The Beginning – Laparoscopic Surgery Laparoscopic surgery, also known as “minimally invasive” surgery, is the use of several thin instruments assisted by a video camera that perform surgery through small incisions of about 0.5 cm. It has represented surgery’s new frontier, presenting a major improvement over “open” or traditional surgery in which a physician uses a single, larger incision.This surgical technique was developed in the 1980s with a landmark procedure performed in 1987 by Dr. Philippe Mouret, who removed a gallbladder laparoscopically for the first time. Thereafter, laparoscopic technology and techniques flourished and expanded into other areas, particularly gynecologic and urologic surgeries. Currently, over 1 million cholecystectomies (gallbladder removals) are performed in the U.S. annually, with 96% removed by the laparoscopic method.
Robotic Surgery
In the mid-‘90s, a second development in minimally invasive surgery came in the form of the da Vinci robot. Developed by California-based Intuitive Surgical, the first da Vinci System was placed on the market in 1999, and in July 2000 it was approved by the FDA for laparoscopic surgery.
How does the da Vinci work?
The core technology of the da Vinci system has two components: the robot itself which performs the operation on the patient, and the separate console where the surgeon controls the robot’s arms. Three of the arms are for tools, such as a scalpel, scissors or electrocautery instruments. The fourth arm has a camera (endoscope) with two lenses that give the surgeon stereoscopic vision as he works from the console.
As the surgeon operates, he looks through eyeholes in the machine to get a 3-D image of the surgical procedure. At the same time, he maneuvers the robotic arms, using foot pedals and two hand controllers. The robot interprets the surgeon’s movements and carries them out through the robotic arms, in fact mimicking the surgeon’s wrist movements.
Better Vision: The first da Vinci robotic system was geared toward overcoming the limitations of regular laparoscopy by providing surgeons with 3-D vision inside the patient’s body. Today it gives surgeons first-rate 3-D high definition visualization.
Enhanced Dexterity: The surgical instruments bend and rotate within the body far beyond what the surgeon’s hand is capable of doing. This offers the surgeon precision and control, as well as ergonomic comfort.
Less Fatigue: Surgeons no longer have to stand for the duration of a surgical procedure and do not tire as quickly.
Primary Uses Today
Robotic surgery is widely used in a number of specific fields. It is not ideal for all surgeries, but it has replaced traditional open surgeries in many specialties, particularly urology and gynecology.
Urology
In the field of urology, the da Vinci robot is widely used for both prostate and kidney surgeries. It has improved these procedures by offering surgeons magnified vision as well as better access to hard-to-reach areas. In the past, surgeons had to make large incisions and sometimes even remove part of the patient’s rib cage for kidney surgery. This is no longer necessary with the robot.
Gynecologists were among the earliest to embrace minimally invasive surgical techniques. As a result, developments in laparoscopic and robotic surgery have made large abdominal incisions in gynecologic surgery practically obsolete. Hysterectomy, the most common operation among women in the U.S., is used for the treatment of fibroids, pelvic prolapse, endometriosis, and heavy menstrual bleeding. Today, the da Vinci System is the main option for minimally invasive hysterectomies performed in the U.S. It is also the number one treatment for women facing gynecologic cancer.
Gynecologists say the robot is a particularly good tool for the pelvis because it allows for tissue visualization far greater than in open surgery. The robot’s magnification and minimally invasive surgical capabilities has been particularly useful in fallopian tube microsurgery, as well as pelvic floor reconstruction (sacrocolpopexy). Whereas open pelvic floor reconstructions normally required three to four hospital recovery days, doctors report patients who choose robotic surgery can now leave the hospital on the same day.
Bariatric Surgery
The da Vinci robot has also been introduced in the field of bariatric surgery, or weight loss surgery. While still somewhat new to the field, the robot has been used to perform a small percentage of “the gold standard” gastric bypasses that make up about half of the 200,000 or more bariatric surgeries performed in the U.S. annually.
The Future of Robotic Surgery
According to Business Insider, the da Vinci robot may have implications for the growth of telemedicine and long distance surgical operations, perhaps one day making it common for a doctor to operate on a patient in another city or state, or even on a different continent. As early as 2001, a team of doctors in New York used a surgical robot to remove the gallbladder of a woman in France; called the “Lindbergh Experiment,” it marked the first transatlantic telesurgical operation in history.
Another more immediate development involves a single incision port, allowing a doctor to make a single, tiny incision through which the snakelike arms of a robot can pass. A single-site capability was introduced by Intuitive Surgical in late 2011; however, it was only approved by the FDA for gallbladder surgery. Gynecologists say they anticipate the release of a single-site technology (port and instruments) designed specifically for hysterectomies this summer.
If you or someone you know is considering robotic surgery, contact your surgeon for more information. As with all medical procedures, prospective patients should discuss treatment options and make the decision that will be best for their individual situation.
