da vinci surgery

[captain bhangra]

just curious, how is the da vinci robot for surgeries for those of you that have used it? good bad useful not useful?
seems interesting

thanks

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[jubb]

I'd ask the urologists. They are the ones who use it the most.

 

[goldenwest]

There are some really good videos on OR live for the da vinci robot.

 

[sponch]

it's useful for working in a deep hole like the pelvis where exposure can be difficult and the room to work is tight

 

[nonbilious]

humble ms3 here so please keep in mind i have no personal experience, but being a robot jockey doesn't seem all that cool to me. Granted the thing is very cool and I do enjoy toys, but I don't like competing with the machine.

can anyone out there who has used it offer some experiences? Is it ever going to be mainstream, as in 25-50% of procedures?

 

[Spine Specialist]

Robot technology helps power new kidney surgery

December 12, 2008


S. Duke Herrell, M.D., right, used a new form of robotic laparoscopic kidney surgery to operate on Bannar Rawlings, left. (photo by Susan Urmy)
by Dagny Stuart
Bannar Rawlings is forever grateful to the Vanderbilt radiologist who saw something suspicious on her kidney.

Rawlings was undergoing an MRI for a back operation when the radiologist spotted a cancerous lesion. The 30-year-old assistant to the chair of Neurosurgery believes she is equally lucky to be at a medical center that offered her a new form of robotic laparoscopic surgery.


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“After having the back surgeries I wanted my downtime to be as short as possible, and I wanted the pain to be minimal,” Rawlings said.

Rawlings was one of the first Vanderbilt patients to undergo robotic laparoscopic kidney cancer surgery, performed by S. Duke Herrell, M.D., associate professor of Urologic Surgery and director of Minimally Invasive Urologic Surgery and Robotics. Herrell has performed more than 1,000 laparoscopic kidney surgeries and partial nephrectomies, making him one of the most experienced laparoscopic kidney surgeons in the country.

Herrell was recruited to VMC to develop advanced laparoscopic and minimally invasive cancer surgeries and to help develop the robotic prostate cancer program. He has now translated those skills to kidney cases.

“Twenty years ago there was one operation if there was something wrong with your kidney, and that was to make a big flank incision through your side, at least six to eight inches, and remove your entire kidney,” Herrell explained. “That was done whether your tumor was the size of a dime or a football. Over the past eight years, I have been using laparoscopic surgery for smaller tumors, putting the kidney back together and getting good cancer results.”

Robots, like the da Vinci Surgical System, may offer surgeons even more control. The robot has a wrist, which normal laparoscopic tools don't have. This wrist action allows the surgeon to maneuver needles and sutures more easily.

“Reconstructing kidneys when you've taken them apart can be very challenging, and you're doing it in a pressured environment because you have the blood flow to the kidney stopped,” Herrell said. “The robot visualization system is 3-dimensional, while laparoscopic surgery is not. With the robot you control the camera and the robot's other arms for suturing and retraction.”

Herrell, however, cautions that the robot is no substitute for experience in minimally invasive kidney surgery.

Removing the cancerous tumor surgically is crucial because kidney cancer often doesn't respond to standard chemotherapy or radiation. Now the challenge is to perform the surgery in a minimally invasive way so the patient maintains good renal function.

“We know we have a surgery that's going to benefit the patient, get rid of the cancer, and now we can make it less morbid for the patient,” said Herrell.

Rawlings was able to go home after just two days in the hospital. She spent several weeks at home recuperating and believes it would have been far worse with traditional kidney surgery.

“I know it's very new but it worked well for me,” she said. “They were able to minimize how much of the kidney they had to remove, minimize the pain, the amount of time I was in the hospital and the time I was out of work.”

 

[Habeed]

Granted the thing is very cool and I do enjoy toys, but I don't like competing with the machine.

The machine isn't doing the surgery. YOU are doing the operation. It just gives you teensy tiny hands that are smaller than those of an asian female, and they don't tremble.

 

[BlondeDocteur]

So says the Special Master's student.

 

[nonbilious]

i know the machine isn't DOING the surgery but I think I would miss getting my hands dirty.

 

[socmob]

Well I don't know any surgeon that ONLY operates w/ the robot. It's only for certain things. Also, I highly recommend that you ask to look into the machine/sit down at it sometime during a robotic case. It's a 3D high-def view as if you're inside the abdomen/pelvis...it's honestly the coolest thing I've ever seen, it's amazing. Training under the robot seems like it sucks (so many hours spent ducking the robot's arms and switching out instruments) but operating the robot itself seems awesome. And you're not scrubbed, can sit the whole case, etc.

 

[Plastikos]

Well I don't know any surgeon that ONLY operates w/ the robot. It's only for certain things. Also, I highly recommend that you ask to look into the machine/sit down at it sometime during a robotic case. It's a 3D high-def view as if you're inside the abdomen/pelvis...it's honestly the coolest thing I've ever seen, it's amazing. Training under the robot seems like it sucks (so many hours spent ducking the robot's arms and switching out instruments) but operating the robot itself seems awesome. And you're not scrubbed, can sit the whole case, etc.

Lots of student interest on this one. The robot is used for certain things, and like many things in medicine once more ppl are comfortable with it the use will expand.
At my institution it is mainly used by urologists for robotic prostatectomies. There are robotic fellowships and there are ppl that focus their practice on robot cases.

 

[beaverfetus]

Lots of student interest on this one. The robot is used for certain things, and like many things in medicine once more ppl are comfortable with it the use will expand.
At my institution it is mainly used by urologists for robotic prostatectomies. There are robotic fellowships and there are ppl that focus their practice on robot cases.

like a wise show said:

"The wars of the future will not be fought on the battlefield or at sea. They will be fought in space, or possibly on top of a very tall mountain. In either case, most of the actual fighting will be done by small robots. And as you go forth today remember always your duty is clear: To build and maintain those robots."

 

[sponch]

it's an extension of laparoscopic surgery. a machine takes your hand movements and translates it into a tremorless instrument. instead of a TV screen you look into a 3D console. at its present state, it's really awkward and clunky to setup, which is why it's only used in situations where the cost of setting it up is outweighed by the technical advantages it gives the operator. it's the equivalent of the computer that used to take up the space of a whole room back in the day. that's where the technology is now. maybe in 10 years robots will get so small and advanced that they can be used routinely because it won't take so much work to get things setup. i can probably do a lap chole skin to skin by the time it takes someone to position the robot and get the ports in.

 

[socmob]

i can probably do a lap chole skin to skin by the time it takes someone to position the robot and get the ports in.

Agreed that logistically the robot still sucks and is gigantic and clunky. Nothing's worse than when the robot's not quite working right or the surgeon is not very adept with it (most attendings didn't train w/ the robot, after all) - I've seen cases take 8 hours due to struggling surgeons or robots, cases that would have taken 3hrs laparoscopically (or 1.5hrs open). I didn't really understand why anyone would bother till I sat down at it and looked inside...I'm still not entirely convinced it's worth the pain (in its current form) but I definitely understand the appeal now.

 

[nonbilious]

for those in residency now or beyond, do you think training on the robot should be something to look for in a program?

 

[sponch]

for those in residency now or beyond, do you think training on the robot should be something to look for in a program?

only if you're going to do uro or gyn

 

[PeepshowJohnny]

like a wise show said:

"The wars of the future will not be fought on the battlefield or at sea. They will be fought in space, or possibly on top of a very tall mountain. In either case, most of the actual fighting will be done by small robots. And as you go forth today remember always your duty is clear: To build and maintain those robots."

Dude, love that episode. That speech had me rolling.

 

[ESU_MD]

robot has a role in mitral valve surgery
IF

- in highly selected patients
- in high volume centers
- if you have done enough cases to be fast

and most of all- if you can't fix the valve open, chances are the robot aint gonna help you

 

[Wardens]

A few centers are using it for ENT procedures as well. Mostly hard-to-reach tongue base tumors right now, but it probably has a bright future in skull base as well. They just need better instruments.