Debunking Myths About Robotic Surgery

By Sondra Forsyth

By Keith Chisholm, MD

Robotics-assisted surgery has become enormously popular, with physicians around the world performing 1.5 million procedures from hysterectomies to heart valve repairs in 2011.

However, myths and misconceptions about robots in the operating room still abound. One is that the robot performs the surgery – “A robot operated on my hernia.” Technically, it’s not a robot because it can’t perform surgery without someone controlling it. It’s actually computer-assisted surgery. The surgeon guides all of the movements using finger-manipulated controls.

Along with many other robotics surgeons, I use the da Vinci Surgical System, which the U.S. Food and Drug Administration approved for minimally invasive surgeries in 2000. Nine years later, the da Vinci was being used in 80% of surgeries to remove cancerous prostates, according to its maker, Intuitive Surgical, Inc.

The benefits of robotics-assisted surgery are numerous. I perform several different procedures using da Vinci and I became the first physician at Florida Hospital North Pinellas to use it for a single-incision cholecystectomy (gall bladder removal).

The robotic arms hold miniaturized surgical instruments, so we can get in through very small incisions. That means there’s less chance of infection, less pain, much less scarring, and a quicker recovery time. Because the arms have “wrists” that can rotate more than 360 degrees, we have far more maneuverability than we do with laparoscopic surgery, and we can get into hard-to-reach areas.

One of the robotic arms holds a magnified 3D high-definition camera, which gives us a much better view of the surgical site than we would have with just our own eyes.

In a 2013 FDA survey, surgeons experienced with da Vinci said their patients have less bleeding, fewer complications, much quicker recovery times, and less time in the hospital – 24 hours on average. Not only that, but those who used da Vinci to remove advanced cancer in the tonsils region of the throat said half of their patients were able to avoid chemotherapy.

What are some other myths and misconceptions?

• Myth: Robotics-assisted surgery costs much more than traditional surgery.
A study conducted by University of Pennsylvania health economist Andrew J. Epstein and published in July 2013 in JAMA Surgery found that half of the minimally invasive procedures reviewed, including robotics-assisted and laparoscopic surgeries, cost insurance providers less than the same surgeries performed in the traditional manner. Four of the six minimally invasive surgeries also resulted in fewer lost work days – sometimes several weeks fewer.

The robotics technology is expensive and the whole surgical team has to be trained, which can add to the cost. But there’s also a tremendous savings compared with traditional surgery because the patient is out of the hospital more quickly and there are fewer complications.

• Myth: Robotics-assisted surgery is riskier than traditional surgeries.
Any surgery has certain risks, but in many ways, robotics-assisted surgeries have fewer overall.

Many times, the robotics-assisted procedures can be done much more quickly, so there’s less risk simply because the duration of the procedure is shorter. You also have the smaller incisions, and less bleeding, factors that reduce the risks.

In addition, the Tampa Bay area is fortunate to have the cutting-edge 2-year-old Center for Advanced Medical Learning and Simulation (CAMLS) operated by the University of South Florida. Our surgical teams have easy access to training, practice with simulators and continuing education, so we’re extremely well prepared.

Dr. Keith Chisholm graduated from the University of North Carolina, Chapel Hill, Medical School and went on to residency training at the University of Florida, becoming an assistant adjunct professor and attending surgeon at the Malcolm Randall VA Medical Center in Gainesville, Fla. He’s believed to have performed the first laparoscopic colon resection in the UF surgical department. From laparoscopy to robotics-assisted surgery was a natural advance for Chisholm, who has a private practice in Trinity, Fla., and is among the robotics-certified surgeons with privileges at Florida Hospital North Pinellas.