The Evolution Of Surgery

November 18, 2013

How We Moved From Open to Robot-Assisted Surgery

It’s been about a year since I was first asked by a patient, “Why do you need a robot? Are you going to be in the lounge doing my surgery with a joystick drinking coffee?” I suddenly realized how far weight loss surgery has come in the past dozen years.  We can now perform surgery through tiny incisions in the abdomen from the console of a 4-armed surgical machine. Yes, this may sound vastly different than the surgery you’re used to—but I can assure you, I’m not sipping coffee in the lounge!

Here is a quick overview of how bariatric surgery has changed over the years:

Open Surgery

Bariatric surgeries performed with the traditional “open” approach are done through a six-inch upper abdominal incision. This provides quick access into the upper abdomen and the ability to “freely” feel and manipulate tissues with our hands. Drawbacks to this method include limited visibility, more post-operative discomfort, longer recovery, and higher risk for hernias and infections.

Laparoscopic Surgery

Many bariatric surgeries today are now performed using the laparoscopic approach, also known as minimally-invasive surgery. I hesitate using the phrase, “minimally-invasive” because even when performed laparoscopically, bariatric surgery is still a major gastrointestinal surgery, but it is a common nickname for this surgical technique. Laparoscopic surgery is performed through a few small, half inch incisions. Tubes called “trocars” guide long, chopstick-like instruments into the abdomen. Surgery is performed with a magnified image generated on a monitor by a long telescope. The small incisions reduce the risk for hernias and infections, and patients are able to leave the hospital and return to work faster. The major drawback with the laparoscopic approach is that the instruments only open and close in one direction, forcing us to move the tissues around so that we can operate in straight lines. In addition, the trocars are less maneuverable in patients with thick abdominal walls, and staff and operator fatigue is common, especially in long complex cases such as revisions.

Robot-Assisted Surgery

The robot-assisted approach is the latest technique in laparoscopic surgery. The “robot” is a four-armed surgical machine that is incapable of independent function (meaning it’s under the complete control of the surgeon). The surgeon works through a console with the help of a specially-trained surgical assistant and crew. Surgery is performed using small incisions and metallic trocars which provide precisely-controlled, three-dimensional movement. This decreases the strain on the abdominal wall which translates to less post-op discomfort for patients. The camera has dual optic channels and zoom capabilities which provide highly magnified, true 3D-HD vision within the abdomen. The robotic instruments have a miniature wrist that works much like the human hand—except they can rotate 570 degrees and can work tirelessly! This allows for remarkable dexterity, precision and the ability to sew around corners.

The “robot” combines the benefits of laparoscopic surgery (small incisions, less post-op discomfort and faster recovery) with the advantages of traditional open surgery (freedom of movement and improved dexterity for the operator) which results in an overall outstanding surgical experience for our patients.

Note: Not all patients are good candidates for robotic or laparoscopic approaches. Patients with extreme obesity, prior gastric or esophageal surgery, complicating medical conditions, etc. may need an individualized approach, which may include open surgery. 

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