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Article: Robotic Surgery Enables Quicker Recovery, Less Pain


(Pictured: Surgeon Nicholas Lambrou, M.D., performs a hysterectomy with the daVinci Robotic Surgical System.)
Robotic Surgery Enables Quicker Recovery, Less Pain


Leonardo da Vinci, the original Renaissance man, painted the Mona Lisa, studied anatomy and excelled in engineering. Around 1495, the artist even invented the first robot, a mechanical knight rigged with cables and pulleys.

Centuries later, it's only fitting that a robotic system for surgery available at South Miami Hospital is named after that archetype Renaissance artist. The da Vinci robot enables surgeons to merge the best of traditional, open surgery with the tools of minimally invasive surgery, according to physicians at South Miami Hospital.

Patients experience less pain, shorter hospital stays, quicker recovery times and less blood loss, surgeons said.

"After prostate surgery, patients are very happy with the recovery time and their postoperative functions. They're happy to be leaving the hospital earlier," said urologist Darren Bruck, M.D.

Avoiding an extended hospital stay was a top goal for Michelle Corbin, a 45-yearold mother. After being diagnosed with a brain tumor and lung cancer in December, Ms. Corbin wanted to spend as much time as possible with her husband and nine-year-old son.

"I didn't want any more surgery," said Ms. Corbin, who underwent brain surgery in December. "I wanted to spend
the summer in the Keys with my son." But her opinion shifted after she read about Dr. Mark Dylewski's minimally invasive chest surgeries in Resource. After it was determined that the cancer had remained isolated in her brain and upper lung, Ms. Corbin was scheduled for robot-assisted surgery.

On June 19, Ms. Corbin underwent a three-hour surgery to remove a tumor from her upper lung and chest wall. Three days later, she was home. And by July 3, Ms. Corbin began an extended camping trip with her husband and son.

The differences between robot-assisted surgery and a traditional operation are particularly noticeable in chest operations, Dr. Dylewski said. Traditional chest surgery requires the surgeon to open the chest, skin and surrounding tissue with incisions six to 12 inches long. Conventional methods may require the physician to spread, fracture or displace ribs in order to remove tumors.

"It sounded like a horrendous, horrendous surgery," said Ms. Corbin, who had consulted several doctors and feared being laid up in bed for two months after traditional surgery.

But the smaller incisions involved in robot-assisted surgery reduce physical trauma and provide other quantifiable benefits to the patient, Dr. Dylewski said. 

Those benefits include fewer complications and reduced postoperative pain.

Gynecological oncologists Ricardo Estape, M.D., and Nicholas Lambrou, M.D., use robotic surgery for hysterectomies and other gynecological operations.

A patient undergoing a radical hysterectomy for cervical cancer can return to work within 23 days after robot-assisted surgery, versus 46 days in traditional open surgery.

Here's how robotic surgery works: The surgical team makes four to six dime-sized incisions in the patient's body.

These incisions are called operating ports, and slender tubes called trocars are inserted into those small openings.

The robot is wheeled into position and the four arms of the robot are docked into individual ports. Surgical tools are attached to the end of the robot's arms.

"Those arms are like an extension of our own hands," Dr. Lambrou said.

One robotic arm holds a digital camera, which provides a three-dimensional view of the internal organs and tissue.

Those images appear on a large screen near the operating table and on a small console, where the surgeon sits during the operation. While watching a magnified, high-definition image of the patient's anatomy, the surgeon manipulates the other three arms of the robot by using foot pedals and hand controls. And while seated just a few feet away from the operating table, the doctor cuts tissue and removes tumors.

Standing by the patient, a second surgeon works with another port. Through that opening, the second surgeon performs several manual chores including suctioning blood, removing specimens for biopsies and changing instruments.

The tools used for robot-assisted surgery cut and cauterize blood vessels in a single step. This multitasking process eliminates steps and reduces blood loss.

"The robot is a tool for the surgeons to use," according to Avelino (Andy) Piñon, M.D., a urologist who uses the da Vinci robot to perform prostate surgery. "It's just like another scalpel."

The robot is programmed with safeguards that protect the patient from abrupt or uncontrolled movements.
For example, safety mechanisms neutralize hand tremors and sudden jerks that could possibly occur in traditional surgery. In prostate procedures, robot-assisted surgery helps to avoid damaging nerves that are vital to bladder and sexual functions, Dr. Piñon said.

Until recently, minimally invasive surgery was not widely used for extremely delicate or complex surgeries. That's because the equipment designed to operate through small incisions included stiff instruments that resembled knitting needles or chopsticks. Those surgical tools ideal for some procedures lacked the flexibility and control of the human wrist.

But the da Vinci technology includes instruments that move and rotate with the flexibility and range of a human wrist. This enables surgeons to carry out complex procedures (removal of tumors and reconstruction of tissue in the chest, pelvis or abdomen) without making large openings in the body.

The technology which includes color monitors magnifies the surgical area by over 10 times. That compares to zero
magnification with traditional open surgery, which relies only on the human eye.

That additional vision compensates for the absence of touch. In open surgery, the surgeon's hands provide information about a tumor and the surrounding area. "You feel the enlargements of the lymph nodes up against the blood vessels. You can feel where they're hard," Dr. Estape said.

In open surgery, that tactile knowledge is important because surgeons operate in deep areas of the body with limited vision. But robot-assisted surgeries provide a magnified image of the body.

"The visibility and dexterity are so much greater with robot-assisted surgery that I don't miss the tactile feel. My visual cues have replaced my tactile cues," Dr. Estape said.

For Ms. Corbin, that robotic technology filtered down to sand between her toes. Instead of spending the summer in bed, she collected shells on the beach and watched her son ride his bike.