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Robots in the Operating Room

Devices Take Laparoscopic Surgery into the Future

Robotic surgery is one of the latest operating room technologies.

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When Jacksonville resident John Koeber was told he was a perfect candidate for a new robotic surgery, he was elated. Always an optimist, the 68-year-old retired airline pilot was already upbeat about the fact that his prostate cancer s caught early and treatable. But when he found out he would be the first patient at Mayo Clinic in Jacksonville to undergo a minimally invasive, robot-assisted procedure to remove his cancerous prostate gland, he was enthusiastic.

"I'm an innovative type, and I've always been interested in the latest technology," says Koeber, who saw his fair share of cutting-edge equipment in the cockpits of jumbo jets. "I'm not afraid of new technology, because I'm used to being around it."

Surgeons at Mayo Clinic have been using the robotic assist device — called the da Vinci Surgical System — since mid-2005 for urologic and gynecologic procedures. They were the first in the region to use robotic assistance in the operating room for a procedure to correct urogenital prolapse in women, a condition caused when pelvic floor muscles and ligaments weaken and push the organs they normally support against the walls of the vagina. In the future, they plan to use it in surgeries involving the kidney and heart.

"Urology leads the way in robot-assisted surgery because the prevalence of prostate cancer is so high," says Dr. Todd Igel, a Mayo Clinic urologist. "Many men with prostate cancer are appropriate candidates for this procedure versus the standard open procedure."

At Mayo Clinic, a standard radical prostatectomy is done through a 3- to 4-inch incision. With the robotic-assisted procedure, surgical instruments and a miniature camera Robots in the operating room held by robotic arms are inserted through much smaller incisions of less than an inch each. The surgeon sits in the operating room at a three-dimensional monitor and uses intuitive hand controls to guide the instruments and camera in the body.

With a smaller incision, men undergoing prostate surgery can expect to go home sooner and recover faster. Surgeons suggest robotic precision will translate into better preservation of the nerves and blood vessels around the prostate, which should lead to fewer incidences of incontinence and impotence. Other benefits of robot-assisted surgery are decreased blood loss, shorter hospital stays and recovery times and less scarring due to smaller incision sites.

"With robotic assistance, we're able to take laparoscopic surgery a big step forward," says Mayo urogynecologist Dr. Anita Chen. "We're able to visualize the procedure in three dimensions, and the robotic instruments duplicate the motion of our wrists."

Traditional laparoscopic versions of these procedures also are minimally invasive, but only offer a two-dimensional view and less range of motion. After her robotic-assisted surgery, one urogynecology patient — who asked that her name not be used — spent two nights in the hospital, about half the time she would have if the surgery had been done through an open incision.

Koeber had a prostatectomy in July and was out of the hospital two days later. By mid-September, he was feeling good enough to participate in his church's outreach mission to help the victims of Hurricane Katrina in Hattiesburg, Miss. or three days, he worked nine-hour shifts in 99-degree heat cutting trees with chain saws and lugging wood to curbs.

"They said the recovery time for this surgery is a lot faster," says Koeber. "I believe it. I was right back out there in no time."

Info:
Department of Medical and Surgical Gynecology
(904) 953-0612
Department of Urology
(904) 953-7330

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