Courtesy daVinci Surgical System
Kelly Moore had a complete hysterectomy on a Monday and was going out to dinner the following Friday. Sarah Stahl had part of a lung removed and was out of bed the next day.
That wouldn’t have been possible had both women had traditional operations with large incisions.
But Moore of Willow Street in Lancaster County and Stahl of York had surgeons that are trained in using the da Vinci Surgical System, a robotic-assisted system that is on the cusp of becoming a standard of care in progressive medical communities.
“We’re in the dawn of the new era,” says Dr. Percival Buenaventura, a cardiothoracic surgeon with WellSpan Cardiothoracic Surgery in York.
“When the Wright brothers flew the first plane, they probably couldn’t have imagined going to Mars or into outer space,” says Buenaventura. “We’re doing complex procedures with robotics even though it is early in the game.” Buenaventura has been doing thoracic surgery using da Vinci for about three years.
Da Vinci has been in use for only about 10 years, beginning with prostate surgeries, but has now expanded into a wide range of procedures. It can be used for a variety of gynecological operations; to treat coronary artery disease; obesity; numerous cancers, including the throat, kidney, bladder, prostate, stomach, pancreas and colon; and other conditions.
Surgeon guided, robot assisted
Not everyone is a candidate for robotic surgery, however. It is just another tool for surgeons, but it might not be the best for all conditions.
Dr. Bryan Yingling of Doctors May Grant Obstetrics and Gynecology in Lancaster has been using the da Vinci system for about three years at Lancaster General Health’s Women & Babies Hospital and says that across the country, at least 30 percent of hysterectomies are done using the da Vinci system.
Yingling believes the da Vinci technology will evolve to a much smaller set of equipment with more ease of use and more capabilities.
“It is interesting to see residents now training on da Vinci. … They come out of school ready to use it,” says Yingling.
On the horizon, Yingling says he’s sure there will be other ways of doing surgery. For example, there is now interest in what is called natural orifice surgery, Yingling says. That is surgery that would have the surgeon enter the body through the throat or the intestinal track, he says.
For now, the advantages over traditional or “open” surgery that robotic surgery offers has some patients singing its praises. Those advantages include quicker recovery time, including a shorter hospital stay, with less pain and less bleeding; smaller incisions; and the ability to get back to work sooner.
Kelly Moore calls robotic surgery “amazing.” She has two other abdominal operations to compare it to. To her the biggest difference was that her hysterectomy was an outpatient procedure. In her other operations, she was in the hospital for a week (and more) each time. With her robotic surgery, she says she had no scarring, and instead of incisions several inches long, she had just four small puncture marks.
She is a huge supporter now, but Moore had to be talked into having the da Vinci surgery, she says. “I just didn’t think I wanted to have a robot inside of me. I felt he [Yingling] wouldn’t have as much control by using the robot,” she says. Now, Moore says, if she had to have surgery again, she would like to be able to have it using the da Vinci system. But, she points out, “I think you need a good doctor behind the da Vinci.”
Pioneering work
Sarah Stahl says she was in the hospital three days after having one of the lobes of her right lung removed by Buenaventura, but described the surgery as very easy. “I was very comfortable from the time I woke up. The day after surgery, I was up and out of bed. It was incredible.”
The surgeons benefit also from advantages of using the da Vinci system, which is currently the only system of its kind on the market.
The range of motion with the four robotic arms and the EndoWrist instruments is greater than the human wrist. The system filters out hand tremor and offers a high-definition 3-dimensional view, along with magnification.
The equipment includes a surgeon console with master controllers and a patient-side cart that holds the four interactive robotic arms and monitors. Although the surgery is called robotic, the da Vinci system cannot act alone, but is guided and controlled by the surgeon and enhances the surgeon’s abilities.
Da Vinci surgery is growing exponentially, says Buenaventura. Ten years ago, there were about 30 systems being used in the country; now there are thousands, he says.
Buenaventura likens the current moment in the development of robotic surgery to the explorers Lewis and Clark.
“It’s really pioneering work. That’s what is exciting about it.”
