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The Future is Robotic Surgery

12/02/2009
by Marc A. Beaghler, MD, MPH

Recently the Star ran an article entitled “Robots’ place in diagnostics, surgeries debated”. The article featured two new technologies, the da Vinci robotic surgical system and a remote robot system named ERNI. Although both represent robotic systems, they function quite differently. As a local da Vinci trained surgeon, I would like to take this opportunity to discuss this system.

As the article noted, there exists many different opinions regarding the future of robotic technology, though one thing is certain, and that is robotic surgery is here to stay. It is not a “gimmicky thing”, but a new and exciting field, and one that represents the next generation of surgical technique, just like the transformation from open surgery to laparoscopic surgery that occurred in the ’80’s. There is no question that robotics and other advanced laparoscopic surgery are the future.

Traditionally, surgeries had been performed in an open manner, in which large incisions were required for the surgeon to plainly observe and manipulate the surgical field. These incisions inevitably created significant patient trauma, substantial pain and suffering, extended recovery time, prolonged pain management and elevated costs.

Laparoscopic surgery is a form of minimally invasive surgery. Although this technique has positive effect on patient trauma and recovery times, it does have its technical drawbacks. The surgeon operates using a standard two dimensional monitor instead of looking at his or her hands. Visualization of the operative field is impaired as surgeons rely on a two dimensional monitor instead of the natural depth of field, and dexterity is limited as surgeons work with fixed wrist instruments.

Robotic surgery represents an evolution in technology. Improvements in surgical instrumentation and optics enhance the surgical capabilities by providing superior visualization, enhanced dexterity and greater surgical precision. The da Vinci Robot is used as an extension of the operating surgeon. It has revolutionized the treatment of prostate cancer. The advantages of less blood loss, shorter hospital stays and a technically better operation have changed the paradigm for the treatment of prostate cancer. Today’s introduction of robotic-assisted surgery is the natural progression in the development of surgical technique.

In terms of the critics of robotics, I believe these are the same folks that debated the need to develop laparoscopic and minimally invasive surgical techniques. When I was a medical student almost all gallbladder surgery was done through a large abdominal incision. Now for the most part, this operation is done laparoscopically. Open incisions are no longer required in many cases, as tiny cameras in instruments called endoscopes or laparoscopes are inserted into the patient’s body through small ports.

There are now over 300 sites in the country that are currently using the da Vinci surgical system. These sites represent the best and brightest medical institutions, and in Southern California include; The City of Hope, USC, UCLA, Loma Linda University, UC Irvine, and UC San Diego.
We are fortunate to have a robust robotics program here in Ventura. Community Memorial Hospital had the vision to embrace the da Vinci Robot, and was the first hospital between Los Angeles and San Francisco to acquire this system. Our robotics program features urologic, general and gynecologic surgeons. These are surgeons, who have recognized the future and have embraced it.

—Marc A. Beaghler, MD, MPH

Dr. Beaghler is a local urologist and da Vinci trained surgeon. He is currently the Medical Director, Operating Room and Chief of Staff- Elect at Community Memorial Hospital.

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