Domo arigato Mr. Roboto! You may remember this song released by Styx in 1983. It made a comeback recently in the operating room when Dr. Vorenberg began his first robotic sigmoid colectomy.
Although the Da Vinci surgical system or “robotic surgery” has long been utilized by pelvic surgeons (urologists and gynecologists), colon and rectal surgeons have been slow to adopt the technology. Colon and rectal surgery typically involves multiple quadrants of the abdomen. We have developed a level of comfort with laparoscopic surgery, as a specialty, therefore, we have not enthusiastically embraced the robot.
Advantages of robotic surgery over traditional laparoscopic surgery are:
- Improved view of the operative field due to 3-D visualization in the operating console
- More precise movements with wristed instruments that articulate mimicking our hands and fingers (traditional laparoscopic surgery involves using non-articulated instruments or “straight sticks”)
- Potentially shorter lengths of stay in the hospital, earlier return to work and daily activities, and less blood loss. More studies need to be done to evaluate these variables.
Disadvantages of da Vinci Surgical System, at this point, are:
- Loss of tactile feedback for the surgeon. There is no feedback from the robotic instruments to the operating console. All feedback is visual.
- Longer operating room times. This is due to the extra time it takes to set up the robot. With increasing experience, operating times should improve as was the case with early laparoscopic surgical experience.
Simply put, robotic surgery represents an advancement of laparoscopic surgery
The robot does not make you a better surgeon – it merely adds another tool to your toolbox. Surgical principles do not change in robotic surgery, and therefore, patient outcomes should not be impacted negatively. On the contrary, with the advances of the robot, a skilled surgeon should be able to perform a better dissection while minimizing collateral damage. All of this should lead to improvement in outcomes.
Definitive studies have not been performed indicating that robotic surgery is superior to laparoscopic surgery. At the same time, no studies have shown robotic surgery to have worse outcomes than laparoscopic surgery.
Given the success of robotic surgery in pelvic surgery by other subspecialties, this modality shows promise for the future of minimally invasive colon and rectal surgery as well.
Conceivably in the future, like the song from Styx… patients will be waking upsaying “Domo arigato, Dr. Roboto!”
Check out Dr. Vorenberg getting started on the da Vinci surgical system!
For more details about robotic surgery, please visit da Vinci surgery website on colorectal procedures.