Robotic Surgery: Advancements in the Operating Room

As a medical student in the late 80s working toward a career in surgery, I hung around the surgery department quite a bit. During the summer between my second and third year of medical school, I was offered the opportunity to spend an afternoon helping with a new professional educational course for fully-trained surgeons who were learning about a “new” way to operate – called laparoscopic surgery.

Although I didn’t know it at the time, laparoscopic surgery – a technique that involves the creation of small surgical incisions that allow a surgeon to insert instruments and a camera lens into various body cavities such as the chest or abdomen without creating large and often painful incisions – would wind up launching a revolution in modern surgical care.

This revolutionary approach would forever alter the way many common surgical procedures are performed, while serving as a fundamental building block that would change the shape of things to come. As a result of this evolutionary change, tens of thousands of people have experienced related benefits, including less post-operative pain and faster recovery times.

After completing my medical school training and beginning a residency in general surgery, it became apparent that the eye-opening innovations I had witnessed some years earlier were quickly evolving into the creation of even smaller and more effective laparoscopic instruments; allowing surgeons to do even more for their patients. Along with the ongoing evolution in minimally-invasive surgery that began in the 1980s, the following decade saw the introduction of the first FDA-approved robotic surgery system, called Aesop.

Clunky and awkward by today’s standard, Aesop was nothing more than a voice-controlled robotic arm designed to assist the operating surgeon in a number of very simple tasks.

Flash forward about 20 years to 2013, and I again found myself being offered an opportunity to test emerging surgical technology; Nationwide Children’s Hospital became one of the first pediatric centers in the U.S. to acquire a robotic surgery system. A far cry from the original Aesop system, the DaVinci-Si Robotic System consists of an advanced robotic platform that stands in at the operating table; effectively replacing the surgeon.

While the idea may seem somewhat unsettling to those who are unfamiliar with how robotic-assisted surgery works, I am always quick point out to my patients that, while the robot is technically carrying out the steps of the operation, the surgeon who has been highly trained in the use of the DaVinci system is in full control, manipulating the movements of the robotic instruments while sitting at a computer console that offers the surgeon a 3-dimensional high-definition view into the patient’s body.

Like traditional laparoscopic surgery, the incisions required for robotic surgery are also very small. The main advantage to using the robot is that unlike non-robotic laparoscopy, surgeons are often able to operate in otherwise hard-to-reach places with more accuracy and precision. This makes robotic surgery a safe and effective solution for many surgical problems.

Robotic-assisted, laparoscopic surgery can be used for many common operations, on kids of all ages and involves surgeons who are trained in pediatric urology and/or pediatric general and thoracic surgery. Nationwide Children’s currently has 11 surgeons certified to perform surgery using DaVinci.

• Abnormalities of the kidney and bladder
• Removal of the spleen or gall bladder
• Inguinal hernia repair
• Hiatal hernia and anti-reflux operations
• Weight-loss (bariatric) surgery

In addition, surgeons have recently begun using the robot to assist with patients requiring complex colorectal and pelvic reconstruction.

The Center for Robotic Surgery at Nationwide Children’s Hospital is one of only a handful of major pediatric centers in the U.S. with a clinical program dedicated to using robotic technology. As a result of our truly integrated approach, the robotic surgery program seeks to leverage specific skills and insight across a number of surgical subspecialties in order to provide safe and effective robotic solutions for many common surgical problems. In 2020, Nationwide took delivery of the Davinci-Xi Robotic System, which has allowed the center to provide our patients with the most advanced robotic technology while simultaneously allowing our team to perform even more complex procedures.

Since its establishment in 2013, The Center for Robotic Surgery has performed nearly 1,000 robotically assisted operations (and expects to hit 1,000 by the end of 2021!), making it one of the busiest and most well-established centers of its kind both in the U.S. and abroad. Under the leadership of Dr. Marc Michalsky, professor of clinical surgery and pediatrics, the center presently consists of 11 highly trained general, thoracic and urologic surgeons. For more information on robot-assisted surgery, click here.