Rolling With The Robot | by Debra Melani

Posted on Thu, Jan 15, 2015

Da Vinci System Moves Into More Surgical Specialties at P/SL

The reach of the four-armed da Vinci Surgical System continues to grow at Presbyterian/St. Luke’s Medical Center, the first hospital in the Rocky Mountain region to offer the robotic technology more than 10 years ago. With the inundation of aging baby boomers in the operating room, and the increased skill level of HealthONE surgeons at performing the minimally-invasive surgery, P/SL doctors are using the robot’s helping hands within more specialties. With the most-recent addition of general surgery, patients can now choose the robotic aide for everything from appendix and gallbladder removal to colon and hernia-repair. Below, Dr. Anthony Canfield, director of Advanced Laparoscopic and General Surgery at P/SL, talks about why expansion and upgrade of the technology is a continued priority for HealthONE.

H&W: Since the robot first rolled onto the medical scene in 2000, its presence has exploded in hospitals and specialties across the board (the maker reports more than 1.5 million surgeries performed). Why has its use become so widespread, particularly in your general-surgery area?

Canfield: Partly because it is a state-of-the-art technology that has only continued to improve. For instance, one advancement since its inception that now comes standard on its latest system is called the Firefly, an illuminating fluorescence imaging system that allows us to see the bile ducts and the blood supply clearly, which can lead to more precise surgery with less blood loss. It also has a vessel-sealing technology that is especially valuable for general surgeries, many of which are highly vascular, such as colon and gynecological procedures. The growing demand also has to do with patients’ desire for minimally-invasive surgery. If you can get back to work or life in two weeks rather than eight, that’s appealing to people.

H&W: How often is da Vinci an option for general surgery?

Canfield: Probably 85 to 90 percent of what I do I can do robotically quite well, and the list is growing. It’s pretty much the best way to fix hiatal hernias, as it creates very little pain for patients and provides excellent results. The optics are so good, you can do a very precise dissection of tiny vessels with very little impact. Another example is gallbladder surgery. It’s rarely done open anymore. And for a lot of colon surgeries, it has a shorter recovery time and, in some cases, better results. If I can offer the same or better results, then it merits using the system.

H&W: Describe what the three-dimensional, high-definition visualization is like.

Canfield: It makes it so realistic. It’s almost like your head and your hands are inside the patient. You are actually looking as you would if you did the surgery open, but it’s highly magnified. It’s like comparing an old, black-and-white television with a new, high-definition TV. The optics is probably one of the best things about it. It’s a very stable picture. There’s no tremor or shake. With laparoscopic surgery, you usually have an assistant holding the camera, and there’s a fair amount of motion artifact that happens with that.

H&W: Why else, as a minimally-invasive-focused surgeon, do you like to use the da Vinci system when you can?

Canfield: It gives me a lot more capability. A lot of that has to do with the flexible wrists on the instruments. The laparoscopic instrument is tiny, but it’s a straight tool that doesn’t have maximum articulation once inside the abdomen. Of course, the robotic system doesn’t replace good surgical techniques. It augments the surgeon’s skill. It doesn’t make a bad surgeon good, and it doesn’t take away all risks that are inherent with surgery. My favorite question is: Well, while the robot’s doing the surgery, what are you doing? The robot is always under the direct control of the surgeon; it cannot move on its own. The skill and training of the surgeon in using the computer-enhanced surgical technology is essential.

H&W: What else makes robotic surgery at P/SL stand out?

Canfield: We have a very rigorous training program here, and one of the things I’m most proud of is the collaborative effort with our group of surgeons. From oncologists to urologists, we frequently all work together, even in the operating room, because a lot of surgeries cross over specialties. P/SL was the first to have a robot in the Denver area, and we’re getting to be the most diverse and advanced program now. Our goal is to become a Center of Excellence for robotic surgery for a variety of specialties, and we are well on our way to reaching that goal.

How it works:

The da Vinci system has two separate but connected components. The tower, positioned next to the patient, includes the robot’s four arms, three for surgical instruments and one to hold the camera. Four incisions, less than an inch long, are generally required, but some surgeries can be done with fewer.

The surgeon sits at the console, a video-game like center, using foot pedals and two joy-stick-like controls to manipulate the highly dexterous tools. Across the room, the tiny ends move delicately and precisely inside the patient in synchronicity with the surgeon’s hands, never performing on their own.

Hospital-stay comparison in days for colon surgery

• 5 to 7, open
• 3 to 4, laparoscopic
• 1 to 2, robotic

(Note: These are averages only, as many variables can affect length of hospital stay.)

Some general surgeries now being done with robotic system:

• Appendectomy
• Gallbladder Surgery
• Splenectomy
• Colon Surgery
• Small Bowel Surgery
• Complex Abdominal Wall Hernia Repair
• Inguinal Hernia Repairs

Learn more: www.advsurgery.com

Tags: Presbyterian/Saint Luke's Medical Center