The da Vinci® Surgical System: Operating with robotic technology
A 7-foot robot is now assisting surgeons at Saddleback Memorial. Its mission: to help make minimally invasive procedures even less invasive.
The four-armed marvel is an important part of the surgical team during a growing number of procedures, with gynecologists and urologists among the first at Saddleback Memorial to incorporate the da Vinci robot into their surgical practice.
"The da Vinci Surgical System is an intricate non-programmable robotic tool that surgeons use—not a robot that performs surgery," says obstetrician-gynecologist Marc Winter, M.D. "For operations such as minimally invasive hysterectomies, the da Vinci represents a significant advancement in treatment over conventional open surgery and other minimally invasive techniques such as laparoscopy." Because the system increases precision, the benefits of robotic-assisted surgery include less blood loss, a shorter hospital stay, less pain, a reduced risk of infection and faster return to daily activities.
The da Vinci Surgical System acts as an extension of the surgeon's hands. Composed of several components, the device includes a large bedside cart with interactive robotic arms, a high-definition, three-dimensional viewing system, a computer console with specialized hand controls, and miniature surgical instruments.
Procedures using the system are performed through small incisions instead of one large opening. The surgeon operates while seated at a computer console a few feet from the patient. The console contains hand controls that the surgeon manipulates to direct the machine's robotic arms, wrists and micro instruments.
The wrists have a range of motion and agility that far exceeds human ability. This accounts in part for the system's incredible surgical precision. Furthermore, the robot's tweezer-like "fingers" can hold miniature surgical instruments steadily for long periods of times without growing tired.
Throughout the procedure, the da Vinci's advanced video system transmits highly detailed, 3-D digital images of the interior surgical area, which greatly enhances the surgeon's ability to view the complex structures, tissues and organs inside the body.
"Robotic-assisted technology has elevated gynecologic surgery to a whole new level," notes Daniel Sternfeld, M.D., obstetrician-gynecologist. "With the da Vinci Surgical System, we can use minimally invasive techniques without compromising the complexity of the procedure being performed." Saddleback Memorial surgeons use robotic-assisted surgery to treat a wide range of gynecological conditions, including ovarian and cervical cancer, uterine fibroids, endometriosis, abnormal vaginal bleeding and loss of uterine support (prolapse).
During a conventional open hysterectomy, a 6- to 12-inch incision is made through the abdomen. Recovery can be painful and take up to six weeks.
In contrast, surgery with the da Vinci is performed through two to four small incisions. "With the da Vinci's magnified three-dimensional imaging and zoom-in capabilities, we can operate deep within the pelvic region through smaller incisions with great accuracy," says Dr. Sternfeld.
Another surgical procedure performed with robotic-assisted technology is the prostatectomy, or removal of the prostate gland. This operation requires only five tiny incisions with patients returning home the next day. Traditionally, the operation's effect on the nerves that govern bladder control and sexual function have been a concern.
The results of a da Vinci prostatectomy significantly surpass other surgical methods and are particularly notable in two important areas: the postsurgical restoration of urinary control and the preservation of sexual function. In clinical comparisons of the da Vinci prostatectomy to laparoscopic removal of the prostate (another minimally invasive approach), 97 percent of men regained urinary function after robotic-assisted surgery versus 83 percent for the traditional minimally invasive approach.
Those studies also showed that sexual function was restored in 86 percent of men after the da Vinci procedure, versus 76 percent of men who had laparoscopy.
Surgeons at Saddleback Memorial have begun to explore the evolving possibilities of the da Vinci Surgical System. "There's a great deal of enthusiasm about this new technology," says Dr. Winter. The da Vinci Surgical System can be used in procedures that treat a range of conditions, including obesity, coronary artery disease, kidney disorders, mitral valve prolapse, and bladder, colorectal and lung cancers.
For any surgical procedure, decisions about the most appropriate treatment are based on an individual's specific diagnosis, medical history and surgeon's recommendations.