Tuesday, March 12, 2013

Advances in surgeries with robots reduce risks and trim recovery times - Houston Chronicle

What if you could have a major surgery with only a short hospital stay, very little pain, low risk of infection, little blood loss, minimal scarring, and a fast recovery and return to normal daily activities?

Such a scenario is becoming increasingly possible thanks to the developing field of medical robotics and the increasing use of robots in surgical procedures. By using robots, surgeons can perform complex operations more easily and precisely, and in a less invasive way that improves results for patients.

"Robotics is an extension of laparoscopic surgery," said Dr. Surena Matin, an associate professor in the department of urology at the University of Texas M.D. Anderson Cancer Center. Matin also is medical director of MINTOS - the Minimally Invasive New Technology in Oncologic Surgery Collaborative Group at M.D. Anderson. "The improvement over laparoscopic techniques comes in terms of improving the surgeon's visibility and dexterity. Surgeons don't have to remove their eyes from the scene of surgery, and they have more range of motion through the wrists of the device than through scopes. (Laparoscopy) is like operating with chopsticks compared to the dexterity of the microwrists on the robotic system."

At least two of the most advanced surgical robotics systems are in use in the Houston area. Surgeons atMemorial Hermann Sugar Land Hospital recently began using the da Vinci Si Surgical System robot to perform procedures in urogynecology, gynecology, oncology and general surgery. St. Luke's Episcopal Hospital has added the same system to its suite of robotics technology to perform urological and gynecological procedures, and perhaps procedures for ear nose, throat and abdominal specialties in the future.

Dr. Nina Dereska, a surgeon at Memorial Hermann Sugar Land, has been using the da Vinci robotic systems for surgeries since 2009. The system allows for more surgical options with certain patients for whom traditional surgery presents a problem.

"With robotic surgery, small mechanical arms are inserted into the patient through tiny incisions," she explained. "Surgeons will be able to control the robotic movements, or the arms, through special hand and foot controls at a console several feet away from the operating table." The robot translates the surgeon's hand, wrist and finger movements at the control console into corresponding micro movements of the instrument's tip.

In other words, the robot can be set to scale down surgeon's movements so that a 1-inch movement on the surgeon's finger becomes a movement of only a fraction of an inch at the tip of the robotic instrument. Similar movements also control the camera to allow the surgeon to see inside the patient's body. The surgeon, sitting at the console, is able to continuously view the scene of surgery and perform highly precise surgical movements without nearly as much fatigue as in traditional surgical procedures, including "straight-stick" laparoscopy.

"Straight-stick surgery is hard on the body - my elbows are up in the air, my shoulders are hunched; it's very fatiguing," Dereska said. "Robotics surgery is much easier on the surgeon, which translates to being better for the patient."

Surgeons at the Methodist Hospital recently became the first to use the Magellan Robotic System to treat patients with peripheral vascular disease. "This new intravascular robotic system represents a fundamental step forward in the transformation of vascular intervention," said Dr. Alan Lumsden, chair of the department of cardiovascular surgery and medical director of the Methodist Debakey Heart & Vascular Center. "It allows us to offer less invasive endovascular options to a broader group of patients suffering from complex vascular disease."

The system allows a surgeon to more precisely steer a catheter inside and around blood vessels. Lumsden said it can be used for any procedure involving complex catheterization and will be especially useful in lower-extremity arterial interventions and branched endografts. In addition, the technology will help reduce both the procedure time and radiation exposure.

The chief drawback of robotics in surgery is the lack of haptic feedback - the ability surgeons have to visualize in their mind what they are feeling with their hands. "We don't have our fingerpads to feel and guide, so we have to learn with our eyes to see how the tissue reacts in order to get a 'feel' for it," Matin said. "This is more of an issue for late-stage cancers where the tactile feedback plays a heavier role in determining where to cut."

Increasingly, surgeons are being trained to use robotic systems in various specialty areas. Peter Herrera directs the Memorial Hermann Surgical Innovation and Robotics Institute in the Texas Medical Center. "The institute has trained numerous robotics surgical teams from around the country since we first opened in 2003," he said. "We are the largest training site for robotic surgery in the nation and the only one in the southwest USA."