DaVinci, Why in the World?

– Program Director Article –

Why in the World Do We Need daVinci?

Here’s a question that I’ll bet you have asked yourself; either privately or out loud. Why add this huge piece of equipment that takes up valuable OR space, has a price tag of nearly $2 million and yearly maintenance and supply costs, not to mention the training costs and time of all involved? With the arrival of every new technology come questions as to its efficacy and practicality. Although robotics aren’t really new (receiving FDA approval in 2000) there are still criticisms regarding its cost to benefit ratio.

The daVinci robotic system requires a good deal of training by the surgeon before he or she can acquire privileges to “operate.” There is a definite learning curve for the surgeon, the surgical assistant, and the surgical technologists to work as a team, but with this comes a fantastic method to improve the outcome for many facing complex surgical procedures. Specialties currently utilizing robotics are cardiac, colorectal, general surgery, gynecology, head and neck, thoracic and urology.

Backing up a few years to the 70’s Kurt Semm, a German GYN surgeon and engineer developed instrumentation and techniques to perform ovariectomy, adenectomy, and myomectomy. It wasn’t until 1982 when he performed an “endoscopic appendectomy” that general surgeons took notice of his techniques.

When laparoscopic cholecystectomies were first performed, I personally remember thinking (oops, dating myself) this seems like an awful lot of extra work for a simple gall bladder removal. However, for the patient whose incision was made through the transverse musculature requiring them to spend up to a week in the hospital following surgery recovering from this large painful incision, it was a boon! An incision that used to be approximately 4-8” long became four 1/2” (and later one approximately 1” incision with single-site procedures) accomplishing the same thing. This was an amazing progression in our field.

In the 90’s when LAVH’s were introduced, I thought “isn’t this a lot of extra equipment and time when we could just perform a typical vaginal or abdominal hysterectomy?” We seemed (in my mind) to have taken a step backward by having both open instrumentation and laparoscopic instrumentation and towers in the room for a case. What’s this all about?

I slowly came to the realization that for certain cases, laparoscopic assistance could come in pretty handy when dissecting the uterus from its attachments prior to moving below and completing the hysterectomy. There was much less bleeding and much less chance of inadvertently damaging a ureter or artery with the laparoscopic dissection. Also, in cases where the patient had undergone previous surgery with a resultant considerable amount of scarring, this new advancement saved the patient from having to experience an open procedure, which as you know is a much bigger surgery with a much more difficult and longer recovery time.

Jumping forward a decade, another new technology arrives that has the surgeon the one to step up and offer to learn a new procedure and it didn’t matter to me that it was an 8-10 hour back fusion; that was my game. Others may just look away when volunteers were asked if they’d like to try something new but I usually jumped in with both feet. Good or bad, that’s what I did. So, when the opportunity came for me to try the DaVinci for the first time, I jumped. I was excited to try this new surgical advance! The day arrived and I was scheduled to co-scrub with another FA who had been doing daVinci cases for a while so he could “show me the ropes.”

We worked together and he did some stuff and I did some stuff and finally, the case came to a close. I couldn’t wait to get out of there. To say I was a fish out of water was an understatement. I was clumsy and fumbled the instruments and was pretty frustrated with my efforts.

Following the case, the surgeon who had originally asked me to work with him asked, “So, how did you like that?” I told him flat out that I did not like it at all. I felt very uncomfortable that he was not scrubbed in beside me and everything seemed so foreign to me. It was nothing like I expected it to be. In spite of my reservations, I told him that I would come back and try it a few more times to see if I could find anything I liked about it. I’m so glad he didn’t give up on me.

Now, more than four years later, I’ve become pretty adept and comfortable with the daVinci. I’ve had the wonderful opportunity of attending a couple of daVinci labs to further enhance my knowledge of this equipment. If you are lucky enough to be chosen to attend any of these labs, don’t hesitate to take advantage! There are many things that can go wrong during these cases, and any new procedures and just the troubleshooting tips alone are worth their weight in gold when you return to the operating room.

When I was a CST on the Urology Team of my local hospital, open radical prostatectomies were somewhat of a mystery to me due to my inability to actually see what the surgeons were doing during the case. What I could see were the suction canisters filling up with blood and thinking how awful this surgery must have been for the patient. There was no such thing as nerve sparing and most patients were told that they would most likely become impotent following the surgery and may even have some urinary issues to boot…not to mention the

extreme amount of blood loss that seemed to always occur. The benefits to the patients undergoing a radical prostatectomy with the use of daVinci are many; minimal blood loss (often less than 30cc’s), a much speedier and significantly less painful recovery and a faster return to activities of daily living.

Many of these patients are now happy to report that their surgery was indeed a nerve-sparing procedure and did not leave them impotent! This is a very important factor, but to those younger men experiencing a radical prostatectomy, this is extremely important to them. The detailed 3D view of the surgeon allows him, along with the extreme dexterity of the robotic arms, to delicately dissect the prostate from its bed with minimal damage to surrounding tissues, nerves and arteries. I have only touched on urologic use of the daVinci, but hopefully, this will give you a good idea of how beneficial this procedure can be.

So, whatever might come in the future in the way of providing our patients with less invasive, safer and more successful complex surgeries, I’ll be right there at the start line to jump on a new experience. I get so excited about these new developments that I have to remind myself it’s not for me, but for the benefit of our patients and their families.

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