da Vinci® Robotic Surgery
When medication and other non-surgical treatments are unavailable or cannot relieve symptoms, surgery is the accepted treatment for a broad range of conditions from urologic to cardiothoracic and more.
Traditional surgery, in which large incisions are made, has been the standard approach when surgery is warranted. Common drawbacks of this procedure include significant post-surgical pain, a lengthy recovery and unpredictable, potentially long-term impacts on the patient's life.
Fortunately, less invasive surgical options are available to many patients. The most common is laparoscopy, which uses small incisions. While laparoscopy can be very effective for many routine procedures, limitations of this technology prevent its use for more complex surgeries.
A new category of surgery, introduced with the development of the da Vinci® Surgical System, is being used by an increasing number of surgeons worldwide for procedures. It allows physicians the opportunity to offer patients minimally invasive options that might not be available with standard laparoscopy. By utilizing the robotic system, surgeons have an enhanced 3D view of the surgical field with the capability to “zoom in” and magnify up to 12 times the normal size. The robotic arms allow superior flexibility and maneuverability that improve the surgeon’s control and precision.
The robot does not make any decisions or movements on its own, nor can it be programmed to act independently. It has no autonomy and moves only from direct input from the surgeon.
The robotic system used at The University of Kansas Health System is the da Vinci® Surgical System, which was acquired in 2004. It was approved by the U.S. Food and Drug Administration in 2000 for abdominal procedures and in 2005 for gynecologic procedures. It is also been used extensively by urologists since 2001 for prostate removal, as well as cardiothoracic surgeons.
How da Vinci® Surgical System Works
Our state-of-the-art da Vinci® Surgical System helps our surgeons perform minimally invasive surgical procedures with greater precision. For patients, this means shorter hospital stays and faster recovery times.
The da Vinci's high-definition 3D vision and magnified view enhances the surgeon's capabilities. Though called a robot, da Vinci cannot act on its own. The surgery is performed entirely by your doctor, who controls the da Vinci system that translates his or her hand movements into smaller, more precise movements.
The robotic system consists of three components, which include:
- A remote console from where the surgeon operates
- Patient side cart, which includes interactive robotic arms
- 3D vision system and cart
At the start of the procedure, the surgeon fills the patient’s abdomen with carbon dioxide using a small incision less than 2 cm. After the abdomen is distended, a light and camera is inserted to view the abdominal contents. If the surgeon feels the operation can be completed robotically, the surgeon will proceed and make 3-6 incisions approximately 1-2 cm in length. Through these incisions, cannulas, or instrument holders, are inserted through the skin into the abdomen. The patient side cart, which includes flexible, mechanical arms, is then brought to the patient and “docked,” or connected to the cannulas.
Using da Vinci, your doctor can perform complex procedures through just a few small incisions. As a result, you may be able to get back to normal life faster without the usual recovery that follows traditional surgery.
The da Vinci Surgical System is extremely versatile. Doctors worldwide have used it successfully in hundreds of thousands of procedures.
da Vinci is used for surgeries that include
Once the robot is docked, the surgeon sits at a master console, which is in the same room as the patient. An assistant surgeon remains at the bedside to change instruments and assist.
At the console, the surgeon sees a magnified, three-dimensional view of the operating field and is able to direct the robot’s arm movements by placing his/her hands in the master control handles. The surgeon’s movements are scaled and translated to precise movements of the instruments at the bedside. The surgeon’s hand tremor is also filtered and removed.
The robotic arms and specialized endowrist instruments combine to allow the instruments to move similar to that of a human wrist. The system allows seven degrees of freedom, or axes of movement.
Once the procedure is complete, the patient side cart is unhooked, or undocked, from the patient. All of the instruments and cannulas are removed, and the small incisions are closed.
Patient benefits may include:
- Faster recovery and return to normal daily activities
- Reduced pain and trauma to the body
- Reduced bleeding and need for transfusions
- Reduced risk of infection
- Shorter hospital stay
- Improved healing and reduced scarring
Together, these technological advancements provide da Vinci surgeons with unparalleled precision, dexterity and control that enable a minimally invasive approach to many complex surgical procedures.
Read more about the da Vinci® Si System's features and benefits.
Dr. David Duchene: We have just witnessed a robotic prostatectomy. This essentially involves making very small incisions on the abdomen of the patient. And insufflating the abdominal cavity with carbon dioxide. After getting the working space. We dock the Intuitive da Vinci Robotic Platform to the patient. And then that assists us in doing the rest of the operation. The robot does give us better magnification, more precise use of our hand controls. And with the pneumoperitoneum, we'll have decreased blood loss. As you can see, our hands control the small controllers, which are one to one correlated with the movements of the robotic platform. Next, with the use of robotic assistance, we dissect free, the tissue surrounding the prostate. This allows us to come on top of the anterior surface of the prostate. Where we clear off this frowning fat.
Dr. David Duchene: Here you can see where we have isolated the endopelvic fascia. We sharply cut the endopelvic fascia. And this divides the prostate from the levator musculature. And from the urethral sphincter. We then, take a staple to staple the dorsal venous complex, which is the large vain that drains the penis and lies right on top of the prostate. Once that has been divided, we then divide the bladder from the prostate, by taking down the anterior bladder neck. And then carefully taking down the posterior bladder neck, in order to get a nice division from the prostate. Next, you'll see us dissect out the seminal vesicals. These are structures that just store the semen and sperm and sit on the posterior side of the prostate. And the most important part of the procedure, which you will see here next. We free the neurovascular bundles from the lateral sides of the prostate.
Dr. David Duchene: This involves incising, something called the lateral prosthetic fascia, and then carefully sweeping these nerves posterior and laterally away and off the sides of the prostate. The robot really helps in this step, because there's about a one millimeter margin of error between the capsule of the prostate and the neurovascular bundles. The neurovascular bundles will be responsible for the return of erectile function after surgery. We then re-approach the prostate anteriorly, and divide the apex of the prostate from the urethra. Again, we try to get a nice urethral stump here, in order to have adequate tissue to hook the bladder neck back up to. We dissect the urethra free. And then the prostate is freed within the pelvis. The prostate is placed in a small plastic back and set aside for later retrieval.
Dr. David Duchene: Next, we will take the bladder neck and hook it back up to the urethral stump. This involves the running anastomosis, or the vesicular urethral anastomosis. Using two sutures, which are tied together, you can see us run the sutures in a circumferential manner to get a nice round and water tight anastomosis. We then test this anastomosis to make sure that there's no leakage of water and what would be urine in the post operative period. We then close the small incisions on the skin with some absorbable sutures to leave a nice appearing abdominal wall, with only five small incisions that will heal very nicely. So, a lot of the advantages of this procedure are, definitely decreased blood loss during the procedure, which makes patients recover quicker and feel better. We've also had very positive results with quicker return to urinary control.
Dr. David Duchene: And excellent results with erectile function postoperatively after a short period of rehabilitation. In general, most patients stay overnight in the hospital and are discharged home the next day. And at three weeks, after surgery, they're able to go back to their normal activities. A lot of patients will actually go back to desk jobs within a few days after the procedure.
Dr. David Duchene: (Silence)