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Should you wind up in an operating room awaiting surgery, you'd expect to be joined by your surgeon, nurse, anesthesiologist, and other surgical technicians. In the most sophisticated hospitals, you may also find another member of the surgical team—one that has four arms, didn’t graduate from medical school, and doesn’t wear scrubs. This addition is the robotic da Vinci XI Surgical System.
Dr. Robert Mordkin, the founder of Virginia Hospital Center’s Robotic Surgery Program in 2005 and current Chief of Urology, explains how this advanced technology is benefiting patients.
NBC 4: What do you mean by robotic surgery? Is there really a robot?
Dr. Robert Mordkin: The term robotic surgery is a bit of a misnomer. The idea of a robot may convey that it is functioning independently at some level, but this is not the case. The robotic surgical system can’t move without me moving my hands. It duplicates my movements, in real time, with incredible precision and dexterity. The instruments themselves are much smaller than the human hand, yet are capable of the same precise movements in a dramatically less invasive fashion.
NBC 4: What are the components of the robotic system?
RM: In the da Vinci XI Surgical System, the surgical robot has 4 “arms.” Each arm can be equipped with a wide range of surgical instruments. A vision cart houses advanced imaging and provides communications across the da Vinci system. It delivers the system’s three-dimensional, high-definition live video, which the surgeon uses to guide his movements and is visible to everyone in the operating room. Finally, there is the surgical console, where the surgeon sits during the operation, watching 12-time magnification of what’s happening inside the body, and making small movements with his or her hands that are precisely recreated by the robot arms.
NBC 4: In what instances would you recommend robotic surgery to a patient?
RM: There are some surgeries where minimally invasive robotic-assisted surgery has a clear advantage and better results than traditional open surgery. I wouldn’t want to perform those operations today without the da Vinci XI Surgical System. For example, surgical removal of the prostate is much better when performed robotically, including benefits to the patient of a quicker overall recovery, less blood loss during surgery, and reduced time in the hospital.
That doesn’t mean we can use robotic-assisted surgery for every operation. At Virginia Hospital Center the surgeons who tend to use robotics most are bariatric surgeons, general surgeons, colorectal surgeons, gynecologists, gynecologic oncologists, urologists, and urogynecologists. The da Vinci technology is exceptional for a fairly well-defined list of operations.
NBC 4: What are the most important advantages for the surgeon performing robotic surgery?
RM: In addition to the incredible dexterity and the ability to do minimally invasive surgery through very small incisions, better visualization is probably the other big advantage. The visual optics are superior with image magnification and real-time high-definition video. It enables surgeons to see things we couldn’t see before.
NBC 4: Would a patient know ahead of time if they’re having robotic surgery?
RM: Absolutely! We always spend a great deal of time speaking with the patient about their operation and going over a wide range of options. We take the time to answer all questions to be sure the patient is informed and comfortable with their choices. In some instances, because of an obstruction or some other unexpected condition that presents during surgery, we may need to convert the procedure from robotic to a traditional open operation. The patient has been informed of this possibility and has given us consent to proceed, if necessary.
NBC 4: What makes the surgical experience different for a patient who has robotic surgery?
RM: As I mentioned, the post-op experience absolutely is improved. For example, after traditional open-prostate surgery, the patient is in the hospital for two or three days. About a quarter of those patients require a blood transfusion. They also require catheters for an extended time after surgery. With robotic surgery, they’re in the hospital for one night and generally only need pain medication for the first 48 hours. And, of the thousands of these robotic surgeries I’ve done, no patient has ever required a blood transfusion.
NBC 4: What qualifications does a surgeon need to perform robotic surgery?
RM: Becoming proficient at robotic surgery requires a steep learning curve. Each specialty has specific credentialing requirements that raise the bar for robotic surgery above standard surgery. The da Vinci XI system actually comes with a training program that is a little like a flight simulator for surgeons. The surgeon can use it to run through multiple clinical scenarios and train on the simulator. But, there is no substitute for experience. Any patient for whom robotic surgery is appropriate should seek out surgeons who consistently perform a high volume of robotic surgeries, not just a few.
NBC 4: What’s on the horizon for robotic surgery?
RM: Single port robotic surgery is the next frontier. With this technology the surgeon is operating through a single small incision instead of four or five small incisions. The technology exists, but it is still in the early stages of development and acceptance.
From there, the next single-port development would be NOTES surgery. NOTES is Natural Orifice Transluminal Endoscopic Surgery. This will allow us to do surgery through natural entry points into the body, to decrease the need for external incisions. For us, that’s the surgical equivalent of Star Trek!
The Surgical Review Corporation has designated Virginia Hospital Center as a Center of Excellence in Robotic Surgery and has recognized several of its surgeons as Master Surgeons in Robotic Surgery for upholding the highest patient safety and quality standards. Click here to learn more about how VHC can give you next-level care.