“We’re using robotics for more procedures than ever before,” said Luis Rojas, MD, Avera Medical Group gynecologic oncologist. Rojas was in on the ground floor as among the first surgeons trained to use surgical robotics at Avera McKennan Hospital & University Health Center nearly 10 years ago, in 2007. Avera has two robotic units – the daVinci® SI and daVinci XI.
“We’re privileged at Avera because we have a team of people with robotic training in multiple specialties: gynecology, gynecologic oncology, cardiothoracic, colorectal, urology, urogynecology and general surgery,” Rojas said.
The trend in surgery is more minimally invasive procedures done on an outpatient basis, overnight or with a short hospital stay. Robotics builds upon laparoscopy as a minimally invasive option. The precise movements of robotic arms and miniaturized surgical instruments – still controlled by the surgeon at a computer console – are more precise and allow for greater dexterity.
Visualization for surgeons is better than real life. Robotics technology allows them to see a lighted view in 3-D at up to 10 times magnification on the computer screen as they control surgical instruments.
Before the 1980s, most surgeries were done through an open procedure. Laparoscopy became mainstream in the early 1990s, and robotics emerged in the mid 2000s.
“Robotics is the next advanced level of surgical care, allowing us to do more intricate and detailed procedures,” said Brad Thaemert, MD, board-certified general surgeon who performs robotic procedures at Avera McKennan.
“Through one or several very small incisions, we can manipulate inside as if our hands were there, yet without the surgical trauma of an open procedure,” Thaemert said. Robotic instruments make very slow, small movements that are more conducive to fast healing. “The robot doesn’t move without a surgeon’s control,” Thaemert added.
Avera’s robotic units are in high demand and not every procedure warrants use of the robot. “Laparoscopy will always have its purpose. Robotic technology is more than we need for some simple procedures like appendectomy,” Thaemert said.
The biggest growth in robotics right now is the area of general surgery, Thaemert said, for example, complex hernias. “We’re seeing a definite improvement in health care costs, pain and recovery time,” he said.
The robot lends itself to complex procedures. Thaemert says esophagectomy – removal of all or part of the esophagus as a treatment or cancer or serious disease – is the most complex robotic procedure he performs using the robot.
Rojas said he prefers using the robot for surgical care of gynecologic cancers, as the robot has exceptional capability for removing tumors. When patients must have their uterus removed due to endometrial cancer, he uses the robot 85 percent of the time. The only exceptions include cases in which the uterus is too big, or if cancer has spread beyond the uterus.
“Our oncology outcomes are the same, and sometimes we can get better lymph node resection on the robot,” he said.
“Whenever you are recommended for a surgical procedure, it’s a fair question to ask: ‘Can I have this procedure robotically?’” Rojas said. “It’s a question I would ask if my wife were going to have surgery. It’s just important to know all your options.”