Continuing advancements in medicine provide us with almost daily stories about new drugs, diagnostic tools, therapies and treatments. These innovations bring new tools to practitioners in their battle to find cures or help patients live better quality lives by addressing the symptoms of their disease.
The practice of surgery as a cure and/or treatment for disease has been ongoing for centuries but only recently, about several decades ago, did it advance into the realm of minimally invasive surgery. Minimally invasive surgery, more commonly called laparoscopy, utilizes small incisions which allow the surgeon access to a treatment site inside a patients body without large openings, as used in traditional surgery. An now, less than ten years ago, a further leap forward for surgery was taken with the advent of robotic assisted, minimally invasive surgery.
As the name implies, the surgeon is assisted in his work by a robot which the surgeon manipulates from a control panel. While in the operating room and seated comfortably at the control panel near the patient, the surgeon views a highly magnified, three dimensional image of the bodys interior through a miniature camera inserted into the body. He uses the controls to move a variety of instruments specifically designed for different types of operations. These robotic instruments are inserted into a patients body through very small incisions of about one to two centimeters. In robotic assisted surgery, the surgeon is performing the surgery through the movements of the robot mechanism instead of the surgeon directly touching the patient.
(l-r) Drs. Darren Bruck, Nicholas Lambrou, Mark Dylewski, Ricardo Estape and Avelino Pinon.
Commenting on the benefits of robotic surgery, Dr. Mark Dylewski, a board certified thoracic surgeon at South Miami Hospital, said, “The primary benefits are less post-operative pain, early recovery, shorter hospital stays, and cosmetically appealing incisions, and the ability to perform complex chest surgery that would have otherwise required large open procedures.”
Concurring with his colleague, Dr. Darren Bruck a board certified urologist at South Miami Hospital adds, “The robot provides better visualization of the anatomy and the robotic wristed instruments, which are controlled by the movement of the surgeons hands and fingers, improve accuracy and make complicated maneuvers inside the body possible.”
Dr. Bruck uses robotic surgery for the treatment of prostate cancer surgeries and said, “Every year more and more prostate cancer surgeries are being performed with the robot. This trend will continue so that in about ten years 80 to 90% of prostate cancer surgeries will involve robotic surgery.”
Commenting on the use of robotic surgery in gynecologic surgeries, another South Miami Hospital surgeon, Dr. Ricardo Estape, board certified in gynecologic oncology and obstetrics and gynecology, listed the following as diseases he typically treats with robotic surgery – cervical and endometrial cancer, early ovarian cancer, restaging of ovarian cancer, fibroids, ovarian masses, endometriosis, adenomyosis, adhesions, pelvic relaxation/prolapse, among others. He continued, “For instance, in cervical cancer patients the average blood loss with an open case is 800 to 1,000 ml. With robotic surgery this is decreased to 100 ml. Risk of transfusion is much less and the patient can go home in one to two days compared to four to five days with recovery time decreased by 70%.”
All three surgeons practicing at South Miami Hospital utilize the da Vinci Surgical System produced by Intuitive Surgical. Intuitive Surgical launched the da Vinci robot in 1999 and in 2000 it became the first robotic surgical system cleared by the FDA for general laparoscopic surgery. Since then the da Vinci system has been approved for additional types of surgery including thoracoscopic (chest) surgery, for cardiac procedures performed with adjunctive incisions, urologic and gynecologic procedures. Today over 700 da Vinci Systems are installed world wide in hospitals.
Commenting on the training for using robotic surgery systems, Dr. Estape commented, “Laparoscopy is the mainstay of training today. If you know how to do laparoscopy then it is a relatively short jump to learn the use of the robot. If you dont do laparoscopy, then it is a long learning process with a steep learning curve.” He continued, “Training on robotic surgery is being done in only a few residency programs and a few fellowship programs and I believe it should be included in the training regimen.”
Speaking about South Miami Hospital and its surgeons being on the leading edge in utilizing robotic surgery, Dr. Dylweski said, “From a thoracic standpoint, South Miami Hospital is the only institution performing major thoracic surgical procedures using the robotic system in South Florida. It is also one of the largest volume centers for robotic surgery and multi-specialty surgeries in the U.S.A.”
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