By Michele Gillis

Though hospitals have been doing laparoscopic surgeries for many years, new robotic technology has completely changed the overall surgery experience.

The Da Vinci Xi, a robotic surgical system, created by Intuitive, has made its way into the Wheeling Hospital system and has improved the surgical experience for patients and surgeons.

Wheeling Hospital has been using robotic technology in surgery for about five years and they just got their third one recently.

“We use the Da Vinci Xi system, which is the newer system,” said Dr. Wayne Myers, general surgeon at Wheeling Hospital. “They’re used for a lot of different surgeries.”

Myers said that initially, around 10-15 years ago, robotic technology became popular for urology and OB-GYN because surgeons were able to get better visualization down in the pelvis where that area is tight.

But today they’re used for hernias, hiatal hernias, inguinal hernia repairs and sleeve gastrectomies. They have become very popular in bariatric fields as well as OB-GYN surgeries.

“I use it a lot,” said Myers. “Pretty much all my hernias are done robotically and I do bariatrics too, so I always use it when I do a sleeve gastrectomy.”

When Dr. Rami Abraham, general surgeon, joined Reynolds Memorial Hospital, he brought with him five years of robotic surgery experience. But, there wasn’t a robotics program in place, so he was excited to share his knowledge and help start a brand new robotic program with the Da Vinci Xi at his new job.

Currently, there is only one Da Vinci Xi at Reynolds, but Abraham said once they get the program rolling, maybe in a couple of years, hopefully, they will add more.

“I thought it was a good opportunity for me to use the experience that I had and help start a program somewhere else,” said Abraham who has completed about 875 robotic surgeries between med school and his time at Forbes Regional Hospital in Pittsburgh. “There are a lot of exciting things that come with that too, right? So I think in the long run, it’s important for me.”

To prepare the surgeons and staff at Reynolds to use the robot, Intuitive brought in a whole team to train the surgeons and operating room staff. They also sent the surgeons to physically train to use the robot on cadavers and pigs.

“So those courses allow you to kind of just get on it, use it, learn, get used to the motion of the joysticks and how that works,” said Abraham. “They learn to use the foot pedals, controlling the instruments, fluidity of movements and things like that.”

For a surgeon to legally have privileges to do robotic surgery, they have to complete three live proctored surgeries. The proctor will either advise on things that need work on or say they are good to go.

Some patients can be reluctant and might even push back when approached about robotic surgery, but both Myers and Abraham explained that the Da Vinci Xi is just a tool to help them be more precise.

“I think that’s kind of a misconception,” said Myers. “Everybody hears robot and they’re like, ‘Oh, we don’t want a robot operating on me’, but it’s just a tool.”

The surgeons are in complete control of the robotic arms.

According to Myers, they set up the ports or little holes going in the abdomen, just like they would for a laparoscopic procedure. “The nice thing with the robot is that the instruments articulate a lot more,” said Myers. “So you sit down at a console where you look at a screen, and there’s a place for your hands and fingers to go. And in real time, the articulation of your wrist moves just like the instruments on the robot. You’re in charge of and can use up to four different arms in the robot.”

The surgeon and console are all inside the operating room with the patient during the surgery.

“You dock the robot, put what instruments you would like to use, and then you go sit at the console, and you can control all four arms and the camera,” said Myers. “And in real-time, the articulation of your wrist moves just like the instruments on the robot. So it really helps that the surgeon’s able to control all arms, because sometimes you have really good help, and sometimes you have brand new help who doesn’t know how to help you, and so it’s nice to be in charge, but the big thing is the visualization.”

The camera on the Da Vinci Xi robot is a 3D visualization that allows surgeons to see inside a patient’s abdomen better than ever before.

“The picture is wonderful, so you can see better, you’re able to get into smaller, tighter areas in the abdomen,” said Myers. Abraham agreed that the 3D camera is very helpful.

“You put your head in the console and it’s a three-dimensional picture ten times magnified,” said Abraham. “And you can get up and you can put whatever you’re working on right in front of your face like you’re working at arm’s length. You can see it so much closer, but you’re still working at arm’s length.”

A major benefit of robotic technology in surgeries is the quicker recovery time for the patient.

“There is just less pain with the robot,” said Myers. “So, you know, there’s always reps that sell everything. And I was always skeptical. Like, how could there be less pain? It’s not that much different from my perspective. But, all the studies have found that there are shorter hospital stays, less blood loss with robotic surgery versus other surgeries, lower risk of infection, because of all those things lead to a quicker recovery.”

Myers said one of the reasons there is less pain is because there is less trauma to the abdomen since the robot is so precise.

“The benefits of the robotic surgery are there’s less pain you can see more and you can see it more clearly,” said Myers. “It allows you to do deeper surgeries because it helps you to just get in there and see a lot better. You can work in much tighter areas, and the big thing is the instruments with the dexterity to rotate just like your wrist would.”

Abraham said using the robot is like using your hand.

“It’s literally like your hand is inside,” said Abraham. “Just the fact that the tips of the instrument articulates your movements to perform things like stitching, Sewing inside the abdomen is extremely difficult with a straight instrument, like a traditional laparoscopic surgery because you have to move your whole arm to do a circular motion, like you’re making a stitch.”

Abraham said the robot allows surgeons to do fine movements more efficiently and accurately leading to trauma to the tissues on the inside, so patients have less trauma and inflammation after surgery. He said that reduced inflammation leads to less pain.

Less pain also leads to less of a need to prescribe narcotics to patients after surgery, so that is a big plus to scheduling this type of surgery.

Another perk to robotic technology in the operating room is the sensors included in the Da Vinci Xi. For instance, the system can detect tissue thickness and recommend the appropriate stapler size, reducing the risk of bleeding and leaks.

“The technology that Da Vinci has put in this machine is amazing,” said Myers. “Just because that machine can tell you, ‘Oh, this tissue is too thin, you should go down a stapler’ or ‘this tissue is too thick, you should go up a stapler’.”

Myers said there is no need for surgeons or operating room staff to fret over losing their jobs. The robots used in surgeries are just another tool and they will always need someone to drive it and hand it tools as well as all the other jobs to make a surgery a success.

According to Abraham, the robots have many safety mechanisms so once the surgeon moves out of the console, the robot won’t move at all.

Abraham acknowledged that some experienced surgeons may be resistant to change due to the cost or other factors.

“In the long run, if you scale it out years in potential costs for readmissions or conversions to open surgery or complications, you’re going to save using the robot,” said Abraham.

Both surgeons acknowledged that sometimes you just can’t use the robot and you need to open the patient and do surgery the old-fashioned way, especially in emergent situations.

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