Surgical ‘robot’ improvement for patients
by The Press and Standard | October 11, 2018 5:00 pm
Last Updated: October 10, 2018 at 10:29 am
Less pain. Fewer drugs. Quicker recovery time. That’s what Colleton Medical Center’s new “robot” is offering patients who have to have certain types of surgery.
The daVinci machine, installed in August, is not really a robot, but more an advancement of minimally invasive surgery, said Dr. Laura Dacks, the first CMC surgeon trained on the device. “With laparoscopy, we have these long chopstick-looking tools,” she said. Sometimes if the ports were not in exactly the correct position, this would cause a lot of torque on the abdominal wall to make these tools work properly — which resulted in more soft tissue damage causing more post-operative pain.
The robot has two significant advantages over laparoscopy. While some of the tools themselves are similar, the robot arms operate with a “wrist,” meaning the tools can rotate almost 360 degrees, greatly increasing the flexibility of the surgeon’s reach and dexterity through the tiny incision ports, compared to the long straight chopstick instruments in general laparoscopic procedures that only provide limited motion.
The view that the surgeon has is also greatly improved. With laparoscopy, the surgeon’s view is with a flat-screen two-dimensional monitor. With the robot, the surgeon looks through a viewfinder on the console that offers a 3D view, allowing for better detailed visualization of the anatomy. “The camera is significantly better and the 3D view gives better depth perception,” Dacks said. “It was pretty amazing the first time I looked through the viewfinder.”
The better control and view help surgeries be more precise with less tissue damage, which is a big plus for the patient. In the two gallbladder surgeries she’s done so far, Dacks said the patients experienced less post-operative pain, needed fewer pain-killing drugs and recovered more quickly than with traditional laparoscopic surgery.
The misnomer is that people think the robot operates on its own. “It doesn’t. I’ve got complete control over the robot through the console,” she said. The console is a also big plus. “I can be at a laparoscopic case and be there several hours on my feet and feel wiped out at the end of the case because of all the maneuvering and positions my body has to be in throughout the case. With the robot and its ergonomic controls at the console, one of my first gallbladder surgeries was about two hours, and it was physically much less taxing on my body.”
Dacks sees the robot being most useful at Colleton Medical Center in gallbladder, hernia and colon surgeries, as well as hysterectomies. The machine was initially used for prostate surgeries because it enabled surgeons to avoid some of the nerve damage inherent with that procedure due to the 3D view and better visualization of the anatomy. In the past five or so years, it’s really gained popularity in other areas, she said.
Hernia surgery patients should see a big improvement in both post-surgery pain and down time, Dacks said. “The old-fashioned way of fixing a hernia is open, and you were down for six weeks with no heavy lifting. So if you were let’s say a construction worker, it was six weeks out of work. No pay, no nothing.” And so people often wait and keep putting surgery off because they can’t afford to be out of work for six weeks. Even with traditional laparoscopic hernia repairs, the use of tacks to hold the mesh in place at times caused an increase in post-operative pain and sometimes chronic pain. With the robot, the mesh can be secured with sutures, which decreases post-operative pain even more than with the laparoscopic method. “Particularly in this community, this is going to add a lot. Less pain, less time off work, getting people back to their normal lives more quickly may encourage patients to get their hernias fixed sooner,” Dacks said.
Surgeons do have to undergo additional training to learn how to use the daVinci equipment. “You already know how to do the surgery, you just have to get used to the different equipment,” she said. Then they are supervised by an expert robotic surgeon and do surgeries on their own before receiving full credentials at the hospital. Dr. Karl Stiegler, Dr. Drew Calcutt and the OB/GYN surgeon Dr. Angela Fisher are all working on completing their training.
The operating room staff has to be trained as well. “There are some changes for the certified scrub techs,” said OR Director Donna Kubik. “But when you’re in an OR environment, you train all the time, so they’re used to it.”
Better equipment may also be helpful in recruiting doctors. “It’s going to be good for us. In this rural area, sometimes it’s hard to recruit surgeons, so this will help because it’s what they’re trained on,” Kubik said.
“I’m just hoping we can take off with this program and start getting more patients who are interested in getting this kind of surgery. It’s really no different than laparoscopy. It’s basically the same thing, it’s just a different tool. But it’s a pretty cool tool,“ Dacks said. “We’ve really made a lot of advancements here at the hospital. We’re not just doing robotics. We’re doing more breast cases, where most of those cases were being sent to Summerville or Charleston. They’re from here and to have to go to a place that’s more foreign and not have their families as readily accessible, that can be significantly more stressful on the patient and their families. So being able to stay in their home town is a big plus.”
Add to that less pain, fewer drugs, faster recovery times and quicker surgeries, and it’s a win for the patients, their families and the surgeons.