Patients have more options than ever before when it comes to advanced surgical procedures and techniques offered in Butte County. As an organization dedicated to delivering innovative and cutting edge technology to the North State, Oroville Hospital's Robotic Institute is home to two leading minimally invasive surgical robots: the da Vinci® Xi and Si Robotic Surgery Systems.
Dr. Ravi Nagubandi, a general surgeon at Oroville Hospital, discusses the benefits of the da Vinci® Robot for surgery of many different kinds for patients and how the technology has changed the landscape of surgery for better outcomes.
The Advantages of Surgery Using the da Vinci® Robot
Featuring:
Ravi Nagubandi, MD
Ravi Nagubandi, MD received his medical degree from Osmania Medical College in India and completed a surgical residency at Montefiore Medical Center, New York Medical College. He also received advanced training in laparoscopic surgery from the University of California, San Francisco. He is board-certified in general surgery and is also a Fellow of the Royal College of Surgeons in Ireland and a Fellow of the American College of Surgeons. In addition, Dr. Nagubandi completed a hepato-pancreatico-biliary surgery research fellowship at Jewish Hospital at the University of Louisville, Kentucky. He is also a recipient of the Butte County fellowship in general surgery for robotic surgery training from Intuitive Surgical, Inc. and the Carol and Tom R. DeMeester Traveling Fellowship for the year 2014 awarded by the Society for Surgery of the Alimentary Tract. Dr. Nagubandi is an attending surgeon and serves as the director of robotic and minimally invasive surgery at Oroville Hospital. Transcription:
Melanie Cole (Host): Using minimally invasive robotic surgery to treat many different conditions has grown in recent years as an option for patients and it may reduce pain and recovery time. My guest today is Dr. Ravi Nagubandi. He’s the Director of Robotic Surgery at Oroville Hospital. Dr. Nagubandi tell us about the da Vinci Robot. How has it changed the landscape of surgery?
Ravi Nagubandi, MD, FRCS (I), FACS (Guest): The da Vinci robot is a specialized robotic platform where you could do minimally invasive surgery, in other words, using small incisions doing the same kind of surgery you could do with larger incisions. This has improved the benefits of the laparoscopic surgery or in other words, we call the traditional laparoscopic surgery where you use the instruments in your hand to achieve the same kind of operative procedure. Whereas using the robot allows you certain benefits. The robotic platform gave us the three-dimensional visualization as opposed to the two-dimensional visualization you achieve with the traditional laparoscopic surgery. At the same time, the freedom of using these specialized instruments in the manner of an open surgery. These instruments have special wrist like movements. They are highly specialized, and you can place sutures, stiches in other words or perform dissection in very difficult angles or corners of your body. So, overall, the benefits of small incisions and early recovery to the patient have improved and in certain situations where there is a possibility of conversion, what we call is a conversion to open surgery, in other words, you start with small incisions and where the difficulty or technical challenge is high; you might end up converting to an open surgery. In other words, placing a large incision. Those chances have reduced with the surgeon’s increased experience and higher training as the surgeon goes on in his career doing more and more of these procedures. And added to this, the benefit of this add Oroville hospital is that about six and a half years ago we did not have a robotic platform, not in Sacramento in Northern California perhaps except in Redding. So, Oroville hospital started this six and a half years ago and we are able to offer these services to a very wide area and offer wide range of procedures across various specialties including general surgery, gynecological surgery, colorectal surgery, and we are also opening up the urology services.
Melanie: So, you mentioned a little bit about the surgeon and training and experience. How long does it take to train for the da Vinci robot and tell us a little bit about some of the benefits, the increased benefits as far as if it’s a long surgery? How does it help you?
Dr. Nagunbandi: The typical initial training involves approximately 35 to 40 hours of it could be didactics and watching other surgeons doing the procedures and learning about the machine or the robot and the moves, how to control the robot safely and once we do the basic training and learning we go into the surgical headquarters, into the surgical being so far the market leader in only robotic platform that’s available. We go there and perform animal procedures just like the way we do in humans. And then we also do cadaver-based surgical procedures. So, once we have the appropriate training; we come to our individual hospitals and perform the initial few operations under the direct observation and guidance of a proctor so that the proctor’s role is to make sure that the surgeon, the new robotic surgeon is doing the appropriate procedure for the appropriate indication and in an appropriate way. Whether the surgeon is using the robot safely or not is the purview of the proctor. And I’m sorry what was the rest of the question?
Melanie: Just how does it help you with extra long surgeries, that sort of thing. Does it make it so that it’s a little bit – you know that you are not quite so fatigued.
Dr. Nagubandi: Yeah. Absolutely. In traditional laparoscopic or open surgery, the surgeon is standing and doing the procedure and particularly when we reach certain areas of – deep areas of the body and at certain awkward angles; we end up turning our bodies and perhaps twisting in certain ways to achieve that area dissection or suturing or whatnot. In the robotic platform, the surgeon is actually sitting at the console, very comfortably and moving the instruments like a pilot is using his hands on the controls in an airplane or in other words in a video game, somebody is sitting and moving the hand controls. So, it’s very comfortable on the surgeon and as you said, even in longer surgeries; it’s quite comfortable and puts less stress on your muscles and that definitely increases your ability to do more complex operations and overall, the surgeon’s wellbeing is also much better.
Melanie: What a great description Dr. Nagubandi to really help us understand it from the physician and the surgeon’s point of view. Speak about how this technique can also help spare nerves, delicate nerves that you do not want traumatized during some surgeries.
Dr. Nagubandi: Very good question. Let us say we are working in the deep pelvis, such as a rectal cancer, a rectal surgery and for the urologists, the prostate gland surgery where during the dissection we come very close to the pelvic nerves. Those nerves supply the sexual function and the bladder function of the body of the person and with the enhanced visualization and the ability to zoom in very close to the tissues and the three-dimensional visualization; it becomes a lot easier and more precise in finding these nerves and avoiding injury, thereby essentially the surgeon is able to preserve those functions to the patient. And also, there are other techniques used in the robotic surgery where the bowel or the intestinal blood supply can be checked before you connect the intestine back after removing this certain portion of the diseased intestine such as cancer or diverticulosis or diverticulitis affected colon for example. Once you remove that, you can check the perfusion or the blood supply to the intestines more confidently and connect it back, thereby it will reduce the chances of that new junction or the connection of the intestine falling apart due to poor blood supply. That’s called a Firefly Technique or fluorescence imaging and that’s a very good addition to the surgeon’s armamentarium to view good results to the patient’s outcomes.
Melanie: Wrap it up for us Dr. Nagubandi. It’s great information about the da Vinci robotic surgical system and really what it takes to learn it and the benefits to the patient and all of those conditions you mentioned that it can be used for. So, wrap it up for us with what you would like listeners to know, what you would like them to ask you if they have to have a procedure that might possibly be done by the robotic surgical system and about recovery times. So, kind of give them what you would like them to know.
Dr. Nagubandi: Well, thank you. We would like them to know that these operative procedures are now well-established, and the entire world is taking up to these procedures at a very fast pace and these are available in northern California in Butte County at Oroville Hospital and we are expanding our services so that they don’t have to travel long distances. For example, to Sacramento or to the Bay Area for achieving the same operative procedures and to obtain the same results. I would recommend to the patients or their physicians who are referring their patients to us or to any robotic surgeons to explore the possibilities and to sit with a doctor and discuss in detail what are the benefits, what are the pros and cons and for example, there is single site surgery for example when you are taking the gallbladder out, traditionally there are four incisions placed whereas in a single site surgery, you place one incision through the belly button and take the gallbladder out. This is possible with traditional laparoscopic surgery and many have done it, but with the robotic surgery it becomes much easier and even in the hands of somebody who hasn’t done hundreds of these procedures; robotic surgery makes it easier technically feasible. So, have a good discussion with your doctor and we are here to clarify any doubts and we welcome discussions. Explore the opportunities and options and then commit yourself for these procedures.
Melanie: Great information Dr. Nagubandi, thank you so much for sharing your expertise in this area and really giving us a great explanation of the da Vinci robot. Thank you again, for joining us. You’re listening to Growing Healthy Together a podcast by Oroville Hospital. For more information on the latest advances in medicine please visit www.orovillehospital.com, that’s www.orovillehospital.com. This is Melanie Cole. Thanks so much for listening.
Melanie Cole (Host): Using minimally invasive robotic surgery to treat many different conditions has grown in recent years as an option for patients and it may reduce pain and recovery time. My guest today is Dr. Ravi Nagubandi. He’s the Director of Robotic Surgery at Oroville Hospital. Dr. Nagubandi tell us about the da Vinci Robot. How has it changed the landscape of surgery?
Ravi Nagubandi, MD, FRCS (I), FACS (Guest): The da Vinci robot is a specialized robotic platform where you could do minimally invasive surgery, in other words, using small incisions doing the same kind of surgery you could do with larger incisions. This has improved the benefits of the laparoscopic surgery or in other words, we call the traditional laparoscopic surgery where you use the instruments in your hand to achieve the same kind of operative procedure. Whereas using the robot allows you certain benefits. The robotic platform gave us the three-dimensional visualization as opposed to the two-dimensional visualization you achieve with the traditional laparoscopic surgery. At the same time, the freedom of using these specialized instruments in the manner of an open surgery. These instruments have special wrist like movements. They are highly specialized, and you can place sutures, stiches in other words or perform dissection in very difficult angles or corners of your body. So, overall, the benefits of small incisions and early recovery to the patient have improved and in certain situations where there is a possibility of conversion, what we call is a conversion to open surgery, in other words, you start with small incisions and where the difficulty or technical challenge is high; you might end up converting to an open surgery. In other words, placing a large incision. Those chances have reduced with the surgeon’s increased experience and higher training as the surgeon goes on in his career doing more and more of these procedures. And added to this, the benefit of this add Oroville hospital is that about six and a half years ago we did not have a robotic platform, not in Sacramento in Northern California perhaps except in Redding. So, Oroville hospital started this six and a half years ago and we are able to offer these services to a very wide area and offer wide range of procedures across various specialties including general surgery, gynecological surgery, colorectal surgery, and we are also opening up the urology services.
Melanie: So, you mentioned a little bit about the surgeon and training and experience. How long does it take to train for the da Vinci robot and tell us a little bit about some of the benefits, the increased benefits as far as if it’s a long surgery? How does it help you?
Dr. Nagunbandi: The typical initial training involves approximately 35 to 40 hours of it could be didactics and watching other surgeons doing the procedures and learning about the machine or the robot and the moves, how to control the robot safely and once we do the basic training and learning we go into the surgical headquarters, into the surgical being so far the market leader in only robotic platform that’s available. We go there and perform animal procedures just like the way we do in humans. And then we also do cadaver-based surgical procedures. So, once we have the appropriate training; we come to our individual hospitals and perform the initial few operations under the direct observation and guidance of a proctor so that the proctor’s role is to make sure that the surgeon, the new robotic surgeon is doing the appropriate procedure for the appropriate indication and in an appropriate way. Whether the surgeon is using the robot safely or not is the purview of the proctor. And I’m sorry what was the rest of the question?
Melanie: Just how does it help you with extra long surgeries, that sort of thing. Does it make it so that it’s a little bit – you know that you are not quite so fatigued.
Dr. Nagubandi: Yeah. Absolutely. In traditional laparoscopic or open surgery, the surgeon is standing and doing the procedure and particularly when we reach certain areas of – deep areas of the body and at certain awkward angles; we end up turning our bodies and perhaps twisting in certain ways to achieve that area dissection or suturing or whatnot. In the robotic platform, the surgeon is actually sitting at the console, very comfortably and moving the instruments like a pilot is using his hands on the controls in an airplane or in other words in a video game, somebody is sitting and moving the hand controls. So, it’s very comfortable on the surgeon and as you said, even in longer surgeries; it’s quite comfortable and puts less stress on your muscles and that definitely increases your ability to do more complex operations and overall, the surgeon’s wellbeing is also much better.
Melanie: What a great description Dr. Nagubandi to really help us understand it from the physician and the surgeon’s point of view. Speak about how this technique can also help spare nerves, delicate nerves that you do not want traumatized during some surgeries.
Dr. Nagubandi: Very good question. Let us say we are working in the deep pelvis, such as a rectal cancer, a rectal surgery and for the urologists, the prostate gland surgery where during the dissection we come very close to the pelvic nerves. Those nerves supply the sexual function and the bladder function of the body of the person and with the enhanced visualization and the ability to zoom in very close to the tissues and the three-dimensional visualization; it becomes a lot easier and more precise in finding these nerves and avoiding injury, thereby essentially the surgeon is able to preserve those functions to the patient. And also, there are other techniques used in the robotic surgery where the bowel or the intestinal blood supply can be checked before you connect the intestine back after removing this certain portion of the diseased intestine such as cancer or diverticulosis or diverticulitis affected colon for example. Once you remove that, you can check the perfusion or the blood supply to the intestines more confidently and connect it back, thereby it will reduce the chances of that new junction or the connection of the intestine falling apart due to poor blood supply. That’s called a Firefly Technique or fluorescence imaging and that’s a very good addition to the surgeon’s armamentarium to view good results to the patient’s outcomes.
Melanie: Wrap it up for us Dr. Nagubandi. It’s great information about the da Vinci robotic surgical system and really what it takes to learn it and the benefits to the patient and all of those conditions you mentioned that it can be used for. So, wrap it up for us with what you would like listeners to know, what you would like them to ask you if they have to have a procedure that might possibly be done by the robotic surgical system and about recovery times. So, kind of give them what you would like them to know.
Dr. Nagubandi: Well, thank you. We would like them to know that these operative procedures are now well-established, and the entire world is taking up to these procedures at a very fast pace and these are available in northern California in Butte County at Oroville Hospital and we are expanding our services so that they don’t have to travel long distances. For example, to Sacramento or to the Bay Area for achieving the same operative procedures and to obtain the same results. I would recommend to the patients or their physicians who are referring their patients to us or to any robotic surgeons to explore the possibilities and to sit with a doctor and discuss in detail what are the benefits, what are the pros and cons and for example, there is single site surgery for example when you are taking the gallbladder out, traditionally there are four incisions placed whereas in a single site surgery, you place one incision through the belly button and take the gallbladder out. This is possible with traditional laparoscopic surgery and many have done it, but with the robotic surgery it becomes much easier and even in the hands of somebody who hasn’t done hundreds of these procedures; robotic surgery makes it easier technically feasible. So, have a good discussion with your doctor and we are here to clarify any doubts and we welcome discussions. Explore the opportunities and options and then commit yourself for these procedures.
Melanie: Great information Dr. Nagubandi, thank you so much for sharing your expertise in this area and really giving us a great explanation of the da Vinci robot. Thank you again, for joining us. You’re listening to Growing Healthy Together a podcast by Oroville Hospital. For more information on the latest advances in medicine please visit www.orovillehospital.com, that’s www.orovillehospital.com. This is Melanie Cole. Thanks so much for listening.