Transcription:
Advanced Robotics for Colorectal Surgery

Melanie Cole (Host): Welcome to Better Edge, a Northwestern Medicine podcast for physicians. Joining me to discuss advanced robotics for colorectal surgery is Dr. Vitaliy Poylin. He's an associate professor of gastrointestinal surgery at Northwestern Medicine. Dr. Poylin, it's a pleasure to have you join us today. This is an exciting topic, and I feel that it's such an exciting time to be in your field. Can you tell us a little bit about robotics? Give us a little background on how it's being used and specifically in GI and colorectal issues, how has this changed the landscape of what you do for a living?

Dr Vitaliy Poylin: Oh, absolutely. Thank you very much, first of all, for having me over. It is actually very exciting, time in, colorectal and minimally invasive surgery overall, to some degree, robotic surgery is kind of a natural, progression in technology. We went from, open surgery to laparoscopic surgery and now to more of a robotic field with an extended, abilities, what we can do, without making, a big incision.

And some of it it's kind of ended up being a combination of what technology is allowing us to do, step by step and year by year, as well as our experience with it. And one of the things that is, kind of interesting and exciting is that, in a lot of ways, we are still learning and figuring out and pushing the frontiers of what we can do with this technology.

So that means we are actually learning from each other, about what we can do with this. So, the colleagues of mine and I, welook at each other's videos, from these procedures and kind of figure out, oh yeah, look at that. That's interesting, but I do it this way. And then we, together, end up moving things, forward. And I think to the benefit of a lot of patients.

Melanie Cole (Host): That's amazing. And I love that you shared that because it really does show how these things advance the field of medicine and how you're all working together just to do that. So what are some of the exciting advancements, tell us about the robots that you're using, and what's changed with those in the last 10 years or so?

Dr Vitaliy Poylin: Absolutely. So, here in Northwestern, we actually have a number of intuitive XI machines. This is, pretty much our go to for most of the procedures. And in the past few years, some, our technological advances such as, for example, a Firefly technology, which allows us to evaluate, for example, blood supply, for me in colorectal. Or visualization of billary tree for my colleagues in [ naudible]i in general surgery.

And, also some things in, for example, lymph nodes for colleagues in gynecology. That actually allows kind of a better visualization. Better versatility of that machine also allows, us to reach the areas that otherwise would've required, repositioning of a patient repositioning of a machine much longer time can now be done, smoothly and without interruption and prolongation of a case.

Another exciting thing is we do have a single port, robot that, I, and some of my colleagues in other fields have been using. In some ways it's, kind of a throw back to what we have done about, seven, eight years ago with laparoscopic surgery when we're trying to really inimize. The number of incisions to do everything through a single port. Robot does allow us for, selected procedures to really push it and make it easier.

The reason, for example, the single port laparoscopic surgery went away was because it was doable. And a lot of patients liked it, but it was actually quite challenging technically and a consensus in the field overall, was, well, additional couple of ports. They don't hurt patients that much. They don't add that much to the pain and morbidity and other things, but it makes it so much easier and faster.

Now, come in the single port, robotic machine and we can actually now go back and say, okay, well, can we still do it now and actually make it easier and faster and better for a patient. And once again, we are still figuring out, what we can do and how we can do things, but so far, the answer is, yeah, it seems to be, we are still early in that process, but it is actually quite exciting.

Melanie Cole (Host): Well, it certainly is ever evolving. Now, specifically, what would you like to tell other providers about some of the exciting things that you're doing there at Northwestern? If they wanna refer their patients, what specific surgical uses are you seeing this biggest benefits for?

Dr Vitaliy Poylin: I think for a couple of areas, what I would like to highlight, going back to learning from your friends and colleagues in the field. And especially this availability of some of this technology, that, for example, allowed me to do a lot of procedures almost fully intraporally. So, as we of learn from each other and then technology allowed us, for example, for a lot of benign collarectal disease.

Such as, diverticulitis and polyps and things like that. Nowadays I do a whole procedure intracaporally. I oftentimes will do a Transrectal extraction. So the patient wakes up with just a couple of eight millimeter ports, and you can tell the difference, with, even somewhat of a bigger incisions with. Pain tends to be ever so slightly bigger and more, and that oftentimes end up translating into longest day and some discomfort.

I can tell you what a lot of the folks in whom I can do this, they're kind of ready to go home the next day. Even though if, you look at they're abdomen, you add up the size of all incisions. It's not that different, but they feel different. And that's, actually been quite a big plus, for me. In addition, for some other, procedures, for example, for right colons and for rectal cancer.

Again, just being able to do this combined in, more and more intracaporally does decreased the folks mobility. We can do things fast so we can get them home. In a better shape and fast and get them up, and running. And another thing, what I think it's really what distinguishes us and, separates us from many other places is that it's Not just me, for example, who do this cases, it's my colleagues and, especially my colleagues in other fields.

So we do a lot of combined robotic cases with urology, with, gynecology, with surgical oncology and hepatobiliary surgery. So that in end, we've done combined cases with thoracic. So it allows us to do a very big and quite complex cases with, small, incisions and get patients again, through, with much less morbidity when compared to what we would, otherwise.

And if anything, we are just continuing, to portion doing kind of a bigger and bigger procedure was oftentimes more than a couple of services, involved. now we're starting to involve, for example, doing some of a flaps with utilizing some of our robotic technology and things like that. That's actually very exciting and we have found a significant benefit to patients as far as their complications as well as much, much quicker recovery.

Melanie Cole (Host): Dr. Poylin, as you're telling us about the benefits, obviously to the patient and even to the surgeon, what are the learning curves involved in using these robots? Because this is high technology. Do you have some technical considerations for providers that are not as familiar with this type of advanced robotic technology? How much does the experience of the surgeon matter in this case? And especially, you mentioned working with all of these other disciplines and combining all of your skills. Tell us about technical considerations.

Dr Vitaliy Poylin: I think, one very important points that I make sure to make, to all of my residents and, oftentimes sound like a broken record is that at the end of a day, this is a tool. It's an instrument and we use it to get a job done. And at the end of the day, if I need to get somebody's rectal cancer out, I need to get a rectal cancer out. And if I can use, a cool thing like a robot, that's wonderful, but at the end of a day, my goal is not to use a robot.

My goal is to take care of patients cancer, and this is very important to keep in mind because it very exciting and, people get caught in that. Now, going back to, residents, pretty much all of our machines have a dual console, which actually does make it easier for us to teach each other, we have done this to each other. We'll come over to our colleagues and I'll go over folks, come to me and then we'll say, Hey, can you help me do this case?

And then we would sit together in a room and can make it actually very easy to point like, oh, you go here, you go there. And it's all on the screen. And you can go back and forth, and very easily proctor people and do that. The Training modules that, machines have, are actually quite useful in, I would probably make an argument more useful than the old fashioned laparoscopic lab that we had in getting people ready.

I think what's interesting about this technology is that. It is much more intuitive compared to straight sticks that we had before. You have a risk motion. You have better visualization. You have a better control in laparoscopic stuff, I have to control my instruments and I have to control my residence instruments and so on and so forth. This one you are kind of in charge all the way.

So some of the folks who trained me in my fellowship, some of them ended up going straight from the open procedures, straight to robotics, skipping laparoscopic all together. But having said that, it does take time. it does take some adjusting to a machine and adjusting of how you're going to do things. And from that standpoint, when I Proctor my colleagues, what I want them to do, I would, obviously would love to see everybody getting through every case every single time.

But I don't get to do it myself necessarily, because again, it's an instrument. It's not a way of life. And, oftentimes what I will do is it's like, let's set up the goals. We will do step by step and then ended up putting things Together. So finally, as they get used to things, get, figure out what their abilities are, then they can get through the case, efficiently and safely. But the advantage of a place like ours is that there is a lot of help. There is always somebody who can come in and help you get through that.

Melanie Cole (Host): This is such an interesting podcast. You're such a great educator, Dr. Poylin, as we wrap up, do you have some areas of clinical and research focus you'd like other provider to know about? And I'd like you to also let referring physicians know that the expertise at Northwestern Medicine specialists using this advanced robotic technology and why referral is so important.

Dr Vitaliy Poylin: My interest in kind of from both clinical, as well as, research standpoint are in quality improvement and improving in workflow. I consider myself, Realist and more of a practical person. So, I concentrate on, optimization of, workflow. I have a grant actually from, American Society of Colorectal Surgery in improving the flow of Robotic surgical cases.

Specifically looking at interruptions and as a first step in trying to figure out how do we intervene and how do we make it better? Other things include just outcomes in more complex, oftentimes stage four, this multi visceral, resections especially utilizing the robotic technology and how can we, optimize it for a better, patient outcome, but as well as for purposes of educating colleagues and residents,

Melanie Cole (Host): So important. And like I said, what an exciting time to be in your field. Thank you, Dr. Poylin for joining us today and sharing your incredible expertise in this area to refer your patient for advanced robotics for colorectal surgery, or for more information, please visit our website atbreakthroughsforphysiciansd.nm.org/gastro to get connected with one of our providers. That concludes this episode of Better Edge, a Northwestern Medicine podcast for physicians. I'm Melanie Cole.