 3D vision, along with greater and more precise movement, she says.

“Robotics give you the ability to move in more ways,” Dr. Young says. “One of the most important things for reconstruction is you have wristed movement; you can do more in circles. This allows you to move your wrist 270 degrees, be extra flexible, more than with a human wrist.”

Robotic surgeons can thus do more, but with less strain: robotic surgery has physical benefits not just for the patients, but for the doctors, too. Because the surgeons are sitting at an ergonomic console, they are not standing for long periods. Among the benefits of performing surgery this way are reduced fatigue, less eye strain, and less spine and neck strain from standing in awkward positions for long hours, Dr. Young says.

Robotic surgeries have quicker discharges; also, she adds, such as patients being released in 24 hours in some cases instead of 5-7 days. Another substantial benefit of robotic surgery, Dr. Young says, is the reduced need for narcotics, an important thing to note given the current opioid crisis. “We have recently instituted the Enhanced Recovery After Surgery protocol, which is a multimodal effort to minimize invasive pre-and post-op preparation and Improve outcomes,” she says. “This has also allowed us to decrease the number of narcotics we give patients during and after their hospitalization. This is critical, considering the current opioid epidemic.”

“Opioid addiction is a real crisis. West Virginia, our neighbor, is having the highest rate of death from it,” Dr. Young states. “With robotics, we are still doing major surgery, but since incisions are smaller and we are using multi-modal anesthesia and meds that attack pain from other receptors that are not opioid receptors, there is less need for using opioid narcotics. In some cases, we’ve had patients in their 70s who are just taking Tylenol after surgery.”

Surgical robots are in use for urological, gynecological, cardiothoracic, and other surgeries. Some procedures include removing kidney tumors, kidney reconstruction, treating prostate cancer, bladder removal, and surgery on the adrenal glands.

With such flexibility and benefits, will robotic surgery become more popular, maybe even the norm eventually? Patients can ask if robotic surgery is an option for them, but the answer comes down to “what the surgeon is more comfortable with,” Dr. Young says. “It’s still up to the doctor: open technique, laparoscopy, or robotics. Surgeon training and surgeon preference are what drives this.” Some people have been slow to adopt the technology, and those who are more trained in open-surgery may still prefer that, she adds.

And robotic surgery is not immune to challenges and limitations. “It’s a tool just like any other tool,” Dr. Young says. “It can malfunction, have problems or recalls, like any equipment anywhere. It’s just a modern, expensive tool that can do more.”

But that is a crucial thing to remember: robotic surgery is surgery aided by a robot, which is a tool. The biggest misconception from patients, Dr. Young says, is the worry that the surgery is automated, leaving the doctor out of the equation. “Some people who aren’t aware of how robotic surgery works will say ‘I don’t want a robot doing my surgery, I want a SURGEON doing my surgery,’” she says, “but it actually IS the surgeon doing the surgery. That said, the robots help a great deal, and it’s technology that continues to grow and evolve and get better.”


Photo Credit Marty Shoup, Blue Lion Multimedia