Frequently Asked Questions about Robotic-Assisted Surgery
What is considered "traditional open surgery"?
Originally all surgery was performed as "open" surgery. Open traditional surgery involves an incision, often quite large, at the site where tissue or organs need repair, treatment or removal. The large incision requires time to heal because superficial tissue, muscle and fascia have been cut through.
A large incision can result in blood loss during surgery and require a blood transfusion. Nearly all open surgeries require a hospital stay of several days and strong pain medication to control discomfort. Once home, a patient's recovery usually means six to eight weeks without strenuous activity or lifting more than 15 pounds. Complications such as infection or improper healing and scarring can require a subsequent surgery to repair.
What is laparoscopic surgery and how does it differ from open surgery?
In the 1980s, surgeons began performing laparoscopic surgery, sometimes referred to as "keyhole" surgery. A needle is inserted into the body and the area inflated with gas, typically carbon dioxide. Small half-inch incisions are made and access portals ("ports") are placed in the body. A camera is inserted in one port to look inside the body. The camera is connected to a monitor that displays the body's interior to the surgeon and the surgical team. Surgical tools on long thin instruments are placed inside the body through the ports and surgery is performed.
Laparoscopic surgery was the first available form of "minimally invasive" surgery and is still frequently performed today. Laparoscopy results in smaller incisions, less blood loss, lower risk of transfusion, a shorter hospital stay, the need for less pain medication and a quicker recovery. Laparoscopy is used for many types of surgery, including urology, general surgery, colorectal, gynecologic, cardiothoracic and orthopedic.
What is robotic surgery?
Robotic surgery is the most recent and innovative surgical technique and became available in the late 1990s. Building on the techniques for laparoscopic surgery, the surgical tools inserted into the patient through the ports are connected to robotic arms rather than held by the surgeon. The robotic arms, however, are fully controlled by the surgeon. The level of surgical precision in robotic surgery is unsurpassed, and there are numerous other advantages as well. The robotic platform available at Inova hospitals is the da Vinci Surgical System.
What are the benefits of robotic surgery?
The advantages of robotic surgery for the patient are significant and may include:
- Shorter hospital stay
- Less blood loss
- Fewer complications
- Less need for narcotic pain medicine
- Faster recovery
- Smaller incisions resulting in minimal scarring
The small incisions made to allow access for the surgical tools and camera mean less blood loss, lower risk of blood transfusion and infection, a shorter hospital stay, decreased need for pain medication and a quicker recovery and return to normal function.
Patients also benefit from the high-tech nature of the equipment. The robotic camera provides ten-fold magnification and three-dimensional vision rather than the two-dimensional vision of a laparoscope. The robotic arms move with incredible precision, moving in, out and with a wrist-like turning motion of 360 degrees. Human tremor is filtered out completely. The surgeon and surgical team work from a comfortable, ergonomic position, resulting in less fatigue during long complex cases.
Who is on the surgical team for robotic surgery?
The surgeon sits at a specialized control center known has a console where he or she controls the camera, robotic arms and other equipment. An assistant sits at the patient's bedside and uses laparoscopic tools through ports to provide suction, change robotic tools, make adjustments to the robotic arms as needed, and to introduce stitches.
A Circulating Nurse will make preparations for the procedure and continually monitor the patient and surgical team during its course. This registered nurse also records the progress of the operation, accounts for the instruments, and handles the specimens throughout the procedure.
A scrub technician sits on the other side of the patient to provide tools and sutures and to make adjustments to the robotic arms. The anesthesiologist remains at the patient's head, providing anesthesia and monitoring the patient's heart and lungs.
Is everyone a candidate for robotic surgery?
Robotic surgery is appropriate for many different types of conditions, including cancer and non-cancerous procedures, and is available for adults and for children.
There are instances when patients may not be able to continue with a robotic surgery. Some people cannot tolerate the inflating of the abdominal area with carbon dioxide. This is most common in smokers who already have higher levels of carbon dioxide in the blood. If it's not possible to safely provide enough oxygen to the body, the robot would be removed and an open incision made to complete the surgery.
Body positioning can also occasionally be an issue. A patient may be tilted on the operating table so that organs naturally shift away from the surgical site, allowing the surgeon better access. If this position makes it difficult to provide oxygen at a safe pressure to the lungs, sometimes an issue with overweight patients, the robot would be removed and an open incision made to complete the surgery.
What are potential complications to robotic surgery?
Any surgical procedure has inherent risks such as infection, bleeding, blood transfusion, need for repeat surgery, recurrence of disease and complications of general anesthesia.
Complications resulting from robotic surgery are rare but can still occur. You should be aware of these potential issues so that you can make an informed decisions about your surgery.
A patient's position during surgery, referenced in the question above, can result in some additional risks. Known as the "Trendelenburg position," the patient is positioned so the head tilts toward the floor and the feet toward the ceiling. This position can cause temporary swelling of the face since the head is lower than the rest of the body. Patients may be more prone to rub their eyes while waking up and (rarely) can scratch the outer surface of the eye. precautions are taken to protect the eyes for this reason.
Lying in one position for a long surgery can also cause neurologic symptoms such as numbness, tingling, weakness or pain in the arms, legs or joints. This is usually temporary but rarely may require further consultation or treatment. Let your physician know if you have any arm, leg, joint or back problems or prior surgeries so we can take extra precautions when positioning you.
Robotic surgery can result in injury to the intestines, blood vessels or surrounding organs. Very rarely a serious injury can occur and the procedure is immediately converted to an open surgery to repair the damage.
After a long surgery, sometimes the patient needs to stay on the ventilator (breathing machine) overnight. Rarely, prolonged ventilation or pneumonia ensues. Also rare are cardiovascular events like heart attack, stroke and even death.
What is Inova's experience with the da Vinci® Surgical System?
In 2001, Inova pioneered the da Vinci robotic-assisted surgery in the Washington, DC, metro area. Now we offer the newest da Vinci model – the Xi – featuring 3D vision for superior physician depth perception and visualization. Our commitment to offering the most innovative, patient-focused treatments is demonstrated by our continuously high patient satisfaction scores. Inova's experience (and expertise) creates the best possible surgical experience for you.