Depending on your perspective, the idea of robotic surgery can seem either progressive or disconcerting. Dr. Ramy A. Awad, a bariatric surgeon at Desert Regional Medical Center in Palm Springs, recalls how some patients reacted when he began performing procedures robotically in 2013: “Robotic surgery? You mean a robot is going to perform my surgery? What will you be doing — reading a book?”
Hardly. It would be more accurate to describe this method of surgery as “robot-assisted.” A clinical robotic system typically involves a camera and mechanical arms with surgical instruments attached to them. The surgeon controls the arms remotely, usually while seated at a nearby computer station.
The benefits to both patient and surgeon are manifold. Surgeons find that the robotic system enhances their precision, flexibility, and control and provides them with an especially intimate view of the surgical site — often into quadrants of the body not readily visible to the naked eye. The method is also ergonomically friendly, which is especially advantageous during long procedures.
“We’re able to perform far more complex procedures because the computer interface makes our placement and usage of instruments infinitely more precise,” says Dr. Bobby Bhasker-Rao, a bariatric surgeon at Eisenhower Health in Rancho Mirage. Considered a trailblazer, Bhasker-Rao performed the first robotic bariatric surgery in Southern California in 2011.
The minimally invasive nature of most robot-assisted surgeries means fewer complications. Incisions are typically small, and patients experience less trauma and pain as well as noticeably less scarring. This translates into shorter hospital stays and quicker recoveries.
It Began with da Vinci
Early surgical robot prototypes had a special focus. Hypothesized as far back as 1967, they were intended for long-distance trauma surgery in battlefield settings. It was a plan supported by the Department of Defense and the procedures were essentially telesurgery performed remotely with robotic assistance.
Innovative medical companies — in many cases headed by doctors — leaned into the research, imagining what it could accomplish in the average hospital operating room. It led to the development of the first fully functional multipurpose surgical robot. The most prominent is the da Vinci Surgical System, which was developed by Intuitive Surgical Inc. and gained FDA approval for general laparoscopic surgery in 2000.
Urologists were among the first professionals to find success using robotics, particularly while performing prostate surgeries. Today, 85 percent of prostate surgeries are performed robotically. Colorectal surgeons soon discovered the efficacy as well.
Dr. Iyoob Ilyas, a colon/rectal and general surgery specialist at Eisenhower Health, performs 99 percent of his surgeries robotically and has done so since 2016. “In 2021, I performed only three open operations. Everything else, hundreds of other cases, I did robotically including emergency operations.”
While completing his fellowship in colorectal surgery at Henry Ford Hospital in Detroit, Ilyas was among the first group of fellows to be trained and certified in robotic surgery. “Detroit is a high-volume center for robotic surgery,” he says. “In fact, the first prostate surgery performed robotically was done at Henry Ford Hospital.”
“The robot is an extension of me, and I have ultimate control.”
— Dr. Ramy A. Awad
The Scope Widens
Other types of surgeons have noticed the superior outcomes achieved using robotics in procedures involving internal organs. Dr. Douglas Roger, an orthopedic surgeon who specializes in minimally invasive hip and knee replacement surgery and director of joint replacement surgery at Desert Regional Medical Center, looked into robotics approximately four years ago. “I had some doubts and questions, because we were already getting very good results with our hip and knee replacement program,” he recalls.
After taking an instructional course and observing a colleague in Tucson, Arizona, who was proficient on the Mako, the FDA-approved robotic unit for knee and hip replacement, Roger became a believer in the technology. “Robotics offer a previously unavailable level of surgical precision,” he concedes. “We combine robotic technology with the enhanced recovery and minimally invasive surgical techniques we’re already known for, so patients get the best of all worlds.”
Meanwhile, patients have come to realize no actual robots perform their surgery. There is no automation involved. “I tell my patients robotics is kind of a misnomer but it’s a cool term, so the surgical field adopted it,” Ilyas says.
Awad, who was introduced to robotics during his fellowship training, explains, “The robot is an extension of me, and I have ultimate control. It translates to better patient outcomes because there’s no variability. You get very reproducible results independent of your assists in the operating room — which is particularly significant considering the staffing shortages most hospitals are currently facing.”
Demand for robotic surgery has supplanted the patient apprehension that existed a decade ago. “Today, if patients can’t get a procedure done robotically, they don’t want to proceed,” Bhasker-Rao says.
Robotics have become an integral part of the curriculum for up-and-coming surgeons, and hospitals want to hire surgeons who are trained in this technology for the future.
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