JANUARY 17, 2013 SHANNON ADAIR, DIETETIC INTERN

Robotic Surgery

Outline

What is robotic surgery?

DaVinci robots

Indications

Procedures available

Treatment

Limitations/ Contraindications

Risks/Side effects

Results

Recovery time

Nutrition

What is robotic surgery?

A minimally invasive alternative to standard or laparoscopic surgery

Surgeon performs surgery by using a computer that remotely controls tiny instruments attached to a robot

Less invasive than traditional surgery, more precise than laparoscopic surgery.

DaVinci Robots

Named after Leonardo DaVinci, student of anatomy and inventor of the first robot

Robotic surgery started to grow through the 80’s and 90’s.

First robotic surgery marketed in 1985

First DaVinci robot marketed in 1999 with FDA approval in 2000

Gold standard of robotic surgery

PHYSICIAN CONSOLE FOUR-ARMED TOWER

Standard DaVinci Set up

Indications

Urology

Gynecology

Cardiothoracic

General Surgery

Colorectal

Head and Neck

Used for both simple and complex procedures. Possible surgery specialties include:

IndicationsCommon conditions treated:

Bladder Cancer

Colorectal Cancer

Coronary Artery Disease

Endometriosis

Gynecologic Cancer

Heavy Uterine Bleeding

Kidney Disorders

Kidney Cancer

Lung Cancer

Mitral Valve Prolapse

Obesity

Prostate Cancer

Throat Cancer

Uterine Fibroids

Uterine Prolapse

Procedures AvailableCoronary artery bypass

Cutting away cancer tissue from sensitive parts of the body such as blood vessels, nerves, or important body organs

Gallbladder removal

Gastric Bypass

Hip replacement

Hysterectomy

Kidney removal

Kidney transplant

Mitral valve repair

Pyeloplasty (surgery to correct ureteropelvic junction obstruction)

Pyloroplasty

Radical prostatectomy

Tubal ligation

TreatmentPt placed under general anesthesia

1-2 cm incisions made for robotic insertion into the abdomen

Surgeon sits at a station nearby to control the robot

High definition 3D camera attached to robot to enable surgeon to see better and more fully than possible laparoscopically

Robot reduces surgeons movements, moving 1/2 inch for every 1 inch the surgeon moves (decreases tremors, increases precision) and gives higher range of motion than laparoscopy

Difference between standard and roboticProstate removal surgery

Limitations/ Contraindications

May take longer, as the robot takes time to set up

Expense limits availability

Not available for certain complex surgeries that require greater ability to move instruments (i.e. some heart surgeries)

Risks/Side Effects

Standard anesthesia risks (reactions to medication, breathing problems)

Standard surgery risks (bleeding, infection)

Risks may be lower than for open or laparoscopic surgeries

Results

Results are the same as standard/laparoscopic results, depending on the procedure

Results may have fewer negative consequences than with standard/laparoscopic surgeries

Dr. Marshall at OSF says gastric bypass outcomes are the same whether done laparoscopically or robotically

Some physicians prefer robotic surgery

Recovery TimeDepends on specific surgery performed.

Pts typically able to walk within 1 day

Because robotic surgical cuts are typically smaller, robotic surgery may lead to:

Faster recovery

Less pain and bleeding

Less risk of infection

Shorter hospital stay

Smaller scars

Nutrition

NPO for 8 hours prior to surgery

Depending on procedure performed, pt may be required to take an enema or laxative the day prior to surgery

Increased calorie and protein needs for healing

Ten days before surgery, pt must stop taking aspirin, blood thinners (coumadin), and supplements (vitamins & minerals)

Nutrition PrescriptionStandard post-surgery diet initiated:

Clear liquids

Advance diet as tolerated

Avoid fatty foods initially

Avoid constipation by consuming enough fiber and water

Future Possibility•Telesurgery

•Major obstacle is latency (surgeon to robot time)

Questions?

ReferencesBonsor, Kevin, and Jonathan Strickland. "How Robotic Surgery Will Work." HowStuffWorks. N.p., n.d. Web. 15 Jan. 2013. <http://www.howstuffworks.com/robotic-surgery1.htm>.

"The DaVinci System." Intuitive Surgical. N.p., n.d. Web. 15 Jan. 2013. <http://www.intuitivesurgical.com/company/history/system.html>.

"Robotic Surgery." Robotic Surgery Benefits. Mount Sinai School of Medicine, n.d. Web. 15 Jan. 2013. <http://www.roboticoncology.com/robotic-surgery/>.

"Robotic Surgery." U.S National Library of Medicine. U.S. National Library of Medicine, n.d. Web. 16 Jan. 2013. <http://www.nlm.nih.gov/medlineplus/ency/article/007339.htm>.

"Surgery Enabled by Da Vinci." Da Vinci Surgery. N.p., n.d. Web. 15 Jan. 2013. <http://www.davincisurgery.com/da-vinci-surgery/>.