When I tell patients I’ll be doing their surgeries with a robotic system, they’re excited to learn about the new technology. Most patients are curious, but some are reluctant because they don’t understand it. Education for patients is of the utmost importance, both for the disease process and how the procedure will be conducted.
Right now, I’m using the da Vinci Surgical System to do cholecystectomies—gallbladder removal—and partial colectomies [removal of the colon], whether it be for malignancy or benign disease. I got interested in the da Vinci as another means for a minimally invasive approach for patients. We’ve been seeing decreased pain and a quick post-op recovery in patients who have had robotic colectomies and cholecystectomies. With these procedures, we strategically place trocars—straw-like instruments that penetrate the abdominal wall and allow for different types of robotic or laparoscopic instruments to be used safely during surgery. Once the trocars are in place, we bring the working arms of the robot up to the patient; the system is docked and the arms are attached to the trocars. They have a remote center that changes the movement so that there isn’t as much force on the abdominal wall. I then go to a console where I can work the instruments at the patient’s side.
The most interesting thing about doing surgery using da Vinci is that it allows me to see the structures in 3-D as well as use wristed instruments. The instruments are small and have more degrees of movement than the human hand. [This enables] safer dissection and less blood loss with better outcomes for patients.
I do single-site laparoscopy—that’s the use of gas [carbon dioxide] to create a working space in the abdomen—but not with a robot. The goal is to move to single-site robotics as the technology continues to evolve. That technology isn’t currently out there but it’s the next wave.
Even with the multiple sites, most [robotic surgery] patients are taking very minimal pain medication by day three or four post-op; they’re having a lot less pain than the standard colectomy. With an open laparotomy—an open incision—most patients leave the hospital in five to seven days, whether they have a right or left colectomy. Now, with robotic surgery, [we are] decreasing the hospital stay by one to two days, depending on the patient. Single-site surgery would be even easier for the patient post-operatively because it’s one or maybe two incisions versus four or five. [It] offers a more cosmetic approach for younger patients and less pain for all patients. We had an 81-year-old who we did a right colectomy on and he went home in three days.
Illustration by HeadcaseOriginally Published in the January 2011 issue.
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