This week, Dr. Deanna Mansker, a board-certified general surgeon with Beaufort Memorial Surgical Specialists in Beaufort and Bluffton, discusses robotic surgery and how it works.
Mansker chairs the Robotic Surgery Committee at Beaufort Memorial Hospital.
Question: I was a bit surprised to learn that a friend of my mother’s recently had her gallbladder removed by robotic surgery, and it made me wonder, how does a robot actually perform surgery? How much does the surgeon do? Also, it seems so futuristic. I have all these images from sci-fi movies running through my head. Is it safe and what are the advantages for having this type of surgery?
Answer: We certainly have come a long way, haven’t we? In a short period of time, we have developed cell phones that can turn off our lights from another state, cars that can drive without us touching the wheel and automatic vacuum cleaners that clean the floor while we sleep.
However, we are not yet at the place where robots can perform operations for us. Today’s robotic technology serves as a tool, allowing surgeons to more safely perform difficult operations. But the surgeon is still doing the work and running the show.
The da Vinci, the most widely used robotic surgical system, works this way: the surgeon inserts the robot’s arms with a tiny video camera and surgical instruments attach through several keyhole-sized incisions.
The surgeon then sits down at a console with a screen that offers a high-definition, magnified view of the surgical site. Using foot and hand controls, the physician is able to tell the robot how to move and what to do. The surgeon is present and in control the whole time.
So, what’s the benefit of robotic surgery? The robot allows surgeons to view things magnified and in 3-D instead of as a flat image. Seeing better is always safer. In addition, the robot instruments are able to bend and flex like a person’s wrists. With traditional laparoscopic surgery, the tools cannot bend.
Wristed instruments make operations much easier, and thus, safer. They also allow surgeons to work in difficult areas, such as around the esophagus or low in the pelvis where visualization is poor or there is little room to maneuver.
Without the improved visualization and precision of a robot, these difficult operations sometimes have to be performed through a much larger opening instead of laparoscopically through small incisions.
Robotic technology has become so advanced, some surgeries can even be performed through a single incision. Gallbladder removal is one of those operations. Originally, gallbladders were removed through a large cut extending from the sternum, along the ribcage, to the back. Recovery from the procedure required a four- or five-day hospital stay.
Gallbladder surgery, also known as a cholecystectomy, took a huge step forward with the introduction of laparoscopy. With just four small cuts in the abdomen, patients could go home the same day.
Now, we can do the surgery with just one inch-long incision in the belly button, leaving the patient with virtually no scar. Some hysterectomies (the removal of the uterus) also can be performed this way.
Surgeons at Beaufort Memorial also use the robot as a tool for many other types of operations, including:
▪ Colon resection or colectomy which is the removal of part or all of the colon to treat a variety of diseases
▪ Nissen fundoplication for the treatment of severe acid reflux disease
▪ Ventral and inguinal hernia repairs
▪ Hysterectomies and other gynecological procedures
▪ Nephrectomies or kidney cancer removal
The Food and Drug Administration also has approved the use of robotic surgical systems for cardiac, head and neck, thoracic procedures, as well as prostatectomies which is the removal of the prostate.