Scott Webb (Host): Robotic surgery is becoming the gold standard, even for the most routine general surgeries. And here to tell us more today is Dr. Beata Belfield. She's a fellowship trained general surgeon specializing in advanced gastrointestinal and minimally invasive surgery.

 This is the St. Joseph's Health Medcast from St. Joseph's Health, I'm Scott Webb.

 So Doctor, thanks so much for your time today. I woke up with a spring in my step today. Anytime I get to talk about robots and robotic surgery, I get excited. And today we're going to be talking about how you enhance patient outcomes, you know, through robotic surgery. So let's start there. Why is St. Joseph's Health so dedicated to robotic surgery?

Beata Belfield, MD, FACS: Thanks so much for having me on the podcast, Scott. I really appreciate being here, and as an area of passion for me, robots is something I'd love to talk about too, particularly robotic surgery. So St. Joseph's has a world class program of da Vinci surgical robots, and this is one of the main things that inspired me to come to St. Joseph. Seeing the way that the OR staff, surgeons, and administration work together to create and maintain a high level robotic surgery program. I really think that this does contribute to enhanced outcomes for my patients.

Host: Yeah, I'm sure that it does. And it's great to have the support of the administration. Of course you have to have the robots, which are very expensive. And of course, in my mind, since I'm always 15 years old, I'm always picturing, droids from, you know, science fiction movies, but I know they're not exactly like that. And maybe you can explain that a little bit and also tell listeners what types of surgeries you do robotically.

Beata Belfield, MD, FACS: Yes, that's a very good point. The robot is in no way like a Star Wars droid. Robot is a tool used by the surgeon. It doesn't look humanoid, and it doesn't make any movements on its own. The surgeon controls every single movement of the surgical robot. So what kind of procedures do we do? Back when the robot was becoming more widely used in surgery, the first specialists to use it for surgery were urologists and gynecologists. And over the years, surgeons have found that robotic technology is extremely useful in other areas as well. And most recently, general surgeons have caught on to the benefits of using a robot in their practice and for their patients.

So, in my practice, procedures that I perform are hernia repairs, whether belly wall hernias, groin hernias, or hiatal hernias. And in our hospital, the cardiac surgeons use the robot. The urogynecologist uses the robot, colorectal surgeons, thoracic surgeons, urologists, and gynecologists all utilize the robot for appropriate procedures.

Host: Yeah, let's stay on that word, appropriate, right? So first of all, it seems like there must be a long line of surgeons down the hall, you know, waiting to use the robot. So I am sure the administration is happy that it's being used. I'm sure patient outcomes are great. Patients are happy, easier, better for surgeons and the whole team. Who's a good option then, or why is robotic surgery a good option for certain patients?

Beata Belfield, MD, FACS: As a surgeon, we used to look at procedures and say, which surgery can I do laparoscopically? And now, over the last 10, 20 years, we've come to a point where we say, which surgery can I not do laparoscopically? Laparoscopic refers to using small incisions in the belly to do a surgery through as opposed to an open incision up and down in the middle of the belly. Robotic surgery is laparoscopic surgery. So, any surgery that could be performed laparoscopically is a candidate to be a robotic surgery. And I feel that selection for robotic surgery should be tailored to the individual patient. There are certain characteristics of patients that make a procedure less or more likely to be a good fit robotically. And that is a conversation that every patient should have with their surgeon. First of all, what surgery do I need? Secondly, what approach do you think is the most appropriate? Open, laparoscopic, or robotic? Our goal at St. Joseph's is never to have the answer be laparoscopic because you can't access the robot.

Host: That's interesting. It's, uh, you know, how things change over time, where whatever was the gold standard 10, 15, 20 years ago today, you know, it's like, well, we have the robot and we can use it for almost everything. So let's try to use that. And I'm not sure if you ever get any pushback from patients and I'm sure they have questions at the very least on recovery time. So are recovery times generally better with robotic surgery?

Beata Belfield, MD, FACS: Compared to open surgery, laparoscopic surgery has decreased recovery time and less pain overall for the procedures that I perform routinely and for most procedures. There is usually no difference noted between laparoscopic surgery and robotic surgery, but there is some recent evidence that is coming out in favor of robotic surgery. What leads to faster recovery time for patients is having fewer incisions, smaller incisions and less trauma to the tissues on the inside.

Host: Yeah, that all sounds right. As a prospective patient anyway, obviously smaller scars, less bleeding, faster recovery, a robot was involved, but of course, the surgeons like yourself, you're doing the surgery. The robot is sort of assisting and helping you do the surgery. Doesn't do anything on its own as we've established here. Let's just sort of look into our crystal ball a little bit here and think about or picture what the future of robotic surgery looks like.

Beata Belfield, MD, FACS: The big thing that's exploding in the country in every single company is AI. What role does AI have? And where does it fit into doing work that used to be done by humans? In surgery, I think, as a profession, we're fairly conservative in risk taking. And I think that AI will start to play a role in potentially helping a surgeon distinguish tissue planes, potentially assisting or augmenting the reality experience through the camera.

But having the machine make any decisions for itself is, I think, still a very long way down the road. Improvements that I could see happening to the technology are having the technology be more accessible, as in less expensive, and accessible to hospitals that don't have as many resources.

Additionally, as more and more surgeons come out of training fully prepared to use the robotic equipment, I see the robot becoming more and more widely available.

Host: Yeah, that sounds awesome. I was just, I got to thinking what you were saying about AI and I'm like, all right, I can get my mind around having an awesome surgeon use the daVinci robot. I don't know if I'm quite to a point where I'm, the surgeon says, all right, so we're just going to let the robot do what it needs to do. We've plugged in the surgery. It's going to use artificial intelligence and we'll see you on the other side.

Beata Belfield, MD, FACS: And to be clear, the current surgical robot does not have that capability and no surgeon would be comfortable with that technology currently.

Host: Right, right. As you say, that may be something down the road, but right now we're still relying on the surgeons doing the surgery with the assistance of the robots, the da Vinci and other robots that are out there. It's been great to get to know you a little bit today, understand a little better how St. Joseph's Health is using robots, why you're using them, which patients they're appropriate for and so on. So thank you so much. You stay well.

Beata Belfield, MD, FACS: Thanks, Scott.

Host: And for more information, please visit SJHSYR.org. That's SJHSYR.org. And if you found this podcast helpful, please share it on your social media. I'm Scott Webb. Thanks again for listening to the St. Joseph's Health Medcast from St. Joseph's Health.