Advancements in Robotic Surgery

The advancement of robotic assisted surgery has changed the game for many surgeons and patients. Robotic surgery has been around since 2001. The surgeries performed are minimally invasive which means minimal trauma for the patient. Incisions are smaller, blood loss is less, and pain and recovery times are shorter.

Boone Hospital Center added its first robot, the da Vinci in 2008. Now equipped with two 2 da Vinci XI robotic surgical systems, Boone Hospital has recently added the Mako robotic-arm assisted surgery for total joint replacement.

“It’s becoming more common place,” says Sara Rush, Director of Surgical Services. “Many fellowships are offering robotics training.”

THE DA VINCI XI

Inside, there’s a 3-dimensional camera that allows the doctor to see things in 3D. It’s not like a 3D movie where objects are coming at you. Instead, the 3D gives the surgeon depth perception. The camera in the robotic system is much stronger, allowing the surgeon to see the patient in a very magnified way. The robot also offers 360-degree movement of the instruments which give the surgeon full range of motion. They are able to mimic how they would naturally move their hands and fingers. This allows the surgeon to move in a much more natural way.

During surgery, the patient lays on the patient bed. The da Vinci is a tall machine with robotic arms that extend. Its arms are what hold the instruments that are used in the patient. Once the instruments are in place, the surgeon sits at the surgeon console during the operation. The surgeon puts their fingers in the hand instruments, and this is how they control the movement of the instruments. The foot pedals are how they control the camera, they can cauterize the cut and adjust the instruments.

HOW IS THE ROBOT USED FOR SURGERIES?

Gynecologic Oncology

Sara Crowder, MD is a gynecologic oncologist and has been performing robotic surgeries for 12 years. Dr. Crowder treats cancers of the female reproductive tract. Through robotic surgery, she can perform hysterectomies, remove ovaries, lymph nodes and other abdominal tissues to determine if a cancer has spread.

In October 2023, Dr. Crowder performed seven gynecologic robotic cases in one day. The manufacturer of the robot does not know of any other time this has been done. And these weren’t short easy cases either. “In order to have been able to accomplish this,” Dr. Crowder says, “it comes from having a good team. It comes from having a team where everyone knows what their role is and having a consistent team, reducing the amount of things that need to be explained. And experience. When you’re having surgery, I think experience is the most important thing. A surgeon who’s experienced and a team who is experienced.”

Lung Resection

Joss Fernandez, MD of Boone Health Heart Surgery has recently started using robotic assistance with lung resection. As Dr. Fernandez explains, “It reduces the size of the incision and reduces post operative pain. It also prevents us from having to spread the ribs so we can get direct access. This enables us to dissect lymph nodes looking more meticulously for cancer that way.” The patient benefits by having smaller incisions, less blood loss, less pain, and a faster recovery.

Colon and Rectal Surgery

Reggie Vaden, MD of Boone Health General Surgery has been performing colorectal surgeries for 25 years. 5 years ago, she started doing these surgeries with the robotic system. “The robot makes us able to do things that were very difficult to do laprascopically,” Dr. Vaden explains. “The robotic system helps us do them minimally invasively where we had to do them open before.” Types of surgeries performed treat colon and rectal cancer, diverticulitis, and inflammatory bowel disease. Using the robot for these types of surgeries shortens the patient’s length of stay in the hospital by a couple days.

Prostatectomy

Philip Fish, MD of Urology Associates of Central Missouri uses the robotic surgical system to perform prostatectomies. This is surgery that removes part or all of a prostate gland. This procedure is used to treat conditions affecting the prostate, such as prostate cancer. With the use of robotics, the surgeon can make small incisions in the lower abdomen to remove part of or all of the prostate depending on the need of the patient.

Hernia Repair

Lisa Rollison, DO of Boone Health General Surgery uses robotic surgery to repair hernias. A hernia is a hole or weakness in the abdominal wall or groin. Robotic surgery allows the surgeon to make small incisions. The robotic instruments cause less trauma which results in less pain and reduced hospital stay.

MAKO ROBOTIC-ARM ASSISTED SURGERY SYSTEM

Alexander Wendling, MD joined Columbia Orthopaedic Group in the fall of 2023. With his addition to Boone Health’s surgical team, Dr. Wendling is able to perform knee replacements with the use of a robot.

Different from the da Vinci, Dr. Wendling is right by the patients’ side while he’s performing surgery. A CT scan is first taken of the knee and used to create a 3D virtual model. The model is loaded into Mako’s software and creates the surgical plan for that patient. The surgeon then uses the robot arms to remove arthritic bone before inserting the knee replacement.

“The mako allows us to accurately plan for each individual patient’s surgery using a CT scan that they obtain prior,” explains Dr. Wendling. “We can then place components and fine tune adjustments to give us a consistent outcome so the patient’s happy with their knee replacement.”

By Erin Wegner