Touro Infirmary

FALL 2013

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I f the idea of robotic surgery conjures up images of the quirky "Star Wars" character R2-D2 attired in scrubs, think again. Flesh-and-blood surgeons are increasingly gravitating toward robotic systems to help them provide better outcomes for their patients and substantially reduce recovery times. Using a surgical robot gives the surgeon added advantages by providing a three-dimensional view of the surgical site within the body and a heightened ability to maneuver in tight places. "Essentially, robotic surgery is a variation on laparoscopic [minimally invasive] surgery," says Dr. Mary Ellen Wechter, an OB/GYN affiliated with Baptist Health, Jacksonville, Fla. "We're operating through small incisions in the abdomen, where we insert narrow tubes, through which we can pass long, thin instruments. Robotic instruments can flex like a wrist, so … it gives you the ability to reach around a corner with the robotic instrument." HOW IT WORKS To perform robotic surgery, the surgeon has to prep the patient, make the incisions, and insert and position the robotic instruments. But while the surgery itself is in progress, the surgeon sits at a console in the surgical theater, away from the operating table. "Think of it as computer-assisted surgery," says Dr. Stephen Klasko, dean of the University of South Florida Morsani College of Medicine. "And because the doctor isn't standing for long periods, there is less of a fatigue factor, which is important in procedures that last for hours." Before you undergo a robotic surgery procedure, your doctor will provide material to familiarize you with how the surgery is performed and what you can expect afterward. Most doctors who perform robotic procedures will give you "Most people do end up taking less pain medication [after robotic surgery]." ~ Dr. Renuka Ramappa, Medical Center of Trinity, New Port Richey, Fla. a DVD to guide you through the procedure from start to finish, says Dr. Susan Carter, medical director of minimally invasive surgery at North Colorado Medical Center, Greeley, Colo. "You can also go on YouTube and easily find videos that walk you through a robotic procedure," she adds. "You can see how the doctor operates within the console. You can see that it's [the doctor's] fingers that utilize toggles and levers with Velcro straps to control the forceps, scissors and the other instruments." HEALING ADVANTAGES After a robotic surgery procedure, you're likely to heal faster because the length and difficulty of post-surgical recovery often has less to do with the organ or tissue that was operated on and more to do with the incision site. "Many post-operative problems and hospital stays have historically been due to complications and recovery time involving the incision," says Dr. Klasko. "Robotic surgery allows for laser focus on the surgery site." Combined with the smaller incisions, "most patients will find they're in less pain," says Dr. Renuka Ramappa, an OB/GYN at Medical Center of Trinity, New Port Richey, Fla. "Most people do end up taking less pain medication." ALTERNATIVE OPTIONS As robotic equipment and techniques continue to evolve, this type of surgery will become an increasingly utilized alternative to traditional surgical methods, say experts. "I'd say we could have the technology to do 80 to 90 percent of surgeries with minimally invasive procedures," says Dr. Pankaj Singhal, director of robotic surgery for Kaleida Health, Buffalo, N.Y. "Right now, there is only one robotic surgical unit [da Vinci] approved by the FDA [for soft-tissue surgery], but in the future, we could see robots designed for specific procedures—a robot used for cardiothoracic surgery, a robot used for gynecological procedures, equipment for specific operations." FINDING A SURGEON With new technology comes a learning curve, and Dr. Singhal encourages patients to ask many questions when considering a robotically assisted procedure. "It takes many years and many laparoscopic operations [for a surgeon] to prepare for robotic technology," Dr. Singhal says. "So you should ask a lot of questions about your doctor's experience, how frequently the doctor has used the technology and so on. If there are any complications to be had, they're probably going to arise due to a lack of experience." Finding a surgeon experienced in robotic surgery is likely to become easier, however, as more doctors embrace the technology and develop expertise with the equipment. In fact, "we have developed a Robotic Institute, where doctors using this technology in our facilities will have to be credentialed," says Dr. Kevin Davis, a gynecologic surgeon affiliated with Swedish Medical Center, Englewood, Colo. "Surgeons with various specialties came together and determined how many procedures and how many training hours a year would keep us all proficient and delivering the outcomes this technology is capable of." • SHUTTERSTOCK w w w. s p i r i t o f w o m e n . c o m FA L L 2 013 SPI RIT O F WOM EN 11

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