December 1, 2021 by John Fernandez
Robotic Revolution: It was Science Fiction Not Long Ago, But it is Now Reality
A surgeon sits at a video console, using joysticks and foot pedals to control three robotic arms suspended over a patient on the nearby operating table. Tiny instruments and a camera attached to the arms move inside the patient, cutting and cauterizing tissue, until the patient’s gallbladder is placed in a little bag and removed, along with the robotic instruments, through an incision whose scar will be concealed in the belly button.
Little more than a decade ago, that scenario was the stuff of science fiction. Today, it’s reality.
And so is this: Robot-assisted surgery is revolutionizing the field of minimally invasive surgery. From urological, gynecological and abdominal to intestinal, chest and throat surgery, the use of robotic technology can make many operations more precise, safer and more effective. With incisions the size of mosquito bites, patients have less pain, fewer complications, quicker recoveries and shorter hospital stays.
And evidence is mounting that using a robotic approach in certain cancer surgeries, including intestinal and esophageal, reduces the risk of recurrence.
The explosive pace of new robotic applications has surprised even leaders in the field, including Baptist Health gynecological cancer surgeon Ricardo Estape, M.D., of the Center for Robotic Surgery, one of the busiest in the world. About 40 Baptist Health surgeons perform more than 2,500 robot-assisted operations annually at South Miami, Baptist and Doctors Hospitals.
“I wasn’t expecting this exciting kind of growth,” Dr. Estape said. “Patients are starting to ask for it. And our surgeons’ experience is unmatched.”
Established in 2006 at South Miami Hospital, the Center uses robotic technology to offer patients the best options and results for surgery.
South Miami Hospital now has four da Vinci Robotic Systems, each of which includes the robotic arms and computerized video console; Baptist Hospital has two and Doctors Hospital, one. Additional robotic systems are planned for other Baptist Health hospitals.
“This is the right thing to do for the patient,” said Dr. Estape, who has performed 2,100 robotic surgeries and teaches other surgeons the robotic techniques he developed for radical hysterectomy, fibroid tumor removal, and endometrial and cervical cancer surgery, among other procedures. More than 90 percent of his surgeries are done robotically — typically 15-20 cases per week.
Robotic arms help surgeons repair hernias, cut out cancer, remove organs, re-route the body’s digestive system in weight-loss surgery and more. Anthony Gonzalez, M.D., chief of surgery at Baptist Hospital and medical director of the Weight-loss Surgery Program at South Miami Hospital, started doing robotic procedures in 2009. Three years later, more than half of the surgeries he performs are robotic, rather than the minimally invasive laparoscopic approach.
“There is no doubt that your vision is better and your ability to manipulate the instruments inside the abdomen is better,” he said. “And the use of the robot can give you better outcomes in rectal and colon cancer than laparoscopy.”
Most robotic surgeries require three or four small incisions where a camera and surgical tools attached to robotic arms are slipped inside the body by specially trained nurses and technicians at the patient’s bedside. Sitting at the console, the surgeon directs the tiny instruments to places a human hand can’t fit, and maneuvers them in ways beyond the capability of a hand or laparoscopic tools.
This is particularly crucial in one of the newer applications for robotic surgery. Nationwide, a small number of surgeons, including Baptist Health ear, nose and throat specialists Agustin Arrieta, M.D., and Rolando Molina, M.D., have learned a robotic approach through the mouth to treat benign and cancerous conditions of the head, neck and throat.
This approach, when possible, avoids disfiguring surgery and a long recovery because muscle, nerve
and bone don’t have to be cut.
Every other year, Baptist Health sponsors a robotic surgery symposium that brings together experts and helps train surgeons in new robotic techniques. Dr. Gonzalez, for example, is a national leader in single-site robotic surgery, which has been approved by the FDA for gallbladder removal. A new robotic platform allows multiple arms to be inserted in a single incision at the belly button.
More robotic tools and advances are on the horizon, Dr. Gonzalez said,including a stapler and a robotic arm that splits into several arms after it’s inserted in the body.
In the meantime, pioneers like Mark Dylewski, M.D., Baptist Health’s director of thoracic robotic surgery, is committed to sharing his expertise.
More than 90 percent of chest surgeries could be performed robotically, Dr. Dylewski said, if more surgeons would learn the technology. Yet only about 20 percent are done so today.
“That’s why I remain active in educating surgeons from all over the world about the advantages of this technology,” said Dr. Dylewski, who has performed more than 900 robotic chest surgeries since 2006. “We’re learning more and more every day as we improve our skills.”