Surgical Robotics Lead to Faster Recovery
SIOUX FALLS, S.D. (Nov. 1, 2007) - No longer the stuff of futuristic science fiction, robotics are a technologically-advanced reality in surgery that allows patients to have shorter hospital stays, lose less blood, experience less pain and get back to work sooner.
Surgeons at Avera McKennan are now doing procedures such as prostatectomies, hysterectomies and other gynecological surgeries using the da Vinci® S HD Surgical System, which integrates three-dimensional, high-definition video and robotic technology to virtually extend the surgeon's eyes and hands for minimally-invasive procedures. The da Vinci® S with 3D HD vision is the most advanced platform for minimally invasive surgery available today. Avera McKennan is the first and only facility in South Dakota to have this new high-definition version of robotic surgery equipment. "Everything in surgery is moving toward being minimally invasive," said Dr. Luis Rojas, gynecologic oncologist at Avera Cancer Institute.
Hysterectomies are the second most common surgical procedure in the United States. Robotics offers numerous benefits over traditional approaches to vaginal, laparoscopic or open abdominal hysterectomy, as it allows the surgeon better visualization of the woman's anatomy. Robotics is also being used for more complex gynecological procedures, such as staging of endometrial cancer, or surgical correction of vaginal prolapse.
"There are clear patient benefits with robotics," says Dr. Rojas. Among them are shorter recovery time, less blood loss, reduced trauma to the body, lowered risk of infection, less pain, less scarring and a shorter length of stay in the hospital.
Average length of stay for a conventional hysterectomy is five days, with four to six weeks recovery time at home. With a robotics hysterectomy, women are staying in the hospital overnight, and going back to work within a week or two.
While no surgical procedure is without risk, studies show that robotics surgery, in comparison to conventional or laparoscopic surgery, decreases blood loss by 60 percent and the risk of surgery-related injuries by up to 70 percent, Dr. Rojas said.
Many of the same benefits are true for men who undergo robotic prostatectomies. A prostatectomy is a common surgical procedure - surgical removal the prostate gland - when a man has been diagnosed with early-stage prostate cancer. Prostate cancer is the most frequently diagnosed cancer in men. It's estimated that in 2007, more than 218,000 new cases of prostate cancer will be diagnosed. "With PSAs (prostate specific antigen screens) we can detect it very early, giving us the option of doing some of these newer procedures," said Dr. David Rosinsky of Urology Specialists Chartered in Sioux Falls, one of several urologists trained to perform these procedures at Avera McKennan. This year, 65 percent of all prostatectomies in the nation will be done using a da Vinci system, according to company information.
Instead of the traditional open procedure, which requires an incision from below the naval down to the groin area, the patient has a few small incisions or operating ports - 1 to 2 centimeters in size - across the abdomen for the insertion of robotic arms. "The main advantage to the patient will be a shorter hospital stay and quicker recovery. The person who undergoes the robotic procedure will feel back to their normal selves months sooner than with the open technique," Dr. Rosinksy said.
Additionally, in men especially, the technique allows surgeons to spare nerves in the pelvic region, helping to preserve continence and sexual function. "Nerves are under 10 times magnification, and the robotic arms are very precise, making it easier for the surgeon to identify those nerves," Dr. Rosinksy said. The latest technology of three-dimensional, high-definition visualization provides improved clarity and detail.
The equipment is a two-part device. The patient side cart used for the actual surgery has four robotic arms. One holds a camera, the other three control miniaturized surgical instruments. Robotic arms can move in more angles than the human wrist, providing for increased precision. The surgeon works at a separate console to the side of the patient, looking through an eyepiece to see magnified, 3-D imaging with real depth perception. The surgeon controls robotic devices through finger holds. "Every movement you make is transferred to the device in the patient," Dr. Rosinsky said.
At the same time, robotic and computer technologies scale, filter and translate the surgeon's hand movements into precise micro-movements of the surgical instruments. Robotics equipment doesn't replace human surgeons - rather it enhances their ability to perform complex minimally-invasive surgery. The robotics equipment cannot be programmed or make decisions on its own to perform any surgical maneuver without the surgeon's input.
"The visuals are so great - it's like doing microsurgery. I can see tissue planes, blood vessels and nerves that I can't see in an open patient," Dr. Rojas said. Robotic technology has the capability of filtering out human imperfections and involuntary movements. Also, the robot's ratio of movement is one to three. For every 3 centimeters a surgeon's hand moves, the robotic arm moves 1 centimeter. "That precision translates into less trauma for the patient, and a better recovery," he said. "My goal is to do as much as I can minimally invasively," Dr. Rojas said.
There are many other possible applications in the future, such as cardiothoracic surgery for heart bypass. "We're just scratching the surface," Dr. Rosinsky said.
