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July 2009: The Impact of Robotic Surgery on Healthcare

30 Jun 2009

Dr. Enrique Elli is a staff surgeon at Weiss Memorial Hospital. He is an Assistant Professor of Surgery at the Division of General, Minimally Invasive and Robotic Surgery at the University of Illinois at Chicago.

 

Enrique Elli, M.D.

General Surgeon

Weiss Memorial Hospital

(312) 355-1493 

eelli@uic.edu

 

The field of minimally invasive surgery is actively evolving; since its introduction in the late 1990s, robotic surgery has clearly improved and expanded its applications.

The term “robot” is derived from the Czechoslovakian word robata, meaning “forced labor.” While today’s robotic surgical tools—like the da Vinci® Surgical System—are highly sophisticated, they do not work independently. Surgical robots ease the technical work of a surgeon, enabling him or her to perform surgery more precisely, through smaller incisions.

How robotic surgery works
The da Vinci Surgical System combines robotics and computer imaging to enable microsurgery in a laparoscopic environment. The system consists of a surgeon’s viewing and control console integrated with a high-performance 3-D monitor system and a patient-side cart consisting of three robotic arms. One arm positions the laparoscope with its two optic systems. The other two arms allow placement of a variety of articulating instruments.

Seated at the console, the surgeon operates using two master controls positioned directly under a magnified 3-D display of the operative field. The surgeon rests his or her head between head sensors on either side of the view port in order to see the 3-D displays. Hand–eye coordination is restored with this system. While observing the image of the operative field, the surgeon controls instrument movement by use of manual manipulators directly linked via electronics to motor-driven arms that hold and move instruments with standard surgical tool tips.

The software within the da Vinci Surgical System translates the surgeon’s hand, wrist and finger movements into corresponding micromovements within the patient’s body without any time delay. The instrument movements are under direct (real-time) control by the surgeon. By employing a kinematic structure (joint movement), the surgeon’s movements at the console are translated to the tips of the instruments. The da Vinci Surgical System provides the surgeon access through small incisions without giving up the dexterity, precision and instinctive movements of open surgery. Using motion scaling, this system reduces hand movements to corresponding smaller instrument tip movements in the surgical field. Several settings allow the surgeon to optimize scaling for different clinical applications. The natural tremor of the surgeon’s hand is eliminated through electronic filtering, which ensures stable and predictable instrument control.

The instruments have almost the same range of motion as the human hand: they feature a total of six degrees of freedom plus grip, two more at the tip than traditional endoscopic instruments. Tip articulation mimics the up/down and side-to-side flexibility of the human wrist. These articulations extend the surgeon’s minimally invasive abilities to a new level. In this system, the surgeon sits remote from the patient at an operating console adjusted to provide an optimal ergonomic environment. In the future, being able to operate at a workstation remote from the patient has the potential benefit of providing advanced surgical care to patients in underserved areas.

Robotic surgery today
Today the use of new robotic surgical systems and advanced surgical instruments is growing rapidly among many health care specialties. At many institutions, including Weiss, robotic surgery is routinely employed and all the operative room personnel are very familiar with the system. With any new technology, there is room for improvement and expansion. The first reports on robotic surgery were scarce, with only a few case series. Today, however, you can find large series in complex procedures. There is no doubt with the development of new techniques supported by technological growth, robotic surgery may soon be the standard of care for many diseases.

Robotic surgery is applied today in urology, gynecology, cardiothoracic procedures, pediatrics, oncology, colorectal and general use. Robotic gastrointestinal surgery is entering its second decade and passing through its second phase of clinical development.

With the assistance of robotic technology, surgeries that require very complex techniques can be performed in a minimally invasive fashion, avoiding a large incision. This benefits the patient in several ways: less pain, a shorter hospital stay, faster recovery and even a better cosmetic result since very small incisions are used.

Operations—ranging from liver resections and complex pancreatic resections to treatments for esophageal, gastric and colorectal disorders, adrenal gland and spleen diseases, hiatal hernias and paraesophageal hernias—are performed every week with the assistance of robotic technology at Weiss Memorial Hospital.

There is no doubt that with the rapidly evolving technology and the expansion of clinical applications more sophisticated robotic tools will assist surgical teams in the near future.

The robotic general surgical team at Weiss
At Weiss, our team of highly trained robotic general surgeons performs a variety of complex robotic-assisted procedures on a weekly basis. Out team is under the leadership of Dr. P.C. Giulianotti, a pioneering surgeon in the field of robotic surgery.

The general surgery robotic team at Weiss includes Dr. P.C. Giulianotti, Dr. Fabio Sbrana and Dr. Enrique Elli.

For more information
If you would like more information about robotic-assisted surgery or would like to schedule an appointment, please call (312) 355-1493 or e-mail Dr. Elli at eelli@uic.edu.