Robot Gives Surgeon Four Arms (Video)

Surgical robot ideal for some procedures

Most of my surgeries are done laparoscopically. That means that instead of making a long painful incision, I can take out a colon using tiny incisions that are hard to see and cause less pain after surgery.

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I get to try the newest innovations in the field of laparoscopy. This includes a robot that transforms my two arms into four operating arms that I can control myself!

Here are some common questions patients ask me about robotic surgery:

Q: What are the robots like? How do you use them for surgery?

A: During a robotic surgery, I can use four robotic arms at once – rather than my own two hands – and perform minimally invasive surgery.

I can move each arm as though it had a human wrist at the tip of the instrument. The flexibility really helps out with suturing or maneuvering in tight spaces like the pelvis.

Q: How does the robot help you see better while you are operating?

A: During open surgery, we usually stand one to two feet away from where we are operating. In the pelvis, we have to operate behind the pubic bone, so it is very difficult to see small nerves and blood vessels around a corner from that far away.

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When I’m performing a regular laparoscopy, the camera is like only having one eye. This means that there is only two-dimensional vision – no depth perception. The more you practice, the better your learned depth perception gets.

However, it is much easier to see what I am doing with the robot because the robotic camera has the equivalent of two eyes. When I look in, I have normal depth perception as if my own eyes were able to get to where the camera can go. Now, we can drive the camera under the pubic bone and look at those nerves and blood vessels from inches away. The difference is night and day.

Q: When do you like to use a robot?

A: The robot helps in tight spaces that require suturing so it is great for prostate and uterine surgeries. It helps in the pelvis, so it is good to use when treating rectal cancer and for repair of rectal prolapse.

Patients with pathology in one area are good candidates: those with prostate cancer, bladder cancer, rectal cancer, rectopexy, needing hysterectomy or ovaries removed.

Q: Can you treat hemorrhoids with a robot?

A: Not usually. While the robot is very helpful in some areas, it takes longer and costs more in others. So for colon, small bowel I prefer to use laparoscopy without the robot. There are many new techniques for internal hemorrhoids, but the robot is not one of them.

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Q: What is the typical recovery time?

A: For a rectal resection, patients are generally in the hospital from four to seven days and recovering at home for about six weeks. Generally, there is less pain, less blood loss and shorter hospital stays than with open surgery.

Q: Are there times when robotic surgery is less ideal than traditional surgery?

A: The robot is only good for organs you operate on in one area of the body. It really adds time to procedures in which it has to move around organs in the abdomen, such as small bowel or colon procedures.

Sometimes, when cancers are advanced, it’s better to do surgery with your own hands because the tactile feedback is essential. In those cases, it is much more important to get a good open cancer surgery than to stick with a minimally invasive method.

Q: Is there anything surprising or interesting you want to share about performing robotic surgeries?

A: The robot is the first tool that takes into account the surgeon’s needs and comfort during the operation. A lot of surgeries we struggle and leave sore and tired, and the robot really helps with that.

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Meagan Costedio, MD

Meagan Costedio, MD, is a surgeon in the Department of Colorectal Surgery whose interests include minimally invasive techniques.
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