Patients undergoing robotic-assisted surgery benefit from the same reduction of pain and recovery time as those patients undergoing standard laparoscopic procedures because the number and length of the incisions are similar.

Minimally invasive surgery has suffered from significant technical drawbacks. Surgeons use a 2-D monitor instead of looking at his or her hands. The lack of 3-D visualization of the operative field, the poor ergonomic design, and the lack of touch sense offered by the laparoscopic instruments are also significant drawbacks. As a result, this technique generally has been used for the simplest surgical procedures. With the advances offered by the da Vinci S, Matsunaga says that up to 75 % of urologic procedures could be done robotically; the projection is even slightly higher for gynecologic procedures, at about 80%, according to Mirhashemi.

 
Another great advantage is the lack of blood loss compared to many open procedures. The robot is so precise and the visual field so sharp that it enables surgeons to clamp or staple a vein that normally would be cut. Matsunaga explains that for an open prostatectomy, a patient can expect to lose 400 to 600cc of blood “even in the best of hands.” However, the blood loss from the same procedure done robotically is may only be 100 to 150cc.

 
Before you start expecting all your doctors to become certified robotic-assisted surgeons, you need to realize that there is a lot of training involved, and not everyone is going to want to move away from traditional, open procedures. “I think it’s one of those things that people get excited about,” Mirhashemi says, “but once they try it, it’s not that easy and it definitely has a big learning curve. At the start, it’s going to take hours to do a case and I’m not sure how feasible it’s going to be for widespread adoption. So my guess is, there’s going to be a handful of people who are routinely going to use it.’

It’s hard to ignore the outcomes, however. Mirhashemi speaks of a patient who had a radical hysterectomy done on a Tuesday. She was having dinner at Spagos the following Saturday and was back to normal activity in six or seven days. “The same patient would have needed a six to eight week postop recovery with an open procedure,” he says. Also, although it may seem like the opposite would hold true, robotic procedures are very good for obese patients because avoiding the large incision can drastically reduce the risk of postoperative wound infection and other complications.

There is one aspect to robotic procedures that has not yet been improved upon from traditional laparoscopy. “There are certainly little intricacies about the procedure that are very difficult,” Mirhashemi says. “I’ll give you an example — the lack of tactile sensation. You have to use a lot of visual cues to reassess what that tactile sensation is going to be. You put a suture through a tissue, and with your hands, you control the robot to pull up through the tissue. Well, if I were doing this in an open procedure, I know how much I’m pulling up with my fingers. With the robot, the hand of the robot is pulling up on the suture, but I don’t get that tactile sensation.”

Both Mirhashemi and Matsunaga are happy to be at the forefront of this new frontier and to help their colleagues as well. However, in time they’ll likely be equally pleased to have some of that time back to themselves. A benchmark seems to be when a new surgeon does a procedure in under four hours; experienced surgeons can do the same case in half the time.

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