Robotic Surgery - What It Is, How It Works

by Jane Ashley

When we hear about robotic surgery, some of us envision a robot standing above the operating table. Our immediate response is, “No way am I going to let a robot operate on me!”

Da Vinci System Si Seated Surgeon Nurse At Cart 400x235

But robotic surgery is nothing like those science-fiction images. The robot doesn’t do the surgery; your surgeon does the surgery, guiding the surgical instruments through the master console.

What is robotically-assisted surgery?

The da Vinci surgical system is the only robotic system approved in the United States. The FDA approved the first da Vinci robotic system in 2000. The manufacturer, Intuitive Surgical Systems, continues to upgrade and fine-tune the system to enable surgeons to do delicate surgery within our body without the necessity of a long incision and the potential complications of an open surgery.

The da Vinci system is composed of three components.

Vision cart. The system utilizes a high-definition camera that is tiny enough to fit in smaller areas of the human body. The camera allows the surgeon to see tiny blood vessels and nerves. It carries two light sources — both white light and U.V. light — the U.V. light allows a surgeon to see indocyanine green contained in specialized dyes given during surgery to find small cancerous tumors and visualize small, but critical, areas like the biliary duct and the ureter. The vision cart enables communication between the 3D vision system, the surgeon’s console, and the patient cart.

Surgeon console. Your surgeon sits at the surgeon's control. The screen provides a 3D image of the operating area providing your surgeon a high-definition, enlarged and lighted view. The control grips allow the surgeon to use the surgical instrument inside the patient’s body with precision. The instruments move like the human hand but have a greater range of motion that a surgeon’s wrist has — this allows the surgeon to work in very tight areas of the body. The surgeon’s console also has foot pedals that control a cauterization tool and a camera focus.

Surgeon Console

Patient cart. The third portion of the cart sits beside the patient. A surgical assistant is stationed beside the cart to change out the surgical instruments as the surgeon works. The surgical cart holds three arms holding surgical instruments and the arm holding the camera. The tips of these instructions act as tiny “wrists” and can move around the surgical area with ease, even in minimal surgical areas.

What are the advantages of robotically-assisted surgery?

Robotically-assisted surgery is minimally invasive. It is a particularly attractive option for a patient who would, otherwise, face an open abdominal surgery necessitating an incision from the breastbone to the pubic bone or a patient facing heart surgery. Robotic surgery benefits both the surgeon and the patient.

Benefits to the surgeon include:

• Provides surgeon with greater dexterity and range of motion, allowing them to do delicate surgeries in hard-to-reach areas of the body
• Provides better vision of the surgical field because of the high-resolution of the camera, the 3D image and two types of lighting
• The surgeon can reach tiny areas where their hand wouldn’t fit, and the surgical arm has almost unlimited range of motion, far more than a surgeon’s wrist can provide
• Less fatigue for the surgeon during a lengthy, complicated procedure because he is not standing on his feet for six-to-eight hours

Benefits for the patient include:

Only a few small incisions (less than one-inch each) – no stiches needed, only surgical glue
• Shorter hospital stay
• Reduced risk of infection
• Less blood loss
• Less scarring
• Reduced pain
• Faster recovery, with less risk of serious complications

Patient Cart

A surgical team is always at the side of the patient monitoring their vital signs and condition.

What types of surgery are performed robotically?

Robotic surgery is used in a wide variety of operations:

• Colorectal
• General Surgery
• Gynecological
• Head and Neck
• Thoracic
• Urological

Pediatric patients benefit too because the surgeon gains access to surgical areas in the smallest of patients. With less pain and faster recovery times, robotic surgery is often a better choice for pediatric patients. Infants, in particular, are a challenge because of their small body size and the small amount of space within their bodies for surgeons to work.

Newer surgical areas include ear and throat, as well as hip and knee replacement.

Are there disadvantages to robotic surgery?

Robotic surgery is usually more expensive. The da Vinci system is costly, up to about $2 million. Your surgery may be $3,000-to-$6,000 more than laparoscopic surgery.

You may have to travel to a hospital equipped with a da Vinci surgical system. Only about 1,500 hospitals in the United States offer robotic surgery.

Robotic surgery is the best option if you have to have a complicated cancer surgery and head and neck surgeries where no laparoscopic procedures exist. There are no advantages to having robotic surgery for procedures like a hysterectomy or gallbladder removal or appendectomy.

Make sure that your surgeon is experienced in robotic surgery.

Here’s one WhatNexters robotic surgery experience…
I needed an abdominal perineal resection (APR) after my Stage IV rectal cancer in October 2014. The surgery would remove my cancer and would result in a permanent colostomy. APR surgery is a complex surgery. If performed with an open incision, patients generally face about a week to 10 days in the hospital. My surgeon was skilled in robotic surgery and offered me robotic surgery. My surgery was performed on a Monday morning. I woke up in recovery at about 4 pm. They got me up the next morning. My numbers were good, and my surgeon told me that if I tolerated solid food on Wednesday that he would probably discharge me. He came by to see me after lunch on Wednesday and said that I was ready to go home. He discharged me from the hospital late Wednesday afternoon — just 2 ½ days after the surgery.

My pain was well-controlled in the hospital with codeine and IV Tylenol; no opioids needed. I only required Norco at home. My surgeon told me to walk as much as I could tolerate. I walked out to my mailbox the next morning after I got home.

I was, of course, nervous on the day of surgery. But I decided not to have any pre-meds to calm my nerves. I wanted to see the surgeon’s console and the robotic arms; I wanted to see with my own eyes the da Vinci surgical system. It was just like in the pictures, and the surgical team was professional and encouraging.

While my experience may not be typical, my experience reflects how robotic surgery can benefit a cancer patient who may be facing additional chemotherapy after surgery. My pathology report showed that I still had positive lymph nodes even after chemotherapy and pelvic radiation. My medical team recommended adjuvant (mop-up) chemotherapy afterward. I began that chemo just six weeks after the surgery. I am grateful that I remain NED five years after diagnosis.

Have you had robotic surgery? How was your experience? Please share in the comments below. 

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