Robots improve surgical outcomes

January 18, 2016 Providence Health Team

The trouble started with a backache. When San Fernando Valley resident Bradley Williams, 58, complained to his doctor about it in February 2015, he got an MRI that revealed three bulging discs, the possible culprits. But the imaging test also showed something unexpected and more ominous: a nearly two-inch mass on his left kidney.

Williams, who works in the security industry, recalls the doctor telling him that he needed surgery and that the whole kidney might have to be removed. Worse, the tumor could be cancerous, requiring additional treatment and an uncertain prognosis. And doctors wouldn’t know whether it was malignant until they could put it under a microscope.

“I was gobsmacked,” says Williams, who plays soccer and softball recreationally throughout the year. “I said, ‘Are you sure you have the right records?’ I’m kind of a healthy guy. I don’t smoke or take drugs, and I don’t drink much alcohol. Hearing something like that really rocks your world.”

Williams was referred to Mayank Patel, MD, a urological surgeon at Providence Tarzana Medical Center, who has extensive experience with the da Vinci surgical robot. The da Vinci, which was approved in 2000 for laparoscopic surgery, is now used for a growing number of procedures, thanks to its advantages for doctors and patients.

Robotic hands help surgeons

To use the robot, surgeons sit at a console to control the device’s arms via its mainframe computer. The camera provides 10 times magnification and high-definition, 3-D vision—greatly improving the doctor’s field of vision. The robot’s “hands” can reach into tighter spots and move in ways that human hands cannot. The machine’s software corrects for any extraneous tremor.

The robot may also reduce physicians’ fatigue since they can sit rather than stand over the patient for hours. Like other minimally invasive procedures, surgeons operate through tiny incisions, which result in less blood loss and faster recoveries.

The success of robotic-assisted surgery, however, is highly dependent on the surgeon and his or her training. Studies show that better outcomes are obtained by surgeons with substantial experience using a robot and in institutions where a higher number of robotic-assisted surgeries are performed.

Game-changing technology

A growing number of conditions are being treated with robotic-assisted surgery as physicians become more familiar with the technology.

“The robot has been a game-changer with kidney surgery,” says Dr. Patel. “It allows us to do the operations we used to do as open procedures through a minimally invasive route. That’s where the freedom of motion and technology comes in.”

In particular, the robot allows skilled urological surgeons to perform partial nephrectomies, the removal of just the portion of the organ where a tumor is nesting, leaving the remainder of the kidney to function normally.

“Traditionally we made a 15- to 20-inch incision, which had higher infection rates, greater blood loss and obviously more pain for the patient,” adds Dr. Patel. “Patients typically spent five to seven days in the hospital. With robotic surgery, they may go home in one to two days and end up using very little narcotic medicine.”

Not everyone with a kidney tumor is a candidate for the procedure, however. According to Dr. Patel, it depends on the size and location of the tumor.

Luckily, Williams qualified. “He had a complex mass in a very difficult location on the kidney,” says Dr. Patel. “But with the robot, we were able to save his kidney, and his kidney function was not affected.”

Bradley Williams went home the next day following robotic surgery for a nearly two-inch mass on his left kidney. and needed little pain medicine. 'I was the poster boy for how things should go,' he says. 'I took a few regular Tylenol—not even extra strength—and I have just four little scars. Two of them you can hardly see.'Less pain, faster recovery

Williams went home the next day and needed little pain medicine. “I was the poster boy for how things should go,” he says. “I took a few regular Tylenol — not even extra strength — and I have just four little scars. Two of them you can hardly see.”

Providence hospitals have strict training and supervisory protocols to protect patients undergoing robotic surgeries. Once surgeons have reached proficiency with the robot, they are required to keep up their skills and achieve certain benchmarks in order to maintain their surgical privileges.

Dr. Patel’s surgical skill was a key consideration for Williams. But no matter how well the surgery went, he still faced a big question after his operation: whether or not the growth was cancerous. It took three days after the procedure to finally get the answer.

“Fortunately the mass was not cancer,” says Dr. Patel. “It would have been a huge loss if the kidney was taken out completely for something that wasn’t malignant.”

“This was a life-changing event no matter what the outcome,” Williams says. “I’m a very lucky guy, which I attribute to having a good surgeon and a good team. I couldn’t have asked for anything better.”

Other procedures surgeons can perform with the da Vinci:

Robotic Gynecologic Surgery

  • Hysterectomy: the removal of the uterus for benign conditions or cancer
  • Ovarian cystectomy: the removal of a benign ovarian cyst
  • Myomectomy: the removal of bothersome fibroids (benign growths on the uterus)
  • Oophorectomy: the removal of one or both ovaries to treat cancer or other ovarian abnormalities
  • Endometriosis: the removal of painful endometrial tissue that has migrated outside the uterus

Robotic Urologic Surgery

  • Prostatectomy: the removal of all or part of the prostate gland as treatment for cancer
  • Pyeloplasty: the surgical reconstruction of the renal pelvis to drain and decompress the kidney
  • Cystectomy: the removal of all or part of the bladder
  • Sacrocolpopexy: surgical restoration of pelvic organs, using synthetic mesh to hold them in place

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