Robotic surgery represents a novel way of doing surgery. It allows physicians the opportunity to offer patients minimally invasive options that might not be available with standard laparoscopy. By utilizing the robotic system, surgeons have an enhanced 3D view of the surgical field with the capability to ‘zoom in’ and magnify up to 12 times the normal size. The robotic arms allow superior flexibility and maneuverability that improve the surgeon’s control and precision.
The robot DOES NOT make any decisions or movements on its own, nor can it be programmed to act independently. It has no autonomy and moves only from direct input from the surgeon.
The robotic system used at the University of Kansas Medical Center is the da vinci Surgical System, which was acquired in 2004. It was approved by the U.S. Food and Drug Administration in 2000 for abdominal procedures and in 2005 for gynecologic procedures. It is also used by extensively by urologists since 2001 for prostate removal as well as cardiothoracic surgeons.
The da Vinci Surgical System
The robotic system consists of three components, which include:
At the start of the procedure, the surgeon fills the patient’s abdomen with carbon dioxide using a small incision less than 2 cm. After the abdomen is distended a light and camera is inserted to view the abdominal contents. If the surgeon feels the operation can be completed robotically, the surgeon will proceed and make three to six incisions approximately 1-2 cm in length. Through these incisions cannulas, or instrument holders, are inserted through the skin into the abdomen. The patient side cart, which includes flexible, mechanical arms is then brought to the patient and ‘docked’, or connected to the cannulas.
Once the robot is docked the surgeon sits at a master console which is in the same room as the patient. An assistant surgeon remains at the bedside to change instruments and assist. Sitting at the console, the surgeon sees a magnified, three-dimensional view of the operating field and is able to direct the robot’s arm movements by placing his/her hands in the master control handles. The surgeon’s movements are scaled and translated to precise movements of the instruments at the bedside. Surgeon’s hand tremor is also filtered and removed.
The robotic arms and specialized endowrist instruments combine to allow the instruments to move similar to that of a human wrist. The system allows seven degrees of freedom, or axes of movement.
Once the procedure is complete, the patient side cart is unhooked, or undocked, from the patient. All of the instruments and cannulas are removed and the small incisions are closed.
The following is a list of procedures currently available with robotic assistance: