Transcription:

This program is community service and is not intended to be a substitute for medical advice. Listeners having questions about their health, should make an appointment to see their personal physician. Any opinions or statements made during the program are those of the individuals or physicians making the statements and are not the opinions or statements of the hospital.

Prakash Chandran (Host): Robotic surgery has advanced quite a bit in the past few decades and machines like the Da Vinci claim to be the most advanced minimally invasive options for complex surgeries. Today, we will be learning about minimally invasive surgery at Sierra Vista and some of the upgrades they have made to improve their patient offerings. Here with us to discuss, is Dr. Eric M. Salinger, a general surgeon at Sierra Vista Medical Center. Dr. Salinger, thank you so much for educating us here today.

Eric M. Salinger, MD (Guest): No, thanks for having me.

Host: Of course. So, before we get into the enhancements at Sierra Vista; why don’t we start by talking about the main benefits that robotic assisted surgery offers versus traditional surgery.

Dr. Salinger: Sure absolutely. I think the biggest benefit for minimally invasive and I think specifically robotic surgery is that you have a reduction in the size of the incision that’s happening with your surgery and therefore have an easier recovery with less postoperative pain after surgery and less risk for things like wound infection and hernias after surgery.

Host: So, I want to get a little bit specific. Like what’s the order of magnitude different. When you say the incision point is smaller like what is that like in comparison to the traditional incision?

Dr. Salinger: Sure, absolutely. So, with robotic surgery, you typically have three or four what we call port sites and port sites are just small incisions that are usually 8-10 millimeters in size, and you’ll have three or four of those and possibly a small maybe two inch incision if something needs to be removed from the abdomen after surgery. Compared to the traditional open surgery which your incision can be anywhere from six inches to ten inches, twelve inches long.

Host: Yeah, that’s fascinating. I’m curious how do you determine who is a good candidate for robotic assisted surgery?

Dr. Salinger: That’s an excellent question. There are a lot of factors that go into that. One is if people have had previous surgery or how many previous surgeries they’ve had and how concerned we are with the extent of scar tissue inside their abdomen. The other is the location or what you are trying to fix or remove and then also, things like patient’s overall health. Some patients may not be healthy enough to undergo a robotic procedure because their heart or lungs may not tolerate having their abdomen filled with air to do the procedure.

Host: I see. So, you have to be relatively healthy in order to have a robotic assisted surgery. Is that correct?

Dr. Salinger: Correct. And that falls along a spectrum of health but in general, patients who are very ill, who have very weak hearts or very weak lungs are not a good candidate for a robotic surgery.

Host: Yeah, the reason I asked is because I think the whole thing is fascinating, but I know that some patients might feel uncomfortable having a machine work on them. So, I’d love for you to maybe put their minds at ease a little bit. Talk to us a little bit about what the training is like and what the device is like itself.

Dr. Salinger: Yeah, absolutely. Absolutely. So, the first thing to know is that this is not an autonomous or self-functioning device. Meaning, there isn’t a computer that’s making decisions about surgery. What it is, is that this is an instrument, a tool that allows us to essentially mimic open surgery in a laparoscopic setting. So, the surgeon is always in the room and the surgeon is always controlling the movements that the robotic arm are making. And so, the process is we put these ports in, much like traditional laparoscopic surgery and then we attach the robotic arms to those ports and then we control the robotic arms from a console that’s in the same room and so we can then operate within the abdomen using the robot.

Host: I’m really glad you clarified that because I think when we think about robotic assisted surgery, we think of this little robot that’s standing next to you and you like point like heh make an incision here. And then the robot does it, but from what it sounds like, it’s really just an extension of your hands, isn’t that right?

Dr. Salinger: That’s correct. Yeah and I think the Da Vinci system there I think their company name Intuitive is quite apt because it is truly an intuitive process. When surgeons sit down to learn how to use it, there is obviously a learning process that goes on and an extensive training that goes on but the function of using the robot itself is quite straightforward. You put your hands into a controlling mechanism or controllers and when you turn your wrist or move your hands; the robot moves the instrument exactly the way that you turned your wrist. And so, fairly quickly, you stop having to think about what you are doing with your hands because you are looking at a screen and when you move your left hand, the robot does what you want it to do. And so, it has certainly allowed us to do much bigger procedures in a much less invasive manner.

Host: Yeah, that is truly amazing. What a cool time to be alive just to know that we have this technology available to us. You talked a little bit about the extensive training. I know that our audience is going to want to hear a little bit more about that. So, maybe talk about how long it takes and what it entails.

Dr. Salinger: Sure, so the training process is – we essentially work with the Intuitive company to go through a training process and the first step is just learning about the robot and how it works and then the second step is practicing via simulators to improve your skills with the robot and then the next step after that is to go to a training facility and you practice first by working on a model and then second you work with a cadaver in a cadaver lab and so you operate on human tissue but on somebody who has donated their body to science. So, you can learn that way. And so, it’s a step-wise process to become adept at using this before you use it on a patient.

Host: So, that’s really comforting to hear that you have had lots of practice by the time you start with a patient, you’ve already operated on cadavers,  a lot of training with the machine so it’s not just heh, you should try using this machine today. So, patients can feel comforted by that. So, I want to shift over to Sierra Vista itself and the upgrades it’s done. Can you maybe talk a little bit about what those upgrades are and what it means for the patient population?

Dr. Salinger: Sure, absolutely. So, just a couple of months ago, Sierra Vista transitioned to the newest robotic system that Da Vinci makes called the XI robot and they spent approximately five or six years taking all of the feedback that they got from surgeons about the current model, the previous model the SI and about all the things that they think could be easier to use and they turned it into the newest version of the robot. And so, the ports are a little bit smaller, they are a little bit easier to attach to the patient and essentially what it means from a patient’s standpoint is we can do more complex procedures without having to place extra ports or convert to an open procedure and so, the ability to do even more extensive surgery, laparoscopically or robotically has been advanced by the new robot.

Host: Yeah, it sounds like Da Vinci has been so proactive at collecting feedback from doctors across the world and I was doing a little bit of research before this show. They have actually been around for a while. This is not their first rodeo. And I’ve seen basically their – just their image in the press go from something that was really questioned to kind of tarnished to really now being something that people are really impressed with and now it’s something that surgeons feel like they can’t live without.

Dr. Salinger: Yeah, they certainly have – they’ve been around for a long time and it’s interesting when you go for training, you get – they have out in their front lobby, they have the evolution of their first surgical robot that they created, that was really just a prototype up until their newest one and it’s amazing to see the process that they’ve gone through and the work that they’ve put into make this a really viable and almost vital thing to have in the surgery world. Sometimes it does feel like you wish you could use it all the time or have it all the time, but we also still have plenty of traditional surgery to do those things as well. We like to keep ourselves versatile so we can tackle whatever comes our way.

Host: Yes, and Dr. Salinger I really appreciate you for educating us today not only on minimally invasive surgery, but just what Sierra Vista now has to offer. I think that’s really exciting for the patient population around that area. Is there anything else that you’d like to share with our audience today?

Dr. Salinger: We are obviously happy to be able to take care of the patients on the Central Coast and in San Luis Obispo county and we look forward to continuing to participate in their care.

Host: Fantastic. So, for a referral to a board-certified physician please call the Sierra Vista Regional Medical Center and Twin Cities Community Hospital physician referral line at 866-966-3680. My guest today has been Dr. Eric Salinger. I’m Prakash Chandran. Thank you so much for listening.