What Is Robotic Surgery?
Robotic Surgery provides surgeons with an alternative to both traditional open surgery and conventional laparoscopy, putting surgeons’ hands at the controls of a state-of-the-art robotic platform.
The objective of using ROBOTS in medicine is to:
Surgeons with the assistance of Robotics are now able to perform even the most complex and delicate procedures through very small incisions with unmatched precision. Robots are presently used for prostate surgery, for hysterectomies, the removal of fibroids, joint replacements, open-heart surgery and kidney surgeries. They can also be used along with MRIs to provide organ biopsies.
However, development in Robotic surgery has been in progress for several decades:
1985
The PUMA 560 robot was used to place a needle for a brain biopsy using CT guidance. Three years later the same machine was used to perform a transurethral resection.
1987
Robotics was used in the first Laparoscopic surgery, a CHOLECYSTECTOMY.
1988
The PROBOT, developed at Imperial College London, was used to perform PROSTATIC SURGERY.
1992
The ROBODOC from Integrated Surgical Systems was introduced to mill out precise fittings in the FEMUR for HIP REPLACEMENT.
Further development of robotic systems was carried out by Computer Motion with the AESOP and ZEUS Robotic Surgical Systems
Intuitive Surgical Inc. introduces the da Vinci Surgical System.
The "da Vinci" and "Zeus" systems are similar in their capabilities but different in their approaches to robotic surgery. Both systems are comprehensive master-slave surgical robots with multiple arms operated remotely from a console with video assisted visualization and computer enhancement.
Our surgeons at Salus employ the "da Vinci Robotic Surgical System".
ABOUT THE DA VINCI ROBOTIC SURGICAL SYSTEM
In 1995, a physician with a eager business sense saw the commercial value of the emerging robotic technology.
Frederic H. Moll, MD, acquired the license for the TELEPRESENCE ROBOTIC SURGICAL SYSTEM pioneered by the NASA-SRI team and proceeded to develop a master-slave telepresence robotic surgical system they named daVinci®.
Leonardo da Vinci invented the first robot using anatomical accuracy and three-dimensional details to bring his works to life - attributes associated with the robotic surgical system named after the artist and inventor.
The da Vinci Robotic System is intended to assist in the control of several endoscopic instruments, including rigid endoscopes, blunt and sharp dissectors, scissors, scalpels, and forceps. The system is also able to manipulate tissue by grasping, cutting, dissecting and suturing.
The da Vinci system consists of three components:
THE VISION SYSTEM
The vision system includes the endoscope, the cameras, and other equipment to produce a 3D image of the operating field. By viewing a high-definition 3-D image on the console, the surgeon is able to see the surgical procedure better than ever before, which magnifies the surgical field up to 15 times.
THE PATIENT-SIDE CART
The patient-side cart has three robotic arms and an optional fourth arm. One arm holds the endoscope, while the other arms hold interchangeable surgical instruments.
The da Vinci system uses EndoWrist surgical instruments, which
THE SURGEON CONSOLE
When in use, a surgeon sits at a console ("Surgeon's Console") several feet away from the operating table and manipulates the robot's surgical instruments. The robot has three hands attached to a free-standing cart. One arm holds a camera (endoscope) that has been passed into the patient through small openings. The surgeon operates the other two hands by inserting fingers into rings.
The arms use a technology called EndoWrist--flexible wrists that surgeons can bend and twist like human wrists, mimicking human hand and wrist movements
The surgeon uses hand movements and foot pedals to control the camera, adjust focus, and reposition the robotic arms. Another surgeon stays beside the patient, adjusting the camera and instruments if needed.
Many conditions which impact your well being can be treated with ROBOTIC LAPAROSCOPIC SURGERY, including:
GENERAL SURGERY
GYNECOLOGY
UROLOGY
THE PROCEDURE
ROBOTIC LAPAROSCOPIC SURGERY is performed under general anesthesia.
During robot-assisted surgery, a highly trained surgeon operates up to four robotic arms that remain under his or her complete control at all times.
The da Vinci® Surgical System enables surgeons to perform operations in a very similar manner to traditional laparoscopically through a few small incisions, instead of a large open incision. The surgical approach involves using multiple trocars (thin tubes) placed through 3 to 5 small incisions. These incisions are usually less than 0.5 cm (less than ¼ inch).
Carbon dioxide gas is then used to slowly inflate the abdomen and an endoscope – a thin tube with a tiny camera and light at the end is sent through one of the trocars. The camera sends images to a video monitor in the operating room to guide doctors during surgery. Specialized instruments are placed through the other trocars to perform the operation.
The skin is then closed normally using absorbable sutures.
The procedure typically takes an hour and a half to perform.
Hospital stay has shortened to 1-2 days for ROBOTIC LAPAROSCOPIC SURGERY, compared to 3-5 days for the traditional open operation.
The Surgical System integrates 3D HD endoscopy and state-of-the-art robotic technology to virtually extend the surgeon’s eyes and hands into the surgical field. As a result, da Vinci enables your surgeon to operate with enhanced vision, precision and control through:
Advantages for undergoing ROBOTIC LAPAROSCOPIC SURGERY include:
PREPARATION FOR SURGERY
Before traveling to Cyprus, as part of your surgery preparation you will complete a detailed specific questionnaire, which will allow our doctors to determine your eligibility for ROBOTIC LAPAROSCOPIC SURGERY.
Ten days prior to your arrival in Cyprus, you will receive all the necessary pre operative instructions, to prepare yourself both physically and mentally for your chosen procedure.
Before your departure your records will be reviewed thoroughly by our surgeon. This includes X-rays and a complete medical and surgical history as well as your specific issues. In addition, you may be asked to consult with a physical therapist to discuss recovery, hip rehabilitation and important precautions you must take postoperatively. The physical therapist may even give you exercises you can begin prior to your surgery in order to aid with recovery.
After traveling to Cyprus, a new set of X-rays will be taken as well as an in person physical examination. The surgeon and anesthetist will also go through you medical and surgical issues with you. During this visit, your surgeon will discuss your Laparoscopic Gynecological procedure and answer any questions.
Getting your house ready before your surgery
It is also important to get your house ready for after you come home from the hospital. At first it will be harder for you to move around, so arrange your furniture and household items ahead of time to make it easier for you during your rehabilitation.
Preparation for the hospital
Here are a few things to keep in mind as you pack and prepare for the hospital and recuperation:
Clothing
Getting dressed in the morning helps you feel better, so be sure to bring some comfortable clothing to the hospital:
Day before surgery
You may need to do a bowel prep to clean the stool out of your colon. Your doctor or nurse will give you more instructions based on the type of prep. You should not eat or drink anything after midnight the evening before your surgery.
Morning of surgery
Bring all your medicines in their original containers with you to the hospital. You will meet with the anesthesiologist. This doctor will talk to you about general anesthesia. This is a controlled sleep while the surgery is being done so you will not feel any pain or remember the surgery. You will have an IV or intravenous line put in to give you fluid and medicine during your surgery. When it is time for you to go to surgery, your family will be asked to wait in the waiting area. Your doctor will talk to your family there after your surgery is done.
Recovery after surgery
When you wake up after your surgery, you will be in the recovery room. You will stay there until you are awake and your pain is under control. Most patients return to their room after a few hours.
You will receive oxygen through a thin tube called a nasal cannula that rests below your nose. A nurse will be monitoring your body temperature, pulse, blood pressure, and oxygen levels.
You will have an analgesia pump device to deliver pain medication into your IV or epidural space (in your spine). You will also have compression boots on your lower legs to help your circulation. They will be taken off when you are able to walk. You will also have 1 or 2 drains in your lower abdomen to drain extra liquid from the area. Most of the time, the drains are removed after a few days. If you will go home with a drain, your nurse will show you how to care for it.
Hospital dischareg and home instructions
Your diet is slowly increased from ice chips to liquids to solid foods as your intestines start functioning.
Before leaving the hospital, our surgeon and staff will help you adjust to recovery in every way possible. You will receive specific instructions and precautions from your surgeon and nursing staff and they will show you safe techniques of simple activities like getting in and out of bed, bathing, going to the bathroom, managing steps at home and getting in and out of a car.
You will be able to leave the hospital when you are:
Most people are able to go home on the day following their ROBOTIC LAPAROSCOPIC SURGERY.
LIFE AFTER SURGERY
These guidelines give you an overview of what you may expect as part of your care after you leave the hospital. Be sure to follow your doctor’s discharge instructions if they are different from what is listed here.
Your Activity
It is fairly common to feel weak and tired immediately after discharge from the hospital. The body needs time to recover from the stress of surgery.
It is common to feel a lump at the sites of the operation. This lump is a combination of normal fluid and scar tissue forming in this area. It usually goes away slowly over the first month or two following surgery.
Your bowel habits
You may have different bowel habits after your surgery. Loose stools are common for the first week or two after surgery. If you have watery diarrhea, call your surgeon. This may be a sign of a bowel infection. Severe constipation should be avoided. See the section below on medicines for constipation.
Your diet
There are generally no dietary restrictions following surgery. Avoid foods that cause diarrhea or digestive discomfort. You will eventually be able to resume your regular diet. A dietary supplement or drink can be used.
Medications
Your medicines: Take the medicines you were taking before surgery, unless your surgeon has made a change.
For pain
Your surgeon will order a prescription pain medicine for you after surgery. As your pain lessens, over the counter pain medicines such as acetaminophen or ibuprofen can be used. They can also be used instead of your prescription for mild pain.
For constipation
Prescription pain medicines can cause constipation. Your doctor may order a stool softener to prevent this. You should be back to your normal bowel routine in about 2 weeks. If the stool softener does not work, take Milk of Magnesia.
Call your surgeon right away if you have:
FOLLOW- UP
Follow-up after surgery is extremely important and our surgeons at Salus are committed to providing all the post surgical care you need. In order to identify and treat any complications as they may arise, close, lifetime follow-up is essential.
Risks
Serious complications may occur in any surgery, including da Vinci® Surgery, up to and including death. Individual surgical results may vary. Patients should talk to their doctor to decide if da Vinci Surgery is right for them. Patients and doctors should review all available information on non-surgical and surgical options in order to make an informed decision.