Imagine your doctor telling you that you can have a major surgical procedure without ever stepping foot in a hospital. And because your surgery will be performed with the help of a robot, your recovery time will be weeks shorter and far less painful compared with traditional surgical procedures.
This is the type of conversation my colleagues and I are now routinely having with our patients at the Mid-Atlantic Permanente Medical Group. Last year, we invested in the state-of-the-art DaVinci Xi Robotic Surgery System. We use this sophisticated technology at the Kaiser Permanente Largo Ambulatory Surgery Center – an advanced outpatient surgical suite where patients go home either the same day as their procedure or the very next day. Patients from all over the region, including Northern Virginia, go to the Largo Ambulatory Surgery Center for their procedures.
Robotic surgery systems allow laparoscopic surgery to be done with enhanced precision, broadening the scope of minimally invasive surgery to include procedures that otherwise would need to be done with an open incision. Robotic instruments have a greater range of motion when compared to traditional laparoscopic “straight stick” tools, allowing fine dissection in tight spaces. The robot gives surgeons a steady hand, with the doctor’s natural tremors filtered out by the sophisticated software. The system features an advanced set of instruments and provides us with a 3D, high-definition, magnified view of the surgical area.
The robotic surgery system has three parts:
• The surgeon console where the surgeon sits to control the instruments
• The patient cart that is the heart of the robotic system. It includes the camera and instruments attached to up to four robotic arms that the surgeon controls from the surgeon console.
• The vision cart, with sophisticated computer systems and a video screen that enable the surgeons’ assistants to provide real-time support to the surgeon
All of the surgeons who use the system have undergone intensive training. Surgeons start with online training modules and then do simulations–similar to playing a video game–to fine tune skills. Once surgeons master their techniques on the simulations, they must complete comprehensive hands-on training including a cadaver lab to become familiar with the system. Only when this is complete do they perform procedures on patients, with an experienced proctor as a guide for the first set of cases. Robotic surgery has become so widespread that many surgeons in the residency stage of their medical training now have this instruction built into their curriculum.
At all times, the surgeon is in complete control of the robot and makes all decisions. In the rare case of a robotic malfunction, the surgeon steps in and can complete the work laparoscopically.
Benefits of Robotic Surgery
The U.S. Food and Drug Administration in 2000 approved the da Vinci system to perform certain general surgical procedures, such as gallbladder removal and anti-reflux surgery. Since then, the FDA has cleared the da Vinci robot to perform more procedures.
We are proud that the Largo Medical Center is the first civilian ambulatory surgery center in the region to use the robotic surgical system. At the Largo Ambulatory Surgery Center, surgeons use robotic surgery (also known as robot-assisted surgery) to treat prostate cancer, complicated hernias, uterine prolapse, endometrial cancer, kidney cancer, and many other conditions.
There are several great benefits to eligible patients, including the chance to avoid the hospital. Many patients are worried about going to hospitals during the COVID-19 pandemic; they can take comfort in knowing they can have their procedure done at an outpatient surgical center.
Because surgeons make only tiny incisions with the robot, patients experience less bleeding, less scarring, decreased post-operative pain, and a shorter recovery time as compared with more invasive procedures. (It is true that many robot-assisted procedures take slightly longer than with other approaches, but patients rarely mind when they learn that recovery time is dramatically shorter and they can return to their regular activities sooner.) Patients who have robotic procedures also have a lower risk of post-operative infections.
I recently had a patient who had a hiatal hernia–a condition in which part of the stomach bulges up through the diagram into the chest. We were able to repair her hernia using the robot. After the procedure, she was quite comfortable with over-the-counter pain medicine and didn’t need any narcotics for pain.
I have performed abdominal wall reconstruction procedures both using open, traditional surgical methods and using the robot. Patients who have undergone open surgery require a big incision. They are in significant pain following the procedure, spend about three to five days in the hospital, and need about six to eight weeks to recover. In contrast, patients who have robotic surgery have tiny incisions and usually are discharged the same day. They report less pain and need about three to four weeks to recover–half the recovery time as those who had the open surgery.
Urologic surgeons also use the robot to perform prostatectomies, a procedure to remove the prostate usually as the result of prostate cancer. After removing the prostate, the surgeon reconnects the bladder and urinary tract. Patients who have had more traditional open prostatectomies experience significant pain, spend several days in the hospital recovering, and have an increased risk of blood clots and erectile dysfunction after the procedure. With robotic surgery they can have their procedure in our outpatient center, often go home the same day, and their risk of complications is reduced.
More examples of how we’re using the robot at our ambulatory surgery center:
• General surgeons use the robot to perform Heller myotomy, a surgical procedure to treat achalasia, a swallowing disorder.
• Urologic surgeons perform radical nephrectomies, a procedure to remove the entire kidney.
• Obstetrician-gynecologists and urogynecologists use the robot to perform hysterectomies, a procedure to remove the uterus.
As surgeons, we love the increased precision afforded to us by the robot. We love how the tools can maneuver around tight spaces in the body. We are excited to use robotic-assisted surgery, especially in the outpatient surgery center, because our patients truly benefit from shorter recovery times, less pain and fewer complications. If you are scheduled to have a surgical procedure, talk to your physician about whether robotic surgery could be an option for you.
Rahul Tevar, MD FACS, is a board-certified surgeon with the Mid-Atlantic Permanente Medical Group and is Medical Director of the Washington, D.C./ Suburban Maryland Ambulatory Surgery Centers. He sees patients at the Kaiser Permanente Largo and Gaithersburg medical centers.
For more stories like this, subscribe to our Health newsletter.