Intro: This is BayCare HealthChat. Another podcast from BayCare Health System.

Scott Webb (Host): Welcome to BayCare HealthChat. I'm Scott Webb, and I invite you to listen as we discuss surgical robots, like the DaVinci and ROSA robots and the many benefits to robotic assisted surgeries with Dr. Lourdes Pelaez-Echevarria. She's a Board Certified General Surgeon with BayCare. Doctor, thanks so much for your time today.

I know that robots in surgery are being used in almost every surgical specialty from general surgery to orthopedics. It's really cool. Everybody loves robots. So great to have you on. I want to have you start by just talking about the different kinds of robots that are used in surgery throughout BayCare.

Lourdes Pelaez-Echevarria, DO, FACOS (Guest): Right now we have multiple different robots throughout our hospitals and hospital system. The DaVinci is probably the most famous of all of them and that's near and dear to my heart because that's the one I use. The DaVinci has been around probably 20 years. And it's wonderful because it allows me to see things up to 40 times bigger than life. So imagine that, and I always like to tell my patients, have you seen the movie, Honey I Shrunk The Kids or Ant Man, you know, where everything is just huge. So, you know, as a surgeon, it's wonderful because I can see all these vessels and all of the anatomic structures in living color.

Beautiful, huge, enormous. I can, you know, avoid injuring things so easily because now they're like enormous. The DaVinci is one of the robots we have. There's also, the MAKO Rio, which is really a robotic arm and RIO stands for robotic arm, interactive orthopedics system, and that's for orthopedic knee and hip surgeries.

It combines CT imaging and it really looks at the CT image of the joint. And it personalizes the operative plan, depending on the patient's unique anatomy. So it guides, the surgeon's cuts and it makes it so that it's more precise to within a fraction of a millimeter. I mean, it makes it really very specific.

There's also a neurosurgery robot called the ROSA. And that's a robotic stereotactic assistance. And neurosurgeons use this to help guide complex neurosurgical procedures in a minimally invasive manner. You know, the brain, you don't have a lot of room for error in the brain when you're operating on a brain.

And I like to think of it like a GPS device for the brain, which is kind of cool, it provides the surgeon kind of a roadmap. You know, this is where we're going, and this is how we're going to get there. And this is how we're going to avoid all these vital structures getting there. And you know, this way they can reach that intended target, the tumor or whatever it is that the neurosurgeon's doing for that particular patient.

Host: Yeah. So this is really amazing Doctor. And I think maybe one of the misnomers for a lot of us, for us lay people, is that somehow the robots are actually doing the procedures, but just want to have you clarify, these are robotic-assisted procedures, the robots, as amazing as they are, they're not actually doing the surgery right?

Dr. Pelaez-Echevarria: That is absolutely correct. Yes. We are a long way from the sci-fi movies that we are seeing on the big screen. Okay. The robots are not doing the procedures. The robots are a tool. They are tools that help guide surgeons, that help the surgeons be better surgeons. You know, the robot makes me a better surgeon.

Why? Because I can see something 40 times bigger than life. It does other things too, which also helps. The human hand has a certain number of degrees of articulation, the robot articulates further much further than my hand. I mean, if you think about your hand, you can only bend it backwards so far. Right?

Host: Yeah. And I'm bending my hand back right now and you’re right. I really can only go so far.

Dr. Pelaez-Echevarria: Well, the robot hand can go all the way backwards.



Dr. Pelaez-Echevarria: Like, imagine your fingers going all the way up against your elbow. The robot can do that. You can't. You know, little things like that, where you're in a corner, in a pelvis or something, and you got to kind of go around the corner around the bend there. The robot helps you get there.

Host: Yeah. So, many benefits. I mean, it's really amazing as you say, 40 times larger, right? I'm just trying to picture just how huge things would look to you and what a benefit that would be. So let's talk about the benefits. First, let's talk about the benefits to the patients in using these robots and the robotic assisted procedures, minimally invasive as they are instead of kind of old school, if you will, open surgeries.

Dr. Pelaez-Echevarria: Like you said it's minimally invasive, it's less invasive. So, the incisions are usually smaller. Now with abdominal surgery, which is one of the things that I do a lot of. We used to have to, you know, slice people open from stem to stern, you know, from xiphoid to the pubes. And what really hurts when we do surgery, is the skin incision.

The inside doesn't really hurt. That is not where the pain receptors are. Your pain receptors are on your skin. So, if our skin incisions are smaller, there's less pain. So, smaller incisions and less invasive is, you know, certainly one of the benefits to the patient. If there's less pain, there's faster return to activity, which means people get back to their regular life faster.

You know, and I already talked about how the robot is more accurate and more precise, particularly with things like the neurosurgery and, you know, when things are blown up bigger than life, it makes me more precise. Since I can be more precise then I lose less blood. If I lose less blood, that's always better for the patient.

Host: Yeah. And for the surgeon as well, I would imagine. Yeah. So you're talking about less pain, faster recovery. I'm assuming smaller scars as well.

Dr. Pelaez-Echevarria: Absolutely. Yes.

Host: A lot of great benefits to the patient, the surgeons. How about the operating room staff and surgical assistants, like just kind of take us inside the room. What's the flow like with the robots and robotic assisted procedures and how does everybody do their jobs?

Dr. Pelaez-Echevarria: Well, in the old days, when we did laparoscopic surgery, the assistants, it was like playing twister. Really, it was, it was like playing twister, the poor assistants, they had to like, you know, lean over, kind of bend over backwards. At the end of the case, the poor assistant was just wiped. They were wiped out because the strange positions they had to stand in to assist the surgeon in doing their job. Now, you know, the robot holds the camera and assists and holds retractors and things like that. So the staff is really, much happier because now they go home and their back isn't aching.

Host: Right. Yeah. For any of us who've ever played twister, we know exactly what you mean. It was always fun, but it's exhausting, right?

Dr. Pelaez-Echevarria: Especially when you've got somebody that decides they want to go from one end of the board all the way over to the other and jump over people just to make it difficult.

Host: Yeah.. Always, there was always that one who always just had to make on the rest of us and, you know, Doctor, I know that every patient is different, right? So, there are many surgeries that are done with robots, but certainly not all. Open surgery is still maybe the gold standard in many cases. How do surgeons, how do you in particular, how do you recommend which procedure is best for a patient? I'm sure it's done on a case by case basis, but maybe just take us through that as well.

Dr. Pelaez-Echevarria: Sure. Well, I've been a surgeon for over 20 years, so I've seen a lot, done a lot. And the robot is certainly not for every patient. It is really a case by case basis. There are procedures that are just not to be done with the robot. They just aren't for the robot. There are patients that just won't benefit from the robot. And so it really should be up to the surgeon's expertise, and their opinion as to which case should be done robotically. And which one should not be done robotically.

Host: Yeah, I'm sure any patient who has the option, you know, as we've discussed the benefits today, plus it's just robots are undeniably cool. Plus all the benefits we discussed. So I'm sure anyone who's eligible for robotic surgery or robotic assisted procedure would love that. But as you say, case by case, surgeon makes their best recommendations, which is great to know.

And as we wrap up, and this has been really educational and fun, talking about twister and robots and all of that, as we wrap up Doctor, what are your takeaways? What do you want people to know about robotic surgery, robotic assisted procedures, the different options available and basically what's available to them at BayCare?

Dr. Pelaez-Echevarria: Robotic surgery is here to stay. It is a wonderful tool in the operating room. It makes your surgeon better. And it is not for everyone. We can do some really cool things with robots which help patients and get them back to their regular life much faster. And if robotic surgery is something that your surgeon recommends, then you know, that is definitely the way to go compared to the old way of doing surgery. But again, it is not for everyone and, you know, not every patient should have a robotic surgery.

Host: Yeah, that's good to know. And great advice from an expert and maybe there will come a day as you say where the robots, you know, R2D2 is actually doing the surgery. But for right now, we still need the surgeons like yourself, 40 times larger, you know, the DaVinci is just, it's just all really amazing. And I just love science and medicine and technology. It's just the best. So Doctor, thanks so much for your time today and you stay well.

Dr. Pelaez-Echevarria: Thank you.

Host: For more information go to BayCare.org. And that wraps up this episode of BayCare Health Chat. Always remember to subscribe, rate and review this podcast and all of the other BayCare podcasts. So we can share the wealth of information from our experts together. I'm Scott Webb. Stay well.