1 week Ago By Uma Raja
Jami Greer was waiting for her 12-year-old daughter to come out of surgery when she received a confusing text: “The robot has docked.”Mia Greer, a patient at UF Health, had already received laparoscopic surgery for a 12-pound ovarian cyst on Jan. 1.
When the cyst returned, pediatric surgeon Steven Raymond recommended robotic surgery, which offers an increased visual field, to ensure that it didn’t come back.“I describe robotic surgery to patients compared to laparoscopic surgery. In laparoscopic, I would be standing directly at the bedside using long, skinny instruments to do the operation, versus me sitting about five feet away on the robotic console and using my hands controlling the robotic at bedside,” Raymond said.
Raymond is the director of pediatric surgery at UF Health and an assistant professor of pediatric surgery at the University of Florida who has performed over 100 robotic surgeries.Jami Greer researched the meaning of the text and discovered that the medical team had placed the robot inside of her daughter’s body so the surgery could begin. Mia Greer was able to return home on March 7, the same day as the operation, and had minimal pain after her four incisions.
She is back to riding horses and attending school, with no evidence of the cyst’s return.Robotic surgery offers patients an advanced technology that reduces recovery time and the length spent in the hospital. However, the scope of the technology is limited, and some risks can be decreased during traditional surgery.
What is robotic surgery?“It’s a minimally invasive surgical technique using very small incisions,” said Avraham Belizon, physician surgeon at Baptist South Florida and robotic surgery training program director at Florida Atlantic University. Belizon was an early adapter of the technology in 2010 and has completed over 3,000 robotic surgeries. “And the technology that is utilized in laparoscopy is using a camera instead of a big incision to open up the abdomen.
And that allows for you to utilize small instruments through small incisions to minimize the trauma of the surgery.”Doctors control a robot that typically holds three surgical instruments and a camera with its four arms. A human assistant takes care of the patient at the bedside, performing tasks such as manipulating the uterus for a hysterectomy.
“There’s a console, you have hand controls, you’re looking into the console, it’s kind of like an Oculus headset in 3D and 4K,” said Scott Jordan, a gynecologic oncologist at Broward Health Medical Center. Jordan completes three to five robotic surgery cases per week. “Everyone else has a 2D image; the surgeon has the best view.
”Raymond describes the technology as similar to how hand movements scale when using a mouse for a computer.“You can move your hand within space on the robotic console a certain distance, but that will translate to only moving it a couple millimeters inside the patient. So therefore it allows you to have more detailed movements, smaller movements,” Raymond said.
The field of robotic surgery has expanded and it is commonly used for general surgery, urology and gynecology. Doctors are always in control of the robot, and artificial intelligence is not used.“You’re controlling robotic arms that have pretty rudimentary innards that are controlling the motion of the wrist, the twist of the instruments; you’re controlling all of that being used by a computer system instead of thinking about how to manipulate the instrument.
There’s no AI, there’s no autopilot — it’s a tool,” Jordan said.The prosRobotic surgery offers a visual field that is magnified 10 times stronger than the human eye. Jordan describes patients waking up from the surgery without realizing that it was over, since the tiny incisions cause less pain than other forms of surgery.
“The pros are quicker recovery, less chance of conversion to a traditional open traumatic operation and less blood loss. The fact is that the patient can return to their normal activity or their job a lot sooner because their recovery is quicker,” Belizon said.According to Tom Nguyen, chief medical executive of Baptist Health Miami Cardiac and Vascular Institute, even the best surgeons have a micro-tremor in their wrist.
Surgeon’s wrists are also limited by the degrees of articulation in human joints.“The robot can eliminate pretty much any tremor that anyone has. You can do an incredibly precise operation with sutures thinner than your hair follicle.
With a human hand, you can only rotate it so many degrees. But with the robot, you have almost an infinite number of degrees or articulation,” Nguyen said.Related Articles‘Within millimeters of accuracy’: Surgeons can practice on realistic bleeding models of their patientsFAU study reveals a surprising new way to relieve back painMany surgical complications stem from an incision, according to Jordan.
Obese and diabetic patients have a lessened risk of complications when the incision size is decreased through robotic surgery.“We’ve got the typical endometrial cancer patient, somebody that’s overweight, has multiple comorbidities and would’ve needed an open hysterectomy, maybe stayed in the hospital for four days to a week and would’ve had significant risk for wound complications. My patients leave the same day or the next morning,” Jordan said.
Intuitive’s da Vinci surgical robot, which has a monopoly on FDA-approved robotic heart surgeries, according to Nguyen, is currently rolling out its fifth-generation model. Artificial intelligence is used in Intuitive training modules to provide feedback to surgeons.“By using AI, it can better assess and give you a score of how good of a robotic heart surgeon you are.
Again, it’s not operating on humans, but whether it be moving pegs around and suturing little holes, it can also potentially build scenarios that are appropriate for who you are,” Nguyen said. “So if you are a mediocre surgeon, then it’ll give you a very tailored course on what kind of modules it goes through versus someone who’s a lot more experienced.”The consRobotic surgery is limited by its nickel-sized incisions.
It is unable to assist with tasks such as a cesarean section, where something large needs to be removed intact, or with suturing inside of the chest. When operating on multiple parts of the heart, a tiny robotic incision does not provide the full access that surgeons need.“If I have to go in and either make one of the incisions bigger to get the specimen out or make an entirely new incision altogether, I could have just done the surgery through that bigger incision,” Jordan said.
Currently, there is no formal training program to ensure that a doctor is adept at robotic surgery. According to Nguyen, Intuitive abandoned its specific training program due to a slow adoption rate from doctors who had to take the time to learn a new skillset. Patients rely on the judgment of the hospital that their surgeon is capable of operating the robot.
“The company Intuitive da Vinci has training modules that you can do, and I think there’s completion certificates for having done those modules, but not something that’s formally regulated by any kind of board of surgery to ensure your surgeon is able to do robotic surgery,” Raymond said.Patients sign a consent form for their operation and agree to the use of a robot. They have a right to refuse any operation and can discuss concerns with their surgeon.
However, they do not have to sign a consent form acknowledging that their doctor might be a novice at robotic surgery.“Sometimes we do stuff for the first time. And I think as physicians, we have a responsibility to be very objective.
And if it is the first time, then have a disclosure of primacy,” Nguyen said.According to Makoto Hashimoto, cardiac surgeon at Baptist Health Miami Cardiac and Vascular Institute and professor and director of robotic cardiac surgery at Florida International University, da Vinci robots cost hospitals between $1.5 million and $2 million.
Disposable robotic instruments are also more expensive than disposable laparoscopic instruments.“There are studies that show that it is actually cost effective, because even though the operation time, operational cost is more expensive, the patients go home faster and spend less time in the ICU and the hospital, so you save money there,” Nguyen said.Some insurance companies are hesitant about funding new technology.
Hashimoto, who performs 10 robotic heart surgeries a month, recently postponed a case because the patient’s insurance did not cover robotic surgery.Excessive scar tissue in patients can also cause surgical complications.“And with some patients it’s a little bit harder if they had prior surgery.
Depending on the type of operations, anatomic considerations can be an exclusion for the robot,” Nguyen said.Mistakes can happenAfter 78-year-old Diane Colletti received her robotic-assisted hysterectomy surgery in Palm Beach County in 2022, she died from sepsis caused by an unnoticed perforation in her bowel. Her husband Gareth Colletti received $1.
2 million in damages in February after a lawsuit against the doctor who performed her robotic surgery.“You don’t get the same feel as if you were touching the colon or slicing through adhesions with your hands. You don’t actually feel the pressure, the tension, with the robotics,” said Samuel Yaffa, a co-lead trial counsel representing the estate of Diane Colletti.
“You don’t, but (the doctor and her team) testified that with operator experience, you overcome that deficiency that exists in robotics.”Diane Colletti’s hysterectomy surgery was a routine procedure that usually takes 30 to 45 minutes. The doctor encountered significant scar tissue from previous operations and perforated two areas of the bowel.
While the doctor fixed one mistake, the other was overlooked, according to Yaffa.“I wouldn’t say that the robotic procedure in and of itself is what caused this. I think that this lady had extensive scar tissue and adhesions (from previous operations) that made any type of laparoscopic procedure, robotic or otherwise, more difficult,” said Andrew Yaffa, a co-lead trial counsel representing the estate of Diane Colletti.
The future of robotic surgeryAccording to Hashimoto, robotic heart surgery has existed for 10 years and became a standard within the past five years. The practice has doubled in the past two years, and with each day that passes, different forms of robotic surgery continue to grow.“The total robotic surgery including (general obstetrics), general surgery, lung surgery, was almost 3 million cases a year.
Last year, 2024, robotic cardiac surgery was 13,000. So it was like 0.5 percent of all robotic surgery,” Hashimoto said.
“It’s a real developing field. And almost half of the cases were done here in the United States.”Artificial intelligence could play a role in assisting surgeons.
In the future, technology could guide doctors while also expanding the access people have to healthcare.“(AI could) learn what a traditional operation is, if you’re about to cut something that you’re not supposed to cut, then it’ll warn you. Or if you are following a sequence of events that isn’t kind of the typical sequence, it could let you know,” Nguyen said.
Telesurgery is the concept of robotic surgery without the doctor being in the same room. Surgeons who live in different states or even different countries could operate on people without the limitations of being in the same physical location.“You can really have experienced robotic heart surgeons like Dr.
Hashimoto and others be able to operate in parts of the world or the region that might not have the ability to have that experienced heart surgeon there, but they could have all the benefits of robotic heart surgery,” Nguyen said..
