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Robot-Assisted Surgery—Overview
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Robot-Assisted Surgery—Overview

En Español (Spanish Version)

Overview; Urologic Procedures ; Laparoscopic Procedures ; Cardiac Procedures ; Thoracic Procedures

Definition

A surgeon guides small robotic arms through several tiny “keyhole” incisions to perform this surgery, allowing for greater range of movement than a surgical hand.

Parts of the Body Involved

  • Abdomen
  • Prostate
  • Heart
  • Lungs
  • Esophagus
  • Blood vessels
  • Uterus

Reasons for Procedure

Robot-assisted surgery is considered for procedures that require precision and do not require open access, especially laparoscopic procedures. Performing surgery in this way can result in less scarring, reduced recovery times, less risk of infection, less blood loss, and reduction in stress response compared to more invasive procedures. If necessary, this method can be abandoned during surgery and the surgeon can take over with a more traditional laparoscopic or open surgery approach. Robotic surgery is performed to treat a variety of conditions, including:

  • Gallbladder disease
  • Severe heartburn
  • Prostate disease
  • Gynecologic problems
  • Urinary problems
  • Heart disease
  • Lung disease
  • Obesity

Many types of surgery, including pediatric surgery, can now be performed with the assistance of a robot, including:

    Risk Factors for Complications During the Procedure

    A risk factor is something that increases your chance of having complications during your procedure. Obesity is a risk factor.

    What to Expect

    Prior to Procedure

    Depending on the reason for your surgery, your doctor may do the following:

    • Physical exam
    • Blood tests
    • Electrocardiogram
    • Chest x-ray
    • Ultrasound—a test that uses sound waves to visualize the inside of the body
    • CT scan—a type of x-ray that uses a computer to create images of the inside of the body
    • MRI scan—a test that uses magnetic fields and radiowaves to create images of the inside of the body

    The days before and the day of your procedure, you will:

    • Review your medications with the surgeon; you may need to stop taking some drugs
    • Follow a special diet, if recommended by your surgeon
    • Take antibiotics, if prescribed by your doctor
    • Shower the night before your procedure using antibacterial soap, if your doctor asks you to
    • Need to arrange for someone drive you to and from the procedure, and for help at home afterwards
    • Eat a light meal the night before
    • Not eat or drink anything after midnight unless otherwise instructed by your doctor
    • Need to wear comfortable clothing

    Anesthesia

    General or local with sedation

    Description of the Procedure

    Small "keyhole" incisions being placed in preparation for a robot-assisted surgical procedure

    factsheet image

    © 2008 Nucleus Medical Art, Inc.

    The surgeon cuts several small (approximately one centimeter) “keyhole” openings in the skin near where the surgery will take place. In most cases, a needle is used to inject carbon dioxide gas into the area around the surgical site, making it easier for the surgeon to see internal structures.

    The surgeon passes a small camera (endoscope) through one of the incisions, which lights, magnifies, and projects an image of internal organs onto a video screen for the surgeon to see. The endoscope is attached to one of three or four robotic arms that form part of surgical system. (There are currently two robotic surgical systems approved by the Food and Drug Administration for use in the United States: the da Vinci Surgical System and the ZEUS Robotic Surgical System.) The other two or three arms hold other instruments such as dissectors, scissors, scalpels, and/or forceps. These instruments are able to grasp, separate, cut, and sew tissue during the operation.

    While sitting at a console several feet away from the operating table, the surgeon looks through lenses at a magnified three-dimensional image of the inside of the body. Another surgeon will stay by the patient during the procedure, where he can adjust the camera and instruments as needed.

    With joystick-like hand controls and foot pedals, the surgeon at the console guides the movement of the robotic arms and surgical instruments. By filtering out hand tremor and translating the surgeon’s larger hand movements into smaller ones, the robotic arms are able to perform surgical tasks with increased range and dexterity than would be possible using traditional surgical techniques.

    After the endoscope and other instruments are removed, the surgeon closes the incisions with stitches or staples, and applies a sterile dressing.

    After Procedure

    Depending on the reason for the procedure, some of the tissue that was removed may be sent to a pathologist for examination.

    How Long Will It Take?

    Usually 1-2 hours or less, but this depends on the type of procedure being done.

    Will It Hurt?

    Anesthesia prevents pain during surgery. Patients typically experience pain and soreness during recovery, but receive pain medication to relieve the discomfort. You may also feel bloated or have pain in your shoulder from the gas used during the procedure. This can last up to three days.

    Possible Complications

    • Damage to neighboring organs or structures
    • Infection
    • Bleeding
    • Anesthesia-related problems
    • Open surgery—sometimes it becomes necessary during the procedure to abandon the robotic method and perform the surgery using traditional methods

    Average Hospital Stay

    A benefit of robotic surgery over traditional surgery is that it permits shorter stays in the hospital. Depending on the procedure, most patients usually require only a few days of hospital care.

    Postoperative Care

    If all goes well, you will likely be encouraged to get up and out of bed the same day of or the day following your procedure. You will receive instructions on when and what you can eat, and to what extent you need to restrict your activity. You will to limit your activities for the first days or weeks of your recovery.

    Outcome

    Depending on your procedure, you should be able to resume regular activities within a few weeks after your procedure. Based on evidence available to date, the risks of robotic surgery appear to be less than the traditional surgeries it is designed to replace.

    Some benefits of successful robotic surgery over traditional surgery include:

    • Reduced trauma to the body
    • Reduced risk of blood transfusion
    • Shorter hospital stay
    • Faster recovery

    Call Your Doctor If Any of the Following Occurs

    It is essential for you to monitor your recovery once you leave the hospital. That way, you can alert your doctor to any problems immediately. If any of the following occur, call your doctor:

    • Signs of infection, including fever and chills
    • Redness, swelling, increasing pain, excessive bleeding, or discharge from an incision site
    • Cough, shortness of breath, chest pain, or severe nausea or vomiting
    • Pain, burning, urgency, frequency of urination, or persistent bleeding in the urine
    • Pain and/or swelling in your feet, calves, or legs, or sudden shortness of breath or chest pain
    • Nausea, vomiting, and/or diarrhea
    • Headache, muscle aches, feeling faint or dizzy
    • Other worrisome symptoms

    RESOURCES:

    American College of Surgeons
    http://www.facs.org

    Food and Drug Administration
    http://www.fda/gov

    CANADIAN RESOURCES:

    BC Health Guide, British Columbia Ministry of Health
    http://www.bchealthguide.org

    Canadian Agency for Drugs and Technologies in Health
    http://www.cadth.ca

    References:

    Computer-assisted surgery: an update. Food and Drug Administration website. Available at: http://www.fda.gov/fdac/features/2005/405_computer.html. Accessed June 20, 2006.

    The da Vinci surgical system. University of Southern California Keck School of Medicine website. Available at: http://www.cts.usc.edu/rsi-davincisystem.html. Accessed June 20, 2006.

    Robotic surgery. Brown University website. Available at: http://biomed.brown.edu/Courses/BI108/BI108_2005_Groups/04/. Accessed June 20, 2006.

    Robotic surgery. Thinkquest website. Available at: http://library.thinkquest.org/03oct/00760/. Accessed May 1, 2008.

    Robots lend a helping hand to surgeons. Food and Drug Administration website. Available at: http://www.fda.gov/FDAC/features/2002/302_bots.html. Accessed June 20, 2006.



    Last reviewed May 2008 by Rosalyn Carson-DeWitt, MD

    Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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