The daVinci robot allows surgeons to use merge all the advantages of traditional open surgery with all the advantages of minimally invasive laparoscopic surgery, without the limitations of current laparoscopic surgery. Patients experience less pain, shorter hospital stays, quicker recovery times and less blood loss than even with open or traditional laparoscopic surgery.
The difference between robot-assisted surgery and a traditional operation are particularly noticeable in abdominal and pelvic operations. Traditional surgery requires the surgeon to open the skin and surrounding tissue and muscle with incisions at least four to six and up to 12 inches long. Conventional methods may require the physician to spread, stretch, and manipulate soft tissues and muscles in order to remove organs or tumors.
Laparoscopic surgery has replaced open surgery in virtually all abdominal and pelvic operations. The surgical team makes one to six dime-sized incisions in the patient’s body. These incisions are called operating ports, and slender tubes called trocars are inserted into those small openings. The surgery is then performed with rudimentary instruments which allow the surgeon to cut, sew, and staple, using a two-dimensional TV system. The disadvantages of this approach are that best current technology in traditional laparoscopic surgery limits the surgeon from seeing things in true 3-dimensional vision, and that it only allows the use of very rudimentary instruments, very similar to chop sticks, which lack the ability to bend at the wrist, or move like a human wrist.
Enter the daVinci robot: using a special camera and three dimensional hood, the surgeon is able to see things in 3-D, magnified and much clearer than any other video laparoscopy system in existence today. Imagine the difference between looking at a family member live next to you with both eyes, and looking at a photograph or video of them – that is the difference between traditional laparoscopy and the use of the daVinci High Definition system.
The second even more important element of robotic surgery is the ability to use instruments which bend at several points (wrists), can rotate independently, and are not held by human hands. Human hands shake, drift, and get fatigued; inherently, all surgeons and their assistants have some degree of tremor and drift — the robot removes all these elements of error, and provides more precise control, and execution, in the translation of the surgeon’s hands. Imagine the difference between watching a video that was filmed on a tripod versus one held in a person’s hands – which type of video would you like inside of you during surgery?
In robotic surgery, the robot is wheeled into position and the four arms of the robot are docked into individual ports, instead of two or more surgeons, or assistants. Surgical tools are attached to the end of the robot’s arms, which form the extension of the surgeon’s hands inside the patient.
One robotic arm holds a digital camera, which provides a three-dimensional view of the intended organs and tissues. Those images appear on a large screen near the operating table and on a small console, where the surgeon sits during the operation. While watching a magnified, high-definition image of the patient’s anatomy, the surgeon manipulates the other three arms of the robot by using foot pedals and hand controls. And while seated just a few feet away from the operating table, the doctor dissects cuts and sews tissues. This can be used to repair tissues or organs, or even remove tumors.
Standing by the patient, an assistant may work with another port. Through that opening, the assistant performs several manual chores including suctioning blood, removing specimens for biopsies, passing needles and thread, and changing instruments. The tools used for robot-assisted surgery cut and cauterize blood vessels in a single step. This multitasking process eliminates steps and reduces blood loss.
The robot is programmed with safeguards that protect the patient from abrupt or uncontrolled movements. For example, safety mechanisms neutralize hand tremors and sudden jerks that could possibly occur in traditional surgery. In complicated procedures, the robot helps to avoid damaging nerves, or vital structures, that may compromise the patient’s functions and organs or surgical results.
Until recently, minimally invasive surgery was not used widely for extremely delicate or complex surgeries. That’s because the equipment designed to operate through small incisions included stiff instruments that resembled knitting needles or chopsticks. Those surgical tools—ideal for some procedures—lack the flexibility and control of the human wrist.
But the daVinci technology includes instruments that move and rotate with the flexibility and range of a human wrist. This enables surgeons to carry out complex procedures (removal of tumors and reconstruction of tissue in the chest, pelvis or abdomen) without making large openings in the body.
The technology—which includes color monitors—magnifies the surgical area by over 10 times. That compares to zero magnification with traditional open surgery, which relies only on the human eye.
That traditional vision compensates for the absence of touch which is currently not present in the most current version of the robot. In open surgery, the surgeon’s hands can provide information about a tumor and the surrounding area. In open surgery, tactile knowledge is important because surgeons operate in deep areas of the body with limited vision. But robot-assisted surgeries provide a magnified image of area being operated on, which provides visual three dimensional clues that mimic the tactile feel lost by using the robot. Thus, the surgeon is not hampered by this perceived sensory loss, but it is regained, in a more visual way. Future versions of the robot, currently under development, will provide a way to simulate tactile feel, and reinforce that ‘lost’ sensation.
Thus, the spirit of daVinci lives on, in our modern world, continuing to advance science and technology, and perform the healing arts, still the leading edge of technology and medicine, providing a tool to make the best modern surgeons even better.
Dr. Dobson is a robotic expert and pioneer, who is a national proctor and robotic instructor for Intuitive Surgical, and travels the United States teaching other surgeons to use the robot safely. He continues to pioneer the use and development of procedural techniques that will make surgery better and safer, for all.
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