A Modern Masterpiece Baystate’s da Vinci Surgical System Emphasizes Robotics

Da Vinci is one of the world’s most recognizable names – but one people tend to associate with 15th centrury artistic accomplishments, not cutting-edge 21st century technology.

But the da Vinci Surgical System, a robotic technology for minimally invasive, laparoscopic surgery, should change that. Since unveiling the system in October, doctors at Baystate Medical Center in Springfield have operated on some 130 patients using state-of-the-art robotics to supplement the skilled hands of the surgeons.

Developed by Intuitive Surgical and the only robotic surgery system of its kind approved by the U.S. Food and Drug Administration, the machine is used at Baystate for a range of procedures, including cardiac surgery, weight-loss surgery, and prostate and kidney procedures.

“This is in keeping with our philosophy that we’re going to be the leading provider of health care for Western Mass.,” said Dr. Neal Seymour, chief of Baystate’s General Surgery Division. “With the use of the robot, the goal is advancing care. Around the world, we’ve already heard of this type of technology being used to improve patient outcomes.”

Clearly, Baystate’s surgeons believe that success can be duplicated in the Pioneer Valley – and they’re proving it on a daily basis.

Making the Cut

Simply put, the da Vinci system upgrades traditional laparoscopy – a type of minimally invasive surgery using tiny incisions and cameras inside the body – by improving the clarity of what a surgeon sees and literally taking a load off his or her hands.

It does this by allowing two surgeons to work in tandem apart from each other. One works directly on the patient, guiding the physical surgery, while the other sits at a console across the room. By viewing in the console what the laparoscopic camera sees, the doctor is able to manipulate four robotic arms inside the patient.

According to Intuitive Surgical, each robotic instrument has a specific surgical mission, such as clamping, suturing, or tissue manipulation, and all are designed with seven degrees of motion that mimic the dexterity of the human hand and wrist.

As a result, da Vinci supplements surgeons’ own skills while maintaining the look and feel of open surgery, thereby allowing doctors not only to perform standard laparoscopic procedures more easily than before, but to widen the range of surgeries that can be done laparoscopically.

Seymour said the technology is especially valuable for procedures with little tolerance for error, such as prostatectomy, the removal of all or part of the prostate. “Our urologists are now using it successfully to perform very good procedures on specially selected patients,” he said. “The trend is clearly toward laparoscopic prostatectomy becoming a robotic procedure.”

One obvious improvement with da Vinci is that the surgeon no longer has to hold and manipulate the camera by hand, which can cause fatigue. But the more dramatic difference is in the way the surgical tools move. The hand, wrist, and finger movements of the doctor at the console are translated into precise, real-time movements of the surgical instruments inside the patient.

“The instruments have a greater number of degrees of freedom in their ability to move and approach the tissue,” Seymour said. Laparoscopy has traditionally been performed with a long rod with a working tip, which is limited in the number of directions it can move.

“You’re basically opening and closing a cut from a specific angle,” he said. “But the robotic instruments have ‘wrists,’ which essentially restore the pattern of freedom and movement associated with the hands. You can move and approach the tissue without restrictions.”

Indeed, Seymour demonstrated to The Healthcare News how the doctor using the console rests his elbows on a flat surface and controls the robotic equipment with his thumbs and index fingers. The result is that any movement he performs with the wrists and hands can be replicated by the robot. “Your ability to work is greatly enhanced by the additional range of motion.”

Like an especially detailed painting, da Vinci also improves the surgeon’s vision with the highest-resolution images available. The camera is larger than those used in traditional laparoscopic procedures, yet the doctor is not weighed down by the size, since he or she does not have to hold it steady.

“There’s no longer a user-fatigue issue, so your ability to deliver an astoundingly good image is much greater,” Seymour said. “It’s not that it would be impossible to use the da Vinci in traditional surgery, but it would be more difficult because of the size of the instruments involved. The doctor would have to bear the fatigue associated with its use, as opposed to the machine doing it with no restrictions.”

Ahead of Its Time

In effect, da Vinci makes minimally invasive surgery even less invasive, because surgeons can accomplish more through the same small incision as before. That, in turn, leads to reduced trauma to the body, reduced risk of infection, less post-operative pain and scarring, and a quicker return to daily activities.
“It has yielded significant benefits, including a shorter hospital stay and fewer physiological repercussions than would be associated with the alternatives,” Seymour said.

But how do patients feel when told they will be operated on by robotic hands?

“I think there’s a very significant level of interest from patients, but they don’t really understand what it entails until it’s explained to them. So we’re making an effort to educate the community,” Seymour said. “We’re not at the point where patients come to us asking for robotic surgery, but we expect they will someday. We’re striving to be a national leader in this.”

The surgeons who work with da Vinci must be specially trained in its use, but Seymour stressed that skill and experience in basic laparoscopy is still the most important factor for doctors.

“It’s yet another tool to perform minimally invasive surgery, but it shouldn’t be viewed as an end in itself,” he said. “The surgeon is actually doing the operation while benefiting from technology.”

Of course, Baystate’s patients – if they continue to recover quickly from surgery and live satisfying lives – are the ones that will benefit the most.