Transcription:
The Advantages of Robotic Surgery

Melanie Cole (Host): In today’s operating rooms, you can find two or three surgeons, anesthesiologists, several nurses, and a surgical robot. Well, that certainly might be the case. My guest is Dr. William Diehl. He is a member of the Department of Surgery at Summit Medical Group, and he is an attending surgeon at Morristown Medical Center. Welcome to the show, Dr. Diehl. Let’s talk about robotic surgery. How long has this been around?

Dr. William Diehl (Guest): Well, robotic surgery has been around probably for about 10 years. It initially got popularized with the urologists who were using it to remove prostates for patients who had prostate cancer, and then subsequently was used extensively by gynecologists who have been using it to do hysterectomies and other procedures that are used for incontinence. But it has only been within the past, say, three to four years that it has started to gain a little bit of wider use in the field of general surgery.

Melanie: So what would be the advantages to robotic surgery versus open surgery? Things are called minimally invasive today. People get confused with all of the terms, Dr. Diehl. So sort it out for us a little.

Dr. Diehl: Sure. Well, conventional open surgery entails making a big incision or a sizeable incision in the abdomen in order to perform the operation, whereas, minimally invasive surgery of which there is laparoscopy and, now, robotic surgery, basically, what we do is perform the surgery through small little stab incisions through which we introduce little tubes. And then through those tubes pass the instruments of either the robot or the laparoscopy. Now, the difference between the laparoscopic surgery, which is also minimally invasive, and robotic surgery is that with a laparoscopy, the surgeon is standing at the bedside and is manipulating the instruments himself or herself. Whereas with the robotic surgery, you attach a robot to the surgical instruments, and then the surgeon sits at a console next to the patient and maneuvers those instruments through, basically, computer aided technology.

Melanie: Wow. That is amazing. Is it more precise than the surgeon manipulating the laparoscopic instruments themselves because there are no hands involved? Is there more room for air or less?

Dr. Diehl: It is more precise. It has many advantages over conventional laparoscopic surgery. The robot, the way it works is that the surgeon grabs the controls at the console of the robot, and every time I move my hands, the instruments inside the abdomen basically mimic the motion of my hands. So, for instance, if I pinch my fingers, the instrument inside the abdomen pinches the tips of the instrument. The other huge benefit is that there is no shaking. The robot is perfectly still. When you do laparoscopic surgery, there is always a lot of motion, and tremors become quite visible. Whereas the robot, you get none of that. But one of the biggest advantages is the ability to see things in three-dimensional view. When you perform surgery laparoscopically, you're operating off of a television screen, and it is only two-dimensional. But the camera that is used in the robot has actually two lenses in the camera. So when you look at the picture on the console of the robot, you see everything in three dimensions and you can also magnify it.

Melanie: Okay. So what are we using it for now? You mentioned at the beginning what it was initially used for. Now what are we seeing?

Dr. Diehl: Well, as we’ve started to use it in other areas and have been able to achieve many of those benefits, we started to use it to perform colon surgery, for instance. So patients who have colon cancer or polyps or perhaps diverticulitis that need to have a segment of their colon removed, we are now able to perform that surgery with a surgical robot. It gives us the advantage over laparoscopic surgery in that when we do it with the robot frequently, we don’t need to make any incision at all other than the small little stab wounds. Because even with laparoscopic surgery, you sometimes need to make an incision in order to extract the tissue that you’ve removed. But we have figured out ways to do it with the robots so that we don’t have to make those incisions.

Melanie: Now, you had also mentioned pancreatic when we spoke before, and typically, people think of pancreatic surgery, Dr. Diehl, as a big open surgery, things like the Whipple procedure. But with the robotic surgery, it’s certainly much different, isn’t it?

Dr. Diehl: Yes, it is. For instance, some smaller tumor that we see in the pancreas that originate from the cells that make hormones, for instance -- it was the disease that Steve Jobs had, although his was a cancerous tumor. But some of these tumors can be quite small. So, for instance, we’ve done several patients now that have these small tumors in the tail end of the pancreas. Now, when we do this surgery, either open or laparoscopically, usually, what we have to do is we have to remove the whole tail of the pancreas. Frequently you need to remove the spleen because of the blood vessels in the area that is being operated on. But with the robot, we’ve been able to remove the tail of the pancreas and yet still preserve the spleen. Now, I've tried to do it with the laparoscope as well, but it is so much easier to do with the robot than it is with the laparoscope.

Melanie: So this gives you greater control and vision during the surgery. It allows you to perform safe, less invasive, and more precise surgical procedures. Is there any reason someone wouldn’t want this?

Dr. Diehl: Well, sometimes you can't use it on all patients. There are some people who are not good candidates for robotic surgery, for instance. Some tumors may be too big, and some of them may not be accessible. It is a technology that is slowly evolving. So, as with everything that we do, we just want to make sure that the patient is safe before we subject them to anything new.

Melanie: What are some of the newer indications that this might be used for? Tell us a little bit about horizon for robotic surgery.

Dr. Diehl: Well, there is a new platform for the surgical robot that they call single-incision robotic surgery. Right now, it is primarily being used for the removal of gallbladders. But with this new platform, what you do is you make one small incision in the belly button. Through that incision, you introduce all of the instruments that are attached to the robot. You have the same advantages as you do when you use multiple puncture sites in that you have the visibility, the preciseness of the robot, but you were able to do it through one single incision. So that is a new and exciting area in robots. And then, what is really going to perhaps revolutionize surgery is still several years down the road. But this is a technology where you are actually introducing the entire robotic operative device into the abdomen. So now, you're going to be able to bring literally the robot inside the abdomen as opposed to have it controlled from the outside. But again, that’s still a few years down the road.

Melanie: Wow. That’s unbelievable, and it’s so amazing to think. When we look at various different classes of surgery, Dr. Diehl, whether they're gynecologic or head and neck or general, something along those lines, you're using it for colon and pancreatic, and even for women with endometriosis and that sort of thing, this is all being used and done by robotic surgery, correct?

Dr. Diehl: That is correct. For instance, one of my partners, Dr. Mike Most, he has been using the robot to perform intraoral surgery for patients that have cancers inside their mouth. These operations frequently required a major operation where you split the mandible in order to get at the back of the mouth. Yet with robot, you were able to do it that way. S, there are many other applications beside the ones that I've been talking about that little by little are being pioneered and are making a huge difference as far as patient treatment is concerned.

Melanie: What about the recovery time, Dr. Diehl, after a robotic surgery? Is that less as well?

Dr. Diehl: Well, it’s much less than open surgery. It can be very similar to laparoscopic surgery, but it is certainly an improvement. Listen, surgery in the first couple of days are still tough. But as opposed to conventional surgery, people recover very quickly and are back to a regular activity within a week or two.

Melanie: That’s just wonderful. Thank you so much, Dr. William Diehl. You're listening to SMG Radio. For more information, you can go to summitmedicalgroup.com. That’s summitmedicalgroup.com. This is Melanie Cole. Thanks for listening.