How a machine can aid surgeons do more delicate work with fewer after-effects

By Rose Schneider

Officials in the Manhattan medical community believe a new $2 million device may revolutionize surgical procedures here by giving physicians greatly enhanced dexterity and precision.

The device, called the daVinci Surgical System, is a robot designed to be utilized by surgeons in what are termed “minimally invasive procedures,” meaning those not involving extensive incisions. Its most common applications here to date have involved OBGYN, urology, and cardiothoracic surgery, although it has also been used in general surgeries.

The device was purchased in October.

Ironically, the system failed in its original incarnation. Developed through the military in cooperation with scientists at Massachusetts Institute of Technology, it was designed to allow surgeons in the United States to operate remotely on soldiers who were injured in the field of battle. However, the delay between the surgeon’s hand movements and the result on the field thousands of miles away made the robot impossible to use for that purpose.

By closing the distance between physician and patient, daVinci has been adapted for uses in local operating rooms. The surgeon isn’t literally at the operating table with the patient; rather, he or she operates the robot from a nearby control panel. Since October the device has been used in two partial kidney removals and six gallbladder removals. Additional surgeries have been scheduled.

“We are continuing to look at opportunities as the patients present themselves,” said John Broberg, Mercy’s president.

Dr. Laki Evangelidis, a urologist who has worked here for seven years,  demonstrated its precision on the children’s game, Operation.

“It’s a different way of operating,” he said. “The instruments are much smaller than the human hand, allowing us to be able to do things we weren’t able to before…even from a laparoscopic technique.”

The small size of the instruments provides enhanced flexibility and dexterity in comparison to the human hand. Before da Vinci, procedures utilizing laparoscopic instruments were limited to only a pinching motion. They didn’t have the wrist, elbow or shoulder rotation that da Vinci has.

“The robot allows my actions from a human hand to be mimicked inside of the patient by the robot,” Evangelidis said.

The robot makes procedures easier for both surgeons and doctors by expanding the surgeon’s capabilities during the operation while offering a minimally invasive option for the patient. That translates to smaller incisions, less blood loss and a shorter recovery time. The robot’s camera gives surgeons a three-dimensional field of vision, allowing them to work in much smaller areas. The machine’s precision is so accurate that it can easily peel the skin from a grape.

Despite the fact that the robot is essentially a very large, expensive computer, it cannot be programmed to make surgical decisions on its own. Even though the surgeon is not in the operating room, his voice comes through the robot, instructing the nurses how to help.

It also has many default mechanisms to ensure safe surgery including a control sensor that will freeze the robot if the surgeon moves his head out of the senor area.

At Mercy, four surgeons have gone through intensive training to operate the device and more are going to do so.

“It has helped having the robot here to get people to come to Manhattan,” Evangelidis said. “We have other urologists coming here to use this … technology.”

Evangelidis trained to use the robot at the University of Kansas before coming to Mercy.

The technology is new to Manhattan, but Broberg said it has existed elsewhere for about nine years. “Seven years ago only 30 percent of prostate surgeries were being done with a robot and now over 90 percent are explicitly robotic procedures,” he said.

“We’re excited to finally have this level of technology in Manhattan” Broberg said.

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