Peter Lundberg MD
Robotics - The New Frontier in Minimally Invasive Surgery
While our #healthcare system is far from perfect, Americans enjoy access to more advanced medical technology than any other country in the world. The eye-popping investments of industry and government into healthcare has ensured that the United States is at the forefront of new medications, instruments, and software that change the way patient receive and physicians practice care.
One of the latest advances is the field of #robot-assisted #laparoscopic #surgery. Starting mainly in urology and gynecology in the mid-2000’s, #robotic platforms are now being used to facilitate #minimally invasive surgeries in general, #bariatric, orthopedic, and many other specialties throughout the country. As a #surgeon who uses #robotics frequently, I find that many patients and colleagues have two common questions — What, exactly, is the robot? And is it worth the investments of money, training, and time?
Simply put, the robot is a tool that helps surgeons perform laparoscopic surgery. Laparoscopic surgery refers to an approach where, instead of one large #incision, several small incisions no larger than a finger’s width are used to inflate the abdomen, allowing a camera and long, thin instruments which are held externally by the surgeon to be inserted to perform the operation inside the patient. A robotic platform consists of at least two units - one at the bedside that holds a more advanced camera and instruments than standard laparoscopy, and one nearby where the surgeon controls them (see image below of the DaVinci XI system by Intuitive Surgical).
The improved visualization, flexibility, and comfort of the robotic platform enable surgeons to perform more delicate and difficult dissections that could not be done safely with standard laparoscopy. There are even some studies that show that patients undergoing robot-assisted surgery have less pain after surgery. In my practice, I use the robot on nearly every #hernia surgery; it allows me to fix large defects in the groin, at the belly button, and at previous incisions with minimal risk of pain, recurrence, and while enabling the patient to go home the same day. I also use the robot to do bariatric or #weight loss surgery, where the platform allows careful dissection in patients who struggle with #obesity. While expertise requires years of training and exposure, there are undeniable benefits to patients and surgeons alike.
That said, this technology is expensive. Many physicians and hospital administrators alike point out that robot-assisted procedures regularly cost more than conventional laparoscopic approaches without significant, long-term changes in outcomes. Nonetheless, these devices continue to gain popularity in operating rooms throughout the United States, and improvements in technique, training, and design are steadily decreasing costs. Assuming these trends continue, I am reminded of the identical concern and skepticism when laparoscopy first started several decades ago. While laparoscopy today is universally recognized as safe and effective — the gold-standard approach for many surgeries including appendix and gallbladder removal — in the 1990’s and early 2000’s it was widely seen as unproven, too expensive, and potentially unsafe.
I believe that robotics in the 2020’s is at a similar moment — the last decade has seen dramatic improvements in use, training, and cost reduction and there is every indication they will continue. I advise all my patients to ask their surgeons about minimally invasive options for any procedure, and to understand why and how a particular technique is being used. With patient and surgeon partnership, robot-assisted surgery could become the gold standard of the future.