The Future of Robotic Surgery

I am a surgeon, and one of my “co-workers” is a robot. That’s because I perform robotic-assisted, laparoscopic surgeries. I’ve been specially trained to direct the motions of robotic arms to perform precision tasks in small, confined spaces that would otherwise require a large painful incision or the use of long, awkward tools to gain access to hard-to-reach areas of the body that need to be repaired. The robot helps me and other trained surgeons perform minimally invasive surgery, which means we make the smallest possible incision so that children can heal faster.

How a Robot Helps with Surgery

Although the robot was originally intended to perform surgery on the battlefield or in other remote places, it turned out to be more useful for minimally invasive laparoscopic surgery in the operating room. The robotic instruments overcome the limitations of traditional laparoscopic minimally invasive surgery and enhance the natural abilities of the surgeon. These instruments also detect and filter out the natural tremor in the surgeon’s hand movements when manipulating the tools. The robotic camera used in the system provides a true 3D, stereoscopic, high-definition picture transmitted to a surgeon’s console.

The robotic surgical system senses the surgeon’s hand movements and translates them electronically into scaled-down micro-movements to manipulate the tiny laparoscopic instruments. The surgeon then controls the robotic arms, which allows him or her to perform the normal movements associated with the surgery using the robotic arms to actually carry out these movements.

I know this all sounds pretty technical, and it is. But it is also very cool! As a robotic surgeon, I love the fact that I can now perform what I used to do with a large, painful, open incision through smaller, less-painful incisions. As these incisions heal, they get less and less noticeable instead of growing larger with the child.

The Potential of Robot-Assisted Surgery

Throughout history, improvements have come with technology. We now fly around the globe instead of sailing, rowing or walking. We build amazing automobiles, planes, satellites and computers using automated robotic processes and instruments. But it is important to know the difference with the surgical robot: the robot does not do anything automatically. The robot only does what the surgeon tells it to do. This is important, because it means the quality and the success of the surgery are still in the hands of the surgeon.

Since the Nationwide Children’s Hospital Center for Advanced Robotic Surgery (NCH CARS) began in 2013, we have performed over 150 minimally invasive robotic surgeries. There are now three highly trained pediatric urologic surgeons and three general surgeons who regularly perform robotic surgeries on the kidneys, bladder, ureters, stomach and colon. We do robotic surgery for children with a wide range of conditions, such as kidney obstruction, urinary reflux, obesity and inflammatory bowel disease. We have also performed robotic surgery to create continent channels for children with spinal disease to catheterize their neurogenic bladders and for anterograde colon enemas for children with neurogenic bowel and chronic constipation. We have even performed robotic-assisted surgery on infants as small as 6 to 12 months of age.

In the future, we are hoping to show that robotic-assisted surgery will have better long-term results compared to traditional open surgery. We also hope that, as the technology improves, we can adapt and expand the use of the robot to more and more complicated procedures and eventually offer this amazing type of minimally invasive surgery to solve more and more complicated problems for children everywhere.

Daniel Herz, MD
Daniel B. Herz, MD, is a member of the Section of Pediatric Urology and director of Robot-Assisted Laparoscopic Surgery at Nationwide Children's Hospital. Dr. Herz has an extensive background in complex urological procedures and unique expertise with robot-assisted laparoscopic surgery. Before joining Nationwide Children’s, he served as director of Pediatric Urology at Children’s Hospital at Dartmouth, and Associate Professor of Surgery and Pediatrics at Dartmouth Medical School. Certified by the American Board of Urology in both urology and pediatric urology, Dr. Herz has published extensively in the field of pediatric urology. He received his medical degree from SUNY Health Science Center at Brooklyn (Downstate Medical Center) and completed his urological residency at University of Pittsburgh Medical Center. He completed a two-year clinical and research fellowship in pediatric urology at the Hospital for Sick Children, University of Toronto. Dr. Herz is trained in all aspects of pediatric urological surgery; however, his expertise and main interest is in robot-assisted laparoscopic urological surgery. His research interests include robotic surgery simulation and outcomes/evidence-based urological surgery.

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