Q. What is robotic-assisted surgery?

A. Robotic-assisted surgery, a type of minimally invasive surgery (MIS), uses surgical robotic equipment which imitates surgical movements. MIS procedures allow surgeons to operate through small ports rather than large incisions, resulting in shorter recovery times, fewer complications and reduced hospital stays. Surgical robotics combines minimally advanced surgery with highly advanced clinical technology.

Q. What surgical procedures will the system be used for at Roswell Park?

A. Currently, the robotic-assisted surgical system is used for the removal of the prostate for cancer (radical prostatectomy). Over 500 prostate procedures have been completed.  Additonally, over 100 patients with bladder cancer have been treated with this system. In the future, the system will be available to patients recommended for surgery for node dissection for testicular cancer. Additional future uses for the surgical system may include pediatric, gynecologic, thoracic, orthopedic, neurosurgery and gastrointestinal cancers.

Q. What are the benefits to patients of robotic-assisted prostate cancer surgery?

A. Following robotic-assisted prostatectomy, patients are usually able to go home the day after surgery. Patients generally experience less post-operative pain and discomfort and have a faster recovery. Many men are able to return to work in as soon as two weeks following surgery.

Q. Is there a difference in patient outcomes when robotic-assisted surgery is compared with traditional surgery?

A. We can use the example of prostate cancer in answering this question. The success rate for the removal of cancer of the prostate is identical to “open” or traditional prostate cancer surgery. A patient’s recovery of urinary control is faster. Preservation of sexual function is at least as good as traditional surgery. In general, these are the advantages for this procedure:

• Less pain
• Less scarring
• Quicker recovery of urinary control
• Decreased blood loss and risk of infection
• Shorter hospital stay
• Faster recovery (many men can return to work in only 2 weeks)

Q. Has the surgical system been approved by the U.S. Food & Drug Administration (FDA)?

A. The da Vinci® Surgical System is the first operative surgical robotic system approved by the FDA. It has been approved for use in performing many surgical procedures, including general laparoscopic surgery, thoracoscopic (chest) surgery, laparoscopic radical prostatectomies, and thoracoscopically-assisted heart procedures.

Q. Where is the robotic-assisted surgical system being used now?

A. According to Intuitive Surgical, the da Vinci® Surgical System is currently being used in major medical centers in the United States, Austria, Belgium, Denmark, France, Germany, Italy, the Netherlands, Sweden, Switzerland, the United Kingdom and around the world.

 

Q. What should I know about the robotic system?

A. The da Vinci prostatectomy uses a robotic surgical system that builds upon the laparoscopic approach and adds a few new benefits:

• The robot has four arms attached to a freestanding cart. One arm holds a camera (the laparoscope) and the surgeon operates the “hands” on the other three arms by inserting his or her fingers into rings and using foot controls.
• The arms have EndoWrists - flexible wrists that bend and twist like human wrists.
• The surgeon uses hand movements and foot pedals to control the camera, adjust focus, and reposition the robotic arms.
• A robotic “arm” surgical system is used to control the endoscopic instruments instead of direct manipulation by the surgeon’s hands. These arms remain steady at all times and electronically dampen the “shake” of the human hand.
• Robotic surgical systems have a three-dimensional lens system, which also magnifies the surgical field up to 15 times. Surgeons have three-dimensional vision instead of the two-dimensional vision with regular laparoscopic procedures. Magnification improves the ability to recognize and control bleeding from small vessels and reduces blood loss.
• The visualization system requires the pressure in the abdominal cavity be increased. This has the added benefit of decreasing the amount of blood usually lost from blood oozing from the veins during surgery.
• The photo at the upper right shows the equipment and console prior to a procedure.

Q. How Does the surgeon operate the system?

A. The surgeon sits at a console several feet away from the operating table while he or she is controlling the robotic system. In the photo at the right, you see a nurse with a patient, while the surgeon works at the far right on the console. The robotic wrists make it easier for surgeons to manipulate tissue and work from all kinds of angles and positions that human surgeons would have difficulty achieving. This makes sewing the bladder to the urethra easier and more precise after prostate removal.

Q. Will robotic-assisted surgery eventually make surgeons obsolete?

A. Absolutely not. It will enable surgeons to be more precise, advancing his/her technique and enhancing his/her capability to perform complex minimally invasive surgery. The current generation of surgical robots cannot perform surgical tasks on their own, but they lend a mechanical “helping hand” to surgeons. The system replicates the surgeon’s movements in real time. It cannot be programmed, nor can it make decisions on its own to move in any way or perform any type of surgical maneuver without the surgeon’s input.

Q. How does the new technology assist the surgeon?

A. Surgeons are able to perform minimally invasive procedures with more precision. Robot arms remain steady at all times and electronically dampen the “shake” of the human hand. Robot wrists make it easier for surgeons to manipulate tissue and work from all kinds of angles – positions surgeons would have difficulty getting to otherwise. The three-dimensional vision system magnifies the surgical field up to 15 times and improves the ability of the surgeon to recognize and control small blood vessels, thereby reducing blood loss. The U.S. Food and Drug Administration (FDA) requires that surgeons undergo special training before they perform robotic surgery on patients. Typical training requires 40 hours. The doctor’s first few robotic prostatectomies are mentored. Experienced prostate cancer surgeons are usually comfortable after approximately 3-10 cases. The nurses who work with the surgeons on the robotic procedure also receive special training.