What You Need to Know about Robotic Surgery

What You Need to Know about Robotic Surgery

by Enrique Ian S. Lorenzo, MD, DPBU, FPUA, FPCS, FPALES 

What is robotic surgery? Is it an operation on robots? Is it an operation done by robots? Or is it an operation done by a human surgeon who is as stiff as C-3PO (the Star Wars robot)? Fortunately, it is none of the above!

Technology has always been utilized to make our lives easier or to aid us to do things better. This is an exciting time as technology is rapidly evolving. What we only imagined and dreamed about before is now becoming reality. Robots, though, have been around since the 1970s being utilized in the machine industry or in space travel. Progress has led to the invention of smaller and smaller robots that have varied uses for different industries. It was only a matter of time that robots would find their way in the medical field.

Concomitantly, laparoscopic or “key-hole” surgery was also developing. The need for long and sometimes disfiguring incisions was avoided. Even major operations were later on performed through small incisions. Using specialized long instruments and a vision system, operations were performed through small holes as some would describe this as surgery with chopsticks.

However, unique challenges were encountered in laparoscopy especially in complex procedures. Hence, robot-assisted laparoscopy, otherwise known as robotic assisted surgery, was born.

The robot is utilized as a master-slave equipment. This means that it is under the full and sole control of the operating surgeon. It functions to maximize the surgeons’ capabilities and provides the surgeon a three-dimensional view inside the patient’s body at 10 times magnification.

Millimeter-sized blood vessels are clearly seen which could have been overlooked by the naked eye. The surgeon’s movements are filtered by the robot, eliminating unwanted natural tremors of the human hand. This translates to precise and purposeful movements. Despite the small sized instruments and precision movements, the robot still possesses robust strength. There is a unique balance in the gentle touch for fragile tissues and strong movements for tough tissues, all under the control of the surgeon. Moreover, all this can be achieved with just three 8-10mm wounds at the least.

What does all this mumbo-jumbo mean for patients? It means patients can be provided with a better operation. Vision is paramount in surgery. Having a 3D, magnified, “inside the patient” view facilitates the surgeon’s identification of important structures and oftentimes difficult to delineate borders of the target organ.

The precise movements allow the surgeon to manipulate only the structures that need to be touched. These translate to accurate dissection with less trauma to other structures and less bleeding. Less trauma and small incisions would mean less pain, shorter hospital stay, and faster return to normal activity. Small incisions would also result in more cosmetically acceptable scars oftentimes barely noticeable.

Is robotic surgery what you need? In the future, all cases for surgery will be done robotically. For now, it is mostly utilized for the most complex procedures in various fields like urology, gynecology, thoracic, head and neck and oral surgery, colorectal surgery and other abdominal surgeries. In urology, robotic surgery is the leading treatment modality for prostate cancer in the world. It obviates the difficulties associated with the location of the prostate deep in the pelvis and it being surrounded by sensitive structures.

Many prostate cancer patients, including those with high risk disease, have been cured at The Medical City (TMC) through robotic surgery. Aggressive urinary bladder cancer will necessitate extensive removal of lymph nodes aside from the tedious task of removing the entire bladder. TMC robotics patients have successfully undergone this highly complex urologic procedure without even necessitating blood transfusions that are necessary in open type surgeries. Kidneys with cancer can be saved by excising only the diseased portion with the aid of the surgical robot. Many patients have benefited from robotic surgery even in other fields as it provides a better way of completing the most complex of tasks.

The Medical City way. The Medical City prides itself with acquiring the first surgical robot in the country way back in 2010 and acquiring its second robot this year. Teams of surgeons trained and skilled in robotics were formed in the various surgical specialties. Combining experience and excellent skills, the teams are prepared for the most complex of procedures. As the country’s leader in robotic surgery, various Philippine firsts were performed at TMC. These include the first robotic prostatectomy performed in June 2010, first robotic colorectal surgery in July 2010, first robotic sacrocolpopexy or gynecologic surgery in July 2011 and the first robotic radical cystectomy to treat bladder cancer in August 2014.

Keeping up to date with the latest techniques and research, the surgeons regularly attend and participate in international conferences. Complementing the new technology is the personalized care and the tenet that patients are partners in the management of their respective conditions.

For more information about The Medical City’s Robotics Surgery Program, you may call the Department of Surgery at 9881000 or 9887000 ext. 6288 or visit www.themedicalcity.com.