Robotics in Medicine Hysterectomies Prostatectomies Surgery Advancements

Imagine a 6-foot tall robot in the operating room with three arms and a computerized bedside console the size of an X-Box. Is it bizarre science or a patient’s best friend? Whichever one it is, its time has arrived.
Medical robots were first introduced about 20 years ago, according to USMD gynecologist Dr. Gary Donovitz of Arlington, Texas.
The most common uses of robotics in the Metroplex are hysterectomies and prostatectomies, but soon, bladder and cardiac applications are expected to be added to the area’s robotically-assisted surgery menu.
“The use of robotics is expanding pretty quickly,” Donovitz said. “I anticipate six more robots to be added to Metroplex hospitals in the next two years.”
Robotically-assisted surgery has the main advantage of being minimally invasive, but there are other benefits, he said. For example, incisions are smaller, there is less risk of infection, hospital stays are shorter, and recuperation time is reduced.
However, there are challenges to minimally invasive surgery. The equipment requires a surgeon to move the instruments while watching a video monitor. The surgeon must move in the opposite direction from the target on the monitor to interact with the correct area on the patient, so hand-eye coordination and dexterity aren’t compromised.
Donovitz explained that the robot’s keen eye provides a 10X magnification compared to a laparoscopic camera’s 4X.
“The camera on the robot has a left and right field of vision, enabling the surgeon to operate in three dimensions,” Donovitz said. “It’s more precise and it makes more complex procedures easier.”
Donovitz said he started his robotic program in Oct. 2005, shortly after robotics for hysterectomies were approved by the FDA. The company that made the robot he uses asked him if he would pilot the program in the Metroplex area.
Donovitz now leads the charge in training other physicians in the region. Prospective candidates start by accumulating 24 hours in an animal lab, learning to use the robot, including how to suture.
He said in his own practice, robotics has reduced the number of cases of women who have to be opened up for a hysterectomy from a standard 20 percent to 4 percent. In addition, the robot is used for tubal reversals, prolapsed vaginal vault, severe endometriosis and the removal of fibroid tumors.
Urology patients are also benefiting from the new technology.
Dr. Justin Lee serves as the director of robotic surgery for the Urology Associates of North Texas, located in Arlington. UANT has been using a medical robot to operate on prostatectomies since 2003. Further, urologists use the robot for partial or full nephrectomies, which removes cancerous tumors from the kidney.
“The amount of blood loss is greatly reduced,” Lee said. “For example, out of the 800-plus robotic surgeries I’ve performed, only two have needed a blood transfusion, compared to as many as 20 percent of patients with traditional surgery.”
He said the main benefit for patients is that recovery times are so much shorter.
“We’re seeing significantly less hospital stays from the former 3-5 days to about 24 hours,” Lee said. “The need for pain medication is usually treated now with over-the-counter preparations like Tylenol and Advil, compared to the old morphine pain clicker.”
He said when he enters the room these days, post-surgery patients are usually smiling instead of grimacing.
Dr. Rich Bevan-Thomas, another UANT urologist, said patients also regain continence and erectile function much more rapidly with robotically-assisted surgery.
“A robot is basically an enhancement for laparoscopic surgery,” Bevan-Thomas said. “It allows us to do more specific and finite, indeed, delicate movements.”