Enhancing Surgical Care Through Use of State-of-the-Art Technology
Friday, July 29, 2011
Committed to providing patients with the most up-to-date technology, the Virginia Commonwealth University (VCU) Medical Center in Richmond, VA, offers a wide range of robotic surgical options.
Photo: Putting the surgeon’s hands at the controls of a state-of-the-art robotic platform, robotic-assisted surgery offers patients at the VCU Medical Center a minimally invasive option for complex and delicate surgical procedures.
Robotic surgery using the da Vinci Surgical System is revolutionizing medicine, offering surgical benefits for both patients and physicians. At VCU Medical Center, robotic surgery is used in a number of disciplines, including pediatric surgery, urology, surgical oncology and gynecology.
The Technology
The da Vinci Surgical System boasts several unique capabilities, including 3-D visualization and enhanced instrumentation, which allow physicians to perform surgeries through several small incisions that generally range in size from 5 mm to 8 mm in pediatric patients and 8 mm to 12 mm in adult patients.
Providing the same dexterity, precision and accuracy available during open surgery, the da Vinci Surgical System features a physician console — which improves ergonomics for physicians by allowing them to remain seated throughout the surgery — four robotic surgical arms, a 3-D camera, high-definition monitor and Endowrist instrumentation.
“The da Vinci Surgical System provides image magnification that is 10 times stronger than normal sight and allows us to visualize structures in 3-D, restoring depth perception that is lost in laparoscopic surgery,” says Amelia “Aimee” Grover, M.D., FACS, assistant professor of surgical oncology at VCU. “The robotic surgical system refines our motions and removes tremors, and the Endowrist instrumentation provides us with greater dexterity over traditional laparoscopic surgery.”
Because of this enhanced surgical technique, the da Vinci Surgical System has many indications in patient care and allows patients who would not normally be candidates for traditional laparoscopy to benefit from a minimally invasive approach.
Indications in Surgical Oncology
At VCU Medical Center, Dr. Grover is using the da Vinci Surgical System to remove masses of the thyroid and adrenal gland.
“Utilizing robotic techniques provides several benefits for patients, including improved cosmesis, as patients undergoing thyroid removal no longer need to have scars visible on the neck,” says Dr. Grover. “Using robotic techniques, the incision made to remove the thyroid mass is located discreetly under the patient’s arm. The magnification allows excellent visualization of the nerves controlling the voice that are located near the thyroid gland. Research is being done to evaluate whether robotic thyroid surgery leads to less pain and quicker recovery.”
Use of the da Vinci Surgical System has allowed other patients to benefit from minimally invasive surgery. For example, patients with larger adrenal tumors who were not candidates for traditional laparoscopy can have these tumors removed by robotic surgery because of the improved visualization and dexterity it provides.
Ideal candidates for robotic thyroid removal have nodules that are less than 4 cm in size. Most patients suffering from adrenal lesions are candidates for robotic surgery.
Advances in the Field of Pediatric Surgery
While robotic surgery is used less frequently in children than in adults, surgeons at Children’s Hospital of Richmond offer several robotic surgical options to pediatric patients, including removal of tumors and the repair of congenital anomalies.
“In pediatric patients, we utilize the da Vinci Surgical System for a wide variety of complex operations in the abdomen,” says David Lanning, M.D., Ph.D., Surgeon-in-Chief at the Children’s Hospital of Richmond and associate professor of surgery and pediatrics at VCU. “Robotic surgery is also especially useful in some difficult thoracic cases.”
For pediatric patients with large tumors of the chest, robotic surgery can prevent the need to have a large incision on the side of the chest or through the sternum. Using robotic techniques, the tumor is placed in a bag and can then be extracted as several smaller pieces through a small incision. Robotic surgery is also useful for patients with myasthenia gravis who require removal of the thymus gland.
“Previously, removal of the thymus gland would have required a median sternotomy or dividing the sternum,” says Dr. Lanning. “Patients with myasthenia gravis are generally already in a weakened state prior to surgery, so making such a large incision prolongs recovery and is more painful. Using robotic techniques, we have experienced great success, and patients make a much quicker recovery, with all of the patients being discharged the day after their procedure. We also have been able to remove large adrenal tumors using the surgical robot and have used it for special cases, such as repairing an injured esophagus.”
The team of pediatric surgeons at the Children’s Hospital of Richmond consists of pioneers in the field of pediatric robotic surgery, allowing regional pediatric patients access to techniques that are only available at a few centers around the country.
MD News July/August 2011, Richmond/Tri-Cities