Robotic Surgery of the Colon: The Peoria Experience

Abstract

The advance of technology in the recent era of surgery has outpaced the ability of the medical community to adequately interrogate the true utility of certain techniques prior to their widespread adoption. Often hospitals and patients within a community seeking the latest technology become a driving force for surgeons to adopt new techniques. Ideally, the benefit of these measures are examined and discussed within the surgical community prior to their establishment as "common practice." Many surgeons would argue that the true role for robotics in surgery is yet to be properly defined. Certainly there is an appeal for hospitals in marketing themselves as centers offering robotic surgery, and for surgeons to be promoted as regional experts in robotics and minimally invasive surgery. Although they may not know why, patients request robotic surgery in the hopes that they are receiving the most advanced care possible. We as surgeons, however, must decide when the application of robotics is truly advantageous. There is no doubt that the robot enhances the technical ability of the surgeon in ways that common laparoscopic techniques currently do not. The wristed instruments increase the maneuverability of the operating instruments with two more degrees of freedom than traditional laparoscopic instruments. The robot adds internal pitch and yaw to the pitch, yaw, grasp, rotation, and in-and-out motions of the laparoscopic instruments. The end result is that the instruments mimic the motion of a surgeon's hands with the added benefits of tremor reduction and motion scaling. Confined spaces such as the pelvis and mediastinum provide arenas where these benefits are best realized. The visualization offered by the da Vinci system also serves as an enhancement to traditional laparoscopy. A stereoscopic camera allows for representation in both twodimensional and three-dimensional views. The three-dimensional view provides a clarity and depth of field which further improves the surgeon's ability to discriminate among tissue planes. Furthermore, the surgeon has the added benefit of control over the camera with one of the robot arms. This eliminates the frustration that can be met with inexperienced or fatigued camera operators and enhances the ability of the surgeon to complete difficult maneuvers in an efficient fashion. Another benefit of robotics not to be overlooked is the reduction of surgeon fatigue. The long term toll of laparoscopy on an individual surgeon may still not be fully realized given the fairly recent adoption of laparoscopy into the every day practice of many surgeons. Over the course of a twenty to thirty year career, the stresses of awkward positioning and maneuvering may prove to be detrimental to the health of many operating surgeons. During a robotic procedure, the surgeon is sitting comfortably with arms and head resting against padded surfaces. Recentering of hand controls eliminates the cumbersome task of maintaining positions beyond the normal range of comfort and convenience. Control of the visual field with the head comfortably supported reduces the neck strain often encountered during many laparoscopic procedures. Although the immediate benefit to any given patient is difficult to demonstrate, the pending dilemma of physician shortage reminds us that