A seven-foot robot stands right alongside the operating team, not as an observer, but as one of the surgeons.

It's a new addition that's helping UMHS pave the way for the future of surgical technology, which may make many operations less invasive and recovery time much quicker.

The robot joined UMHS's operating team late in 2001, and has successfully assisted in several surgeries, including donations of organs for transplants and prostate and gynecological procedures.

UMHS is one of the first hospitals in Michigan and the United States to perform robot-assisted surgery since the Food and Drug Administration approved the approach. Surgeons at the Health System are also dedicated to providing valuable research into this new technology, to see how it compares with more conventional techniques.

This fall, Juan Arenas, M.D., assistant professor of surgery at UMHS, began using the robotic device for laparoscopic living kidney donations, one of the first surgeons in the country to do so. All of the operations have been successful.

Instead of performing the surgery by the patient's side, Arenas operates from a console a few feet away, viewing a three-dimensional image captured by cameras inside the patient and controlling the surgical instruments. Although a second surgeon, nurses and medical assistants are next to the patient, Arenas performs the entire surgery by operating the arms of the seven-foot robot remotely.

Laparoscopic surgery is minimally invasive, performed through several small incisions versus a single large opening. Surgeons slide a tiny video camera inside the patient's body through one incision and operate with small instruments fed through another.

In robot-assisted surgery, the robot actually has three arms -- one to hold the camera, the other two to perform the operation -- increasing the possibilities of this surgery.

"The primary advantage of robotic surgery is that it provides a full range of motion similar to a human's wrist. Traditional laparoscopic surgery doesn't allow that," Arenas says. "But the robot goes beyond just wrist movement. It can actually rotate 360 degrees, something human surgeons could never do. This asset gives surgeons more precise and accurate movements."

The da Vinci robot is a $1 million device created by Intuitive Surgical, Inc. In July of 2000, the FDA approved its use in laparoscopic surgeries. But Arenas says the robot isn't intended to replace the surgeon.

"The robot literally gives us an extra set of hands at the operating table," he notes. "It's the next major step in surgery for the 21st century."

As of mid-December, Arenas had used the robot in five laparoscopic living kidney donation surgeries, and plans to continue to use it in all appropriate cases. Patients who might be a candidate to donate "robotically" are given the option after talking with their surgeon.

Jennifer Gerber is one of Arenas's patients. In late December, she donated her kidney robotically to her sister, who was in complete renal failure. Jennifer's mother had also been a kidney donor years ago, and had undergone surgery in the traditional, open-abdomen manner. Jennifer was encouraged when Arenas told her robotic surgery would be less painful and have a quicker recovery than what her mother went through.

"I chose the procedure because, number one, the healing process was faster, and second, I was told that the process would be easier on me and, so far, it has been," Jennifer said from her hospital bed. "I would encourage anyone and everyone to donate a kidney, if they're able to."

Arenas isn't the only surgeon at UMHS using the robot. Arnold Advincula, M.D., clinical assistant professor of obstetrics and gynecology, as well as director of minimally invasive surgery for the department, recently performed one of the first robot-assisted laparoscopic hysterectomies in the nation. On the same day, Advincula performed a second robot-assisted laparoscopic surgery to remove fallopian tubes.

Advincula feels the robot advances surgical technology, allowing physicians to approach gynecological problems in a laparoscopic fashion that previously would not have been considered an option.

He and his colleague Kevin Reynolds, M.D., hope to help many more women beat these problems with the least invasive surgery possible.

"Our plans are to apply robot-assisted surgery to treat difficult hysterectomy cases, advanced endometriosis, and management of myectomy," he says. "Although many of these procedures are being done with conventional laparoscopy, the use of robotics will now allow us to more accurately replicate what is being done with traditional open cases, but in a less invasive manner."

Advincula also points out that in both of his first robotic surgeries, recovery time was extremely speedy. One patient went home the same day the procedure was performed; the other, the next morning.

Male patients at UMHS are also benefiting from the new device. Stuart Wolf, M.D., associate professor of urology, and co-director of the Michigan Center for Minimally Invasive Urology, was the first UMHS surgeon to use the robot for a prostatectomy back in early October, and has performed several more since.

Wolf says, "I am impressed that the robot helps us do some of the more detailed parts of the procedure, such as sewing the bladder to the urethra following the removal of the prostate."

He hopes to use the robot for more complicated procedures such as reconstructing the renal pelvis and ureter if there is a blockage.

Another U-M urologist, James Montie, M.D., says although robot-assisted surgery has great potential for the advancement of surgery, it may not be the answer in all surgical cases. He cautions the robot shouldn't be turned into a marketing tool or gimmick before concrete data is collected and analyzed.

"Robot-assisted surgery has the potential of making great advancements in the operating room," Montie explains. "However, it remains uncertain whether or not the long-term results for an operation such as a radical prostatectomy are any different or better than traditional methods."

Because robot-assisted surgery is so new, the exact outcomes are still unknown. That's why many UMHS departments have initiated research efforts comparing patient data from robotic surgery to patient data from laparoscopic and open surgeries.

The data collected will ultimately decide if robots are an improvement in the operating room. - By Carrie Hagen

01-Feb-2002