The old days.
The cosmetic superiority of laparoscopic surgery, also boosted in popularity by its low infection rates, resulted in a brisk, competitive “arms race” among several companies that fine-tuned the technology to very sophisticated levels. Ultimately it was realized that some limitations and problems of this “minimally invasive surgery” could not be solved. For example, if surgery required anything more than removing tissue and retrieving it in a small bag for removal, separating scar tissue or shelling out cysts, sealing blood vessels, or burning away abnormal tissue, then something else was necessary. Laparoscopy, it seemed, had only a finite bag of tricks. The laparoscopic gallbladder operation probably represented the maximum benefit of laparoscopy, but in such cases when complications occurred, the laparoscopy route would be abandoned and the traditional surgery would be started. Clearly, in spite of sporadic improvements in laparoscopy, something else was needed. Surgeons wanted more—the ability to do much more complicated procedures with the same cosmetic and recovery time advantages.
In 2000 a company called Intuitive Surgical received FDA approval for its product, the da Vinci® Surgical System. This was the next big leap in advanced surgery, combining the cosmetic same-day surgery techniques to the advantages of the digital age, such as 3D and magnified stereoscopic views of the inside of one’s body. The jointed thin, long instruments still were able to use the smallest of incisions while being controlled from a “station” in the same room. From this station, the surgeon is immersed in the virtual reality of the internal body, wearing stereoscopic 3D goggles. Also, both hands are matched with right and left articulating controls that makes it possible for bimanual dexterity of instruments in the surgical field.
If you have your surgery with the surgeon’s station in a different time zone from where the da Vinci is used, does this mean you’ll have a surgery in the future?
This is a joke, of course, but it is interesting to note that originally the robotic surgery technology was investigated as a way of performing long distance surgery such as on the battlefield or in remote areas like the Antarctic. However, even at the speed of light at which the remote control signals moved, there was still a lag time that spoiled the robot’s tactile responsiveness to the surgeon’s hands. (Trying to cauterize or seal a bleeding blood vessel whose bleeding is even a tenth of a second before what the surgeon is witnessing proved dangerous and unworkable.)
Same time zone—in real time.
When the surgeon’s station is in the very room, however, the visuals and directed robotic movements are instantaneous. The presence of the surgeon in the same room also assures availability for performing surgery the old-fashioned way should the need arise, although this is not a typical concern due to the meticulousness of today’s robotic systems
Advantages of the da Vinci robotic technology:
- Small incisions, cosmetically superior.
- Minimal exposure of the internal body to the outside world (via the same small incisions), reducing infection risk.
- Meticulous movements are possible in real time, at magnification levels that allow progress even millimeter by millimeter.
- Very rapid recovery, even for what are traditionally felt to be major operations.
- Better visualization than even the surgeon’s naked eyes, allowing magnification 3D views and the ability to see structures from angles impossible with traditional surgery or even with laparoscopy, e.g., from under a tumor or a fibroid.
Who can perform robotic surgery?
This is not something for which a surgeon can merely watch a video, take an on-line course, or attend a weekend seminar in a nice vacation spot. While these are ways to introduce the concepts, the road to being accredited and qualified to perform robotic surgery involves a systematic progression of attending (viewing), then assisting (participating), performing under the direction of a mentor, and ultimately doing unsupervised robotic surgery. Some surgeons, such as Dr. Bozdogan at Endometriosis, even go on to become the mentors themselves, teaching other surgeons the technology and the art of robotic surgery. As proficiency goes, experience such as his is the pinnacle of expertise in the da Vinci robotic surgery techniques.