image of doctor controlling a surgical robot

Robotic Surgery: Advancements in the Operating Room

As a medical student in the late 80s interested in steering my future toward a career in surgery, I did what any medical student would do; I hung around the surgery department. During the summer between my second and third year of medical school, I was offered the opportunity to spend a Saturday afternoon helping out 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 new way to operate would forever alter the way many common operations are performed, while serving as a fundamental building block that would change the shape of things to come. As a result of this shift in the way patients undergo many operations, thousands of people have experienced related benefits, including less post-operative pain and quicker 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 laparopscopic instruments; allowing surgeons to do even more for their patients. Along with this ongoing evolution of minimally-invasive surgical technology that was 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. Although I certainly thought it was “cool”, my impression was that this device was pretty “limited” and that it probably wouldn’t become a standard tool for most surgeons. My assumptions were correct.

Flash forward about 20 years to 2013, during which time I hadn’t heard much more about robotic surgery nor did I have any first-hand experience, and I again found myself being offered an opportunity to test emerging surgical technology; Nationwide Children’s Hospital become 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 Robotic System consists of an advanced robotic platform that stands in at the operating table; effectively replacing the surgeon.

While idea may seem somewhat unsettling to those who are unfamiliar with how robotic-assisted surgery works, I am quick point out that, while the robotic is technically carrying out the steps of many types of operation, the surgeon is in full control the robot. To be more specific, surgeons who have been highly trained in the use of the DaVinci system directly control 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 laparosocpic 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
  • 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 surgical problems.

Since its establishment in 2013, The Center for Robotic Surgery has performed over 500 robotically-assisted operations 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.

 

Marc P. Michalsky, MD
Marc P. Michalsky, MD,FACS is the Director, The Center for Robotic Surgery and the Surgical Director, Center for Healthy Weight and Nutrition at Nationwide Children's Hospital, a multidisciplinary center dedicated to the treatment of overweight and obese children and adolescents. He is also a Professor of Clinical Surgery and Pediatrics at The Ohio State University College of Medicine. He is the father of two teenage boys.

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