Minimally Invasive Robotic Technology Is Changing Surgery (video)

Unlike open surgery which usually requires a large incision across the surgical area, minimally invasive surgery (also known as laparoscopic surgery) is performed using just a few very small incisions. The surgeon inserts a tiny video camera and slender surgical instruments through the incisions and, guided by images projected onto a video screen, manipulates the surgical tools to perform the procedure. Because the surgery is less invasive, it can offer benefits, including faster recovery times, less pain and scarring, fewer risks of complications and a quicker return to activities.

However, this type of minimally invasive surgery does have limitations.

“Unfortunately, it is limited to very straightforward surgeries,” says Dr. Salem. “You’re operating through keyhole openings with instruments that you rotate using your own wrist, and your movements are limited. Plus, you’re using the video as a guide, so your movements must be sort of the opposite of what you’re seeing on the camera. Any time we tried to expand it to more complicated surgeries, it was super challenging and just not feasible.”

Enter robotic technology, which allows surgeons to perform surgery using robotic “arms” inserted into the surgical area through tiny incisions. Guided by high-definition, three-dimensional video that magnifies the surgical area up to 10 times larger than normal vision, the surgeon stands at an instrument panel and controls every movement of the robotic arms. As the surgeon moves their hand, wrist and fingers, the robotic arms perform the same movements, giving the surgeon much more dexterity.

“This robotic technology is absolutely phenomenal,” says Dr. Salem. “It allows surgeons to see much greater detail and manipulate surgical tools in ways that human hands cannot, so minimally invasive surgery can be applied to many more complicated surgeries that we couldn’t do before.”

At Scripps, more than 60 specially trained surgeons now use minimally invasive robotic surgery for procedures ranging from basic to very complicated. Robotic technology is used for surgery on the lungs, prostate, gallbladder, kidneys, pancreas and even cardiac surgery.

“Minimally invasive robotic heart surgery is one example of where the difference in the patient’s experience is extreme,” says Dr. Salem. “We used to have to make a large incision across the patient’s chest to open it and insert a cardiac valve, and that was a very invasive procedure that left a significant scar. Now the same procedure can be done robotically through three small holes that leave only tiny scars.”

Robotic technology also can perform many types of gynecological procedures, including surgery for endometriosis, fibroids, pelvic floor prolapse and hysterectomy. In some cases, the surgeon may be able to remove the uterus through a single incision hidden in the belly button, leaving no visible scar.

With a few exceptions, most patients are able to have robot-assisted procedures. In fact, Dr. Salem says, robotic technology has made surgery possible for more people who weren’t candidates for open surgery.

Because it is less invasive, says Dr. Salem, robotic surgery can significantly reduce recovery times in many cases. But it is important to remember that it is still surgery.

“It depends on what organ we’re talking about, but in general, you could easily say it improves recovery time by at least 50 percent,” she says. “But as with any surgery, there is going to be a recovery period. Your body still has to rest and heal.”

Additionally, like any surgery, minimally invasive robotic surgery has risks, such as infection and other complications. If you’re considering this type of procedure, talk with your surgeon about potential risks.

Dr. Salem points out that using robotic technology is a skill that requires extensive training and expertise.

“The technology is great, but you have to have the experience behind it,” she says. “Scripps surgeons, with their experience and their expert surgical teams, have really been able to take full advantage of this type of technology.”