UAB Synopsis, Vol. 28, No. 24, June 22, 2009
UAB Synopsis recently talked about UAB’s robot-assisted surgery program with cardiothoracic surgeon Christopher W. Akins, MD; surgical oncologist Martin J. Heslin, MD; gynecologic oncologist Warner K. Huh, MD; and head and neck surgeon Eben L. Rosenthal, MD. UAB surgeons are expanding applications of the da Vinci robot, the minimally invasive surgery system acquired in 2001. UAB is one of five pilot institutions in the nation designated to train residents on the robot.
Synopsis: What are the advantages of surgery with the robot?
Dr. Huh: Da Vinci robot-assisted surgeries reduce morbidity, postoperative pain, blood loss, and recovery time. The system offers surgeons improved dexterity and surgical precision, increased range of motion, and better visualization compared with other minimally invasive approaches. The biggest difference between traditional two-dimensional laparoscopy and da Vinci robotic surgery is the surgical instruments. Standard laparoscopy is like operating with chopsticks. The instruments are rigid and fixed, and you have little mobility. The da Vinci’s articulating arms mimic actual wrist movement.
Depth perception also can be a problem with laparoscopy, but the robotic system’s console produces a three-dimensional image similar to the traditional surgical field of vision.
Synopsis: How does the surgeon operate the robot?
Dr. Huh: The surgeon is in complete control of the robot, operating the instruments from a console through highly responsive gloves. The system seamlessly translates the surgeon’s hand, wrist, and finger movements into precise, real-time movements. The console displays the surgical field with tenfold magnification in a three-dimentional image, so that surgeons’ visualization is optimized.
Synopsis: What surgeries are we performing at UAB with this robot?
Dr. Huh: In 2006, UAB became the first hospital in Alabama to apply the technology to women’s pelvic cancers. UAB now has two da Vinci robots that surgeons are using for a variety of urologic, gynecologic, cardiac, oncologic, and head and neck cancer surgeries.
Robot-assisted gynecological surgeries at UAB include hysterectomy, hysterectomy with pelvis and para-aortic lymph node dissection, radical hysterectomy, and oophorectomy. We also can treat endometrial cancer, cervical cancer, and benign gynecological conditions such as fibroids, uterine bleeding and pain. As seen in urology, robotic surgery has had a notable impact in gynecologic oncology. Our volume has tripled in the first part of 2009 and our entire group is using this approach.
We also have had remarkable success and excellent outcomes in obese and morbidly obese women — a population that could not be treated laparoscopically but can be treated using the robotic approach.
Post-operative pain has not been studied formally, but I am firmly convinced that pain is substantially less than with standard laparoscopy. Our patients are pleased with the surgical results and cosmetic outcomes. Patients often go home within 24 hours of the procedure and may not require narcotics. Recovery time is reduced from 2 months for a traditional open surgery to around 2 to 4 weeks for a da Vinci procedure.
Nongynecologic Surgeries
UAB surgeons perform more than 300 robot-assisted urologic surgeries annually. Many of these surgeries are prostatectomies, but surgeons also are performing robot-assisted anterior pelvic exenterations, radical cystoprostatectomies, partial nephrectomies, and pyeloplasty.
Synopsis: How are cardiothoracic surgeons using the da Vinci robot?
Dr. Akins: We can use a minimally invasive approach for all mitral valve conditions, primarily for regurgitation, in addition to tricuspid valve disease, aortic valve disease, and atrial fibrillation. We also perform coronary artery bypass graft (CABG) surgery for patients with blockages in the left anterior descending artery and its branches. These minimally invasive approaches require only four to five small (5 to 6 mm) incisions and avoid the breastbone division and extensive recovery open procedures require.
Synopsis: How is UAB using robot-assisted surgery in surgical oncology?
Dr. Heslin: For selected tumors in gastrointestinal and abdominal applications, anecdotal reports indicate patients have similar benefits to those who undergo laparoscopic procedures. However, some of the advantages with intra-corporeal dexterity that the robot provides will need more careful study to determine the full benefits. We have performed splenic-preserving distal pancreatectomy, partial gastrectomy, adrenalectomy, and abdominal perineal resection for rectal cancer.
Clinical Studies
Synopsis: Are UAB surgeons using the robot in any investigational applications?
Dr. Rosenthal: UAB is one of three sites contributing to feasibility studies of robot-assisted surgery in head and neck tumors. Under an IRB-approved protocol, more than 80 patients have undergone transoral robotic surgery, effectively removing tumors and providing better functional outcomes. Results indicate that patients have reduced scarring, improved swallowing, and less damage to speech with robotic procedures compared with open procedures, which often require ear-to-ear incisions and lip-splitting mandibulotomy and require long recovery involving tracheotomy and feeding tubes.
Synopsis: What future applications are planned for UAB’s da Vinci robots?
Dr. Rosenthal: UAB surgeons expect in the next 2 to 5 years to offer abdominal sacral colpopexy for female pelvic organ prolapse, hepatectomy, esophagectomy, retroperitoneal lymph node dissections in testicular cancer, and nephroureterectomy.