Robots in the Workplace
By Don Sadler
In only about 15 years, robotic surgery has become increasingly common for many different types of surgical procedures. These include prostate, hernia, gall bladder, colon and hysterectomy surgeries, among others.
Improving Patient Outcomes
“It’s all about improving patient outcomes,” says Dr. David B. Samadi, M.D., the Chairman of Urology and Chief of Robotic Surgery at Lenox Hill Hospital in New York, New York. “And robotic-assisted surgeries result in better patient outcomes in the vast majority of cases.”
Samadi was one of the pioneers in performing robotic-assisted laparoscopic prostatectomy (or RALP) in the U.S. nearly 15 years ago. Since then, he has performed about 6,500 of the procedures and devised his own custom RALP: the Samadi Modified Advanced Robotic Technique, or SMART.
Using the SMART technique, Samadi has achieved a 90 percent patient satisfaction rate with their prostate cancer treatment decision more than a year after surgery. Ninety-six percent of his patients regain urinary control in two to three months and 85 percent regain sexual potency within 12 to 24 months.
“With this procedure, it’s about much more than just a surgery – we’re talking about quality of life,” he says. “Urinary control and sexual potency are a huge part of being a man.”
The SMART technique avoids mobilizing and moving the nerves before removing the prostate, Samadi says.
“The less you have to touch or move the nerves, the less chance there is of damaging them and causing incontinence or impotence. The result is a higher post-treatment quality of life,” he explains.
According to Samadi, the majority of robotic surgeries today occur in urology, and about 90 percent of these are prostate surgeries.
“The prostate is the deepest organ in the body and it’s surrounded by sensitive nerves so robotics are a perfect fit,” he says.
“If the surgeon is experienced in robotics, there is no longer any reason not to perform the surgery robotically,” Samadi adds. “I believe that the era of open prostate surgery has ended.”
What Exactly Is Robotic Surgery?
The term “robotic surgery” often conjures up images of robots in the OR performing surgeries, but this isn’t the case. Surgeons still do the procedures, but they use robotic arms to control miniaturized instruments that are inserted into tiny incisions like with other minimally invasive techniques.
Samadi lists a number of specific patient benefits of RALF compared to traditional open surgery:
• Shorter surgery times – about an hour to an hour and a half versus three to four hours
• No transfusion or bleeding
• No incision versus a six- to eight-inch incision
• Less patient pain and faster recovery time
• Faster removal of catheter – one week versus two weeks or longer
• Higher rates of regained urinary control and sexual potency by patients
Dr. Chad Engan, M.D., FACS, the Director of Robotic Surgery at Benefis Health System in Great Falls, Montana, has performed about 250 robotically assisted inguinal hernia repairs over the past three years.
“Robotics provide all the benefits of any minimally invasive surgical technique,” he says. “In hernia repair, these are mainly less pain neuralgia and faster recovery time.”
“Robotics are a tool that helps me do what I do better,” he adds.
According to Engan, a recently published study concluded that robotically assisted single-site transabdominal preperitoneal (RASS-TAPP) inguinal hernia repair is both safe and effective.
“The absence of clinical evidence of recurrence or neuralgia is extremely encouraging,” he says.
Last summer, Sharon L. Morris, BSN, RN, CNOR, Surgical Services, North Valley Hospital in Whitefish, Montana, attended a presentation by Engan where he shared the results of this study.
“I have to say I was a little skeptical at first,” she says. “We have been doing hernias open and laparoscopic for a long time.”
“However, when he shared his research on the decrease of post-op pain and zero recurrence rate my ears perked up,” Morris continues. “The number one complaint of patients who undergo hernia surgery is post-op pain.”
Robotic surgery is not just beneficial to patients – it’s also beneficial to surgeons.
“For example, there are ergonomic benefits for surgeons,” says Engan. “We are sitting in a console operating the instruments instead of standing over the patient for hours with our arms extended.”
“And the instrumentation allows 540 degrees of wristed articulation versus 270 degrees with the human wrist,” Engan adds. “Also, the optics and three-dimensional clarity are far superior, and the software eliminates surgeon tremor for smoother and more efficient manipulation of tissue.”
“The main benefit for surgeons is better visualization,” adds Samadi. “This can mean the difference between removing all of the cancer and leaving some of the cancer behind.”
More Robotic Successes
One of the most recent robotic surgery success stories was reported from California, where the thoracic surgery team at John Muir Health’s Concord medical center used a robotic-assisted device in a lobectomy procedure. The team has successfully completed more than a dozen of these procedures robotically using the da Vinci surgical system.
In a traditional open chest cavity surgery, surgeons must cut between the ribs, and sometimes even spread the ribs, to access the lung. This leaves patients with a large incision on the side of the chest and results in a longer and more painful post-operative recovery.
But when performed robotically, the incision is no more than one centimeter in length, which results in decreased pain levels and a shorter recovery time.
Dr. Wilson Tsai, co-medical director of the thoracic program at John Muir Health, points out that recent studies indicate that robotic-assisted lung surgery can deliver equal or better results compared to open chest cavity surgery.
For example, one study recently published in The Annals of Thoracic Surgery concluded that robotic-assisted thoracoscopic surgery was safe and effective in various settings by delivering outcomes better than open thoracotomy and equal to video-assisted thoracic surgery (VATS). The robotic-assisted surgery resulted in two to four fewer days spent in the hospital, fewer blood transfusions, shorter usage of a chest tube by at least one day, and fewer air leaks lasting more than five days.
“Surgical applications with advanced robotics expand treatment options and offer outcomes comparable to other minimally invasive approaches, especially for patients with more complex cases,” says Tsai. “Patients appreciate the shorter recovery time that allows them to go home and get back to their normal lives quicker.”
OR Team Experience Is Essential
Engan stresses the importance of training and experience in robotic surgical equipment and techniques for OR team members.
“Having an experienced and well-trained team of perioperative nurses and technicians is critical to making robotic surgery a success,” he says.
Robotic surgery places unique challenges on perioperative nurse managers and directors, adds Ramona Conner, MSN, RN, CNOR, editor-in-chief, Guidelines for Perioperative Practice for the Association of perioperative Registered Nurses (AORN).
“In particular, they face challenges in coordinating multiple demands for the equipment by an increasing number of surgeons,” says Conner. “They also have to provide specialized training and competency verification for personnel and coordinate staffing schedules to provide competent OR personnel for every robotic-assisted procedure.”
Ultimately, robotics is just a tool, Samadi stresses.
“It’s a piece of equipment,” he says. “But in the hands of a skilled and experienced surgeon, robotics can result in extremely high levels of patient satisfaction.”
