da Vinci® Robotic Surgery
Robotic surgery is the most advanced form of minimally invasive surgery available today. The University of Kansas Health System offers the da Vinci® surgical system for robotic-assisted surgery.
What is robotic surgery?
Robotic surgery with the da Vinci surgical system allows physicians to perform complex procedures with precision. The da Vinci's high-definition 3D vision and magnified view enhances the surgeon's capabilities. The surgery is performed entirely by your doctor, who controls the da Vinci system that translates their hand movements into smaller, more precise movements.
Who can have robotic surgery?
Not every surgery can be performed with the da Vinci surgical system, and not everyone is a candidate for robotic-assisted surgery. Your doctor will talk more with you about your surgical options when you discuss your treatment plan together.
How does the da Vinci surgical system work?
By utilizing the da Vinci surgical system, our 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 da Vinci surgical system is extremely versatile. Doctors worldwide have used it successfully in hundreds of thousands of procedures.'
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 1-to-1 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. 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 vein 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 vesicles. 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. 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 1 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 reapproach 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 bag and set aside for later retrieval.
Dr. 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 2 sutures, which are tied together, you can see us run the sutures in a circumferential manner to get a nice round and watertight anastomosis. We then test this anastomosis to make sure that there's no leakage of water and what would be urine in the postoperative period. We then close the small incisions on the skin with some absorbable sutures to leave a nice appearing abdominal wall, with only 5 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. 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 3 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.
Benefits and risks of da Vinci robotic surgery
Using da Vinci, your doctor can perform complex procedures through just a few small incisions. As a result, you can get back to normal life faster without the usual recovery that follows traditional surgery.
Benefits of robotic surgery may include:
- Faster recovery and return to normal daily activities
- Improved healing and reduced scarring
- Reduced bleeding and need for transfusions
- Reduced pain and trauma to the body
- Reduced risk of infection
- Shorter hospital stay
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.
What happens during robotic surgery?
The da Vinci robotic system consists of 3 components:
- 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 robotic surgery procedure, the surgeon fills the patient’s abdomen with carbon dioxide using a small incision less than 2 centimeters. After the abdomen is distended, a light and camera are 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 centimeters in length. Through these incisions, cannulas (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.
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, 3D view of the operating field and is able to direct the robot’s arm movements by placing his or 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 7 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.