Health & Fitness
Robotic assistance
By Anna Lamy | Hernando Today
Published: February 10, 2011
Since 2000, robotic assistance for surgical procedures has been approved by the U.S. Food and Drug Administration (FDA).Published: February 10, 2011
Robotic technology is entrenched in the automobile industry and now it has reached the operating room of hospitals and surgical centers.
A procedure requiring a large team of about a dozen medical personnel can be performed with one surgeon, one or two nurses and an anesthesiologist.
The FDA has approved the da Vinci Surgical System for laparoscopic surgeries for urological, gynecological and some cardiac procedures, making it the first robotic system permitted in operating rooms in the U.S. Since approval it has been used to perform tens of thousands of minimally invasive surgeries.
Brooksville Regional Hospital recently announced it offers the da Vinci Surgical System.
The surgical system's manufacturer, Intuitive Surgical states it offers unparalleled precision, dexterity and control that enable a minimally invasive approach for many complex surgical procedures and the best surgery experience for patients.
Having this system available at Brooksville Regional Hospital provides surgeons the ability to perform procedures with the cutting edge of technological advancement, providing the least-invasive, highest quality medical care to patients.
Sheilagh Barry, director of surgical services at Brooksville Regional Hospital, lists better pain management and smaller incisions resulting in a shorter hospital stay (in most cases just over night) as benefits of using this system.
"Physicians who use the device enjoy better visibility of the surgical site, as the cameras provide a detailed 3-D image that cannot be seen in a traditional surgical setting," Barry added.
Now, many surgeries can be performed laparoscopically, where as before the procedures involved major open surgery and large incision sites.
Laparoscopic surgery utilizes small incisions, which includes procedures for cardiac, hysterectomy, gallbladder removal, colon resection, cystectomy, prostatectomy, colorectal surgery, laparoscopic-assisted vaginal hysterectomy (LAVH), lobectomy, and oophorectomy (ovary removal).
How it works
The robotic system is guided by the surgeon, who makes three or four incisions, depending on the number of arms the model features. The incisions are about the diameter of a pencil in the patient's abdomen. This allows the surgeon to insert three or four stainless-steel rods, for the robotic arms to hold in place.
One of the rods has two endoscopic cameras inside to provide the image of the site to the surgeon on the display screen. The surgeon sits at a control console a few feet from the operating table. Looking at the surgical site with the display screen, the surgeon is able to examine the 3-D images received from the cameras inside the patient.
The other rods have the surgical instruments, used to dissect and suture the tissue. The surgeon does not touch these surgical instruments directly. The images show the surgical site and the two or three surgical instruments mounted on the tips of the surgical rods.
Using joystick-like controls located below the display, the surgeon can manipulate the surgical instruments. As the surgeon moves the joystick, the computer sends a signal to one of the instruments, to move it just as if it were the surgeon's hands. The surgeon removes the rods from the patient's body and closes the incisions, after the procedure is complete.
Dr. Philip Townsend, M.D., a gynecologist in Brooksville, explains the advantages of using the da Vinci system for his procedures, as laparoscopic procedures are limited visually in two dimensional (2-D) images. With this system the view is three dimensional (3-D), sparing small nerve damage, plus less bleeding.
"Many times, in normal surgery or in laparoscopic surgery, surgeons cannot completely see the entire area," said Townsend, "with this system, it is a big step forward, especially the view of the surgical site, where we can be much more thorough having a magnified view of ten times in a 3-D image."
The manufacturer promotes it easily maneuvers into tight spaces better than human doctors.
Dr. Samir Shakfeh, M.D., obstetrician and gynecologist in Spring Hill said the use of the devise is very precise.
"The view of the surgical site and resolution of the image are excellent," Shakfeh said.
Townsend added two thirds of the procedures performed with the da Vinci are hysterectomies, with urologists performing almost another third, there are some general surgeons who use the system. Urologists have had tremendous success in prostate cancer surgeries, where becoming impotent may occur, as they can avoid small nerve damage.
I like using the equipment, because my patients have good results, Shakfeh added.
Dr. David Marler, M.D., obstetrician and gynecologist in Brooksville, said the post-operative pain from an abdominal hysterectomy is minimal when using the da Vinci system.
"The greatest thing when using this device for the patient is that the tissues from the surgical site are minimally manipulated, which results in quicker recovery and less pain," Marler said. "Normally recovery is two to three days, with the da Vinci it is the next day."
Dr. Niloufer Kero, a gynecologist practicing in Brooksville was unavailable for comment.
Robin Schneider, director of marketing at Brooksville Regional Hospital, provided at this time, local OB/GYN physicians affiliated with the hospital are performing procedures with the device.
"We also have urologists interested in using the da Vinci for prostatectomy and other urological procedures," said Schneider.
It easily maneuvers into tight spaces better than human doctors.
"As the device is used more often and physicians see these excellent outcomes, other surgeons may become interested in using this technology," Schneider added.
The da Vinci
Surgical System
The da Vinci Surgical System is a technologically advanced robotic surgery system which allows skilled surgeons the ability to perform intricate surgeries that provide patients the best possible surgical outcomes and fastest recovery times. This is achieved because surgeons utilizing the da Vinci can make smaller incisions and see magnified real-time imagery of the surgery site in high-definition detail.
Surgeons perform the surgeries by sitting at a computer console, viewing magnified, high definition imagery of the surgery site and using hand controls to manipulate the da Vinci's robotic arms to make precise surgical maneuvers. The surgeon maintains full control of every precise surgical movement.
The da Vinci has several unique features designed to provide additional clinical benefits and efficiency in the operating room, many of which translate into patient benefits.
These features include enhanced 3-D, high-definition images with up to 10x magnification, superior visual clarity of tissue and anatomy, surgical precision far greater than even the human hand, and one million automated safety checks per second.
Anna Lamy is the Health and Fitness Content Coordinator for Hernando Today. She can be contacted at alamy@hernandotoday.com.