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Robotics Surgery

Introduction

Robotic surgery is a type of minimally invasive surgery. “Minimally invasive” means that instead of operating on patients through large incisions, we use miniaturized surgical instruments that fit through a series of quarter-inch incisions. When performing surgery with the da Vinci Si—the world’s most advanced surgical robot—these miniaturized instruments are mounted on three separate robotic arms, allowing the surgeon maximum range of motion and precision. The da Vinci’s fourth arm contains a magnified high-definition 3-D camera that guides the surgeon during the procedure.

Philosophy

We are pleased to offer the opportunity for residency programs to obtain a robotic training kit that can be used in conjunction with our standardized robotic surgical training curriculum. Since 2010, nine Obstetrics and Gynecology programs have collaborated to form the Robotic Training Network with a mission to develop an educational curriculum to teach the basic principles of robotic surgery. Our goal is to design a standardized approach to teach basic robotic surgical skills in a stepwise fashion to trainees throughout Graduate Medical Education training programs.

Nature of treatment

Using the most advanced technology available today, the da Vinci Surgical System enables surgeons to perform delicate and complex operations through a few tiny incisions with increased vision, precision, dexterity and control. The da Vinci Surgical System consists of several key components, including: an ergonomically designed console where the surgeon sits while operating, a patient-side cart where the patient lays during surgery, four interactive robotic arms, a high-definition 3D vision system, and proprietary EndoWrist instruments.

Side Effects of Robotics Surgery

There are risks to positioning, such as the lungs being unable to tolerate Trendelenburg position (bed tilted with the head towards the floor, feet toward the ceiling). If this case, the robot is removed an open incision made to complete the surgery. Trendelenburg position often causes some temporary swelling of the face since the head was lower than the rest of the body during surgery. Patients may be more prone to rub their eyes while waking up and rarely can scratch the outer surface of the eye (corneal abrasion). Precautions are taken to protect the eyes for this reason. Being in one position for a long surgery can also cause neurologic side effects like numbness, tingling, weakness or pain in the arms, legs or joints. This is usually temporary but rarely may require further testing or investigation with a neurologist or orthopedic surgeon. Let the anesthesiologist know if you have any arm, leg, joint or back problems or prior surgeries so we can take extra caution positioning this area.

Advantages

  • These robotic systems enhance dexterity in several ways. Instruments with increased degrees of freedom greatly enhance the surgeon’s ability to manipulate instruments and thus the tissues.
  • These systems are designed so that the surgeons’ tremor can be compensated on the end-effector motion through appropriate hardware and software filters.
  • Another important advantage is the restoration of proper hand-eye coordination and an ergonomic position. These robotic systems eliminate the fulcrum effect, making instrument manipulation more intuitive.
  • With the surgeon sitting at a remote, ergonomically designed workstation, current systems also eliminate the need to twist and turn in awkward positions to move the instruments and visualize the monitor.

Disadvantages

  • To date, mostly studies of feasibility have been conducted, and almost no long-term follow up studies have been performed.
  • Another disadvantage of these systems is their cost. With a price tag of a million dollars, their cost is nearly prohibitive. Whether the price of these systems will fall or rise is a matter of conjecture.
  • Another disadvantage is the size of these systems. Both systems have relatively large footprints and relatively cumbersome robotic arms. This is an important disadvantage in today’s already crowded-operating rooms.

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