University of Texas Southwestern doctors test robotic surgeon for laparoscopy

Dallas 14 February 2006Having a surgeon with four arms is one of the advantages of the latest robotic technology now being studied at University of Texas (UT) Southwestern Medical Center. The $1,4 million robot named da Vinci can hold a camera in one hand while manipulating tiny laparoscopic surgical tools in its other hands. And it never tires like its human counterparts. With a human surgeon at the controls, da Vinci filters out tremor, enhances precision, offers three-dimensional imaging and eliminates the inverted manipulation of instruments usually required in laparoscopic procedures.

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"The buzzword is more precise than humanly possible. That's the rationale for this technology", stated Dr. Daniel Scott, director of the Southwestern Center for Minimally Invasive Surgery and assistant professor of surgery at UT Southwestern. Although testing the four-armed robot is still ongoing, Dr. Scott stated: "It seems advantageous from the standpoint of precision for some procedures."

Da Vinci is most popular in urology for that reason, especially for prostate operations. It's also proved useful in surgeries on the esophagus and stomach. Researchers also are investigating its practicality for cardiac surgery such as coronary artery bypass grafting and valve replacement. "It may well prove useful for general surgery procedures that have traditionally required open incisions like biliary reconstruction or pancreatic surgery", Dr. Scott stated.

Laparoscopic surgeries, also called minimally invasive surgeries, are performed via several tiny holes rather than one long incision, reducing post-operative pain and recovery times. The method is increasingly popular. The first robotic surgery, performed in 1995, relieved the need for an assistant to hold the camera during laparoscopic procedures. Da Vinci represents the next step, offering an instrument that actually performs the surgery based on controls handled by the surgeon.

"It's not difficult to learn", Dr. Scott stated. But he said it does take longer to set up, mostly to position the robot. It is also expensive and cumbersome, which limits the operative field and can make it impractical for exploratory surgeries or surgeries that require surgeons to go in more than one area. "It takes choreography", Dr. Scott explained.

Surgeons are still learning what its full potential is. But to be successful, Dr. Scott added, "It needs to supersede laparoscopy in terms of efficiency before the average surgeon is going to use it. But as this technology continues to evolve, no doubt it will be miniaturized. Smaller is going to be better."

Automation may also be in the future, with a doctor pointing to sections of tissue that need suturing and the robot doing it. That could potentially be integrated with computed tomography or magnetic resonance imaging scans, which could offer opportunities for dress rehearsals of procedures.

Another potential for the technology is for telerobotic surgery across distances - doctors in one city using the robot to perform an operation in another city. The first test of such a surgery was a successful trans-Atlantic gallbladder procedure, with the surgeon in New York and the patient in France. "It certainly could have applications for rural surgery or mentoring surgeons in the community on new procedures", Dr. Scott stated.

"There are big permutations for the future of surgery, and that's why we need to be leaders in this field as a medical school and as a centre dedicated to minimally invasive surgery", he stated. "We have a strong track record of embracing robotics and research into this new type of technology here, and we look forward to continuing those activities with this new acquisition."

More news about the use of the da Vinci robot in laparoscopic procedures is available in the VMW May 2005 article Intuitive Surgical receives FDA clearance for gynaecological laparoscopic procedures.


Leslie Versweyveld

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