Intuitive Surgical’s new system
requires only a single incision for its robotic arms and a camera to enter the
body.
SURGEONS once made incisions large enough to get to a gallbladder or
other organs by using conventional tools they held in their own hands. Today,
many sit at a computer console instead, guiding robotic arms that enter the
patient’s body through small openings not much larger than keyholes. But even
this minimally invasive surgery usually requires multiple incisions: one for
the camera system showing the way to the surgeon at the console, and others for
each of the robotic arms that do the cutting and stitching.
Now there are robotic systems — one on the market, others in development
— that are even less intrusive. They require only a single, small incision
through which the robotic arms and camera enter. This could lead to faster
recovery, said Dr. Michael Hsieh, a Stanford
professor and a urologist at Lucile Packard
Children’s Hospital and Stanford
Hospital. “There’s only one wound to heal with this procedure, rather than
three,” he said.
Dr. Hsieh, who performs abdominal surgery on small children, uses
minimally invasive techniques that typically now require three incisions. His
patients generally go home a day or two after surgery, he said, “but I think
they would recover more quickly if I could reduce my multiple incisions to just
one,” he said. “And there will be less scarring, or even no scarring, if you
enter through the navel.” He will soon have a chance to try out the new method
on his patients. Stanford Hospital is buying a system from Intuitive Surgical called
Single-Site that requires only a single incision of about one inch. The system,
approved by the Food and Drug Administration only for gallbladder
removal, is used as an add-on to a basic robotic system from Intuitive,
known as the
da Vinci Si.
The Si costs $1.3 million to $2.2 million, said Angela Wonson, a
spokeswoman for Intuitive, based in Sunnyvale, Calif. The Single-Site can add
$60,000 or more to the bill, or far less, depending in part on the equipment those
hospitals might already have. The East Jefferson General Hospital in Metairie, La., has bought a Single-Site system. Seated
at a computer there, Dr. Joseph Uddo Jr. can control the instruments, which can
enter the body by way of one incision in the navel. Surgical instruments like
scissors are at the ends of the robotic arms. “To change a tool, you take out
one instrument and load in another,” he said.
ANOTHER surgical robotic system, now in development, enters the body
through a remarkably small incision — six-tenths of an inch, or 15 millimeters.
The robot was designed by Drs. Dennis Fowler and Peter Allen of Columbia
University and Dr. Nabil Simaan of
Vanderbilt University. Once inside the body, it unfolds to reveal a camera
system and two snakelike arms that perform the surgery. The system has been
licensed to Titan Medical in Toronto.
Minimally invasive surgery through a single incision can also be performed with
long, thin laparoscopic tools that surgeons wield as they watch a video
monitor. But single-incision laparoscopic surgery with hand-held instruments
can have problems, said Dr. Adrian Park, chairman of the department of surgery
at the Anne Arundel Medical Center in
Annapolis, Md., who specializes in minimally invasive gastrointestinal surgery.
One difficulty is its ergonomic challenge to doctors, while another is the
pressure that the tools place on tissue during single-incision operations.
Robotic systems, by contrast, are likely to ease single-incision
surgery, said Jeffrey J. Tomaszewski, a fellow in urologic oncology at the Fox Chase Cancer Center in Philadelphia. “Robots
are an extension and multiplier of our own surgical hands,” Dr. Tomaszewski
said. He has done traditional laparoscopic surgery with hand-held instruments,
including operations through a single incision. “But you can be working at
constrained angles,” he said. “A robot can improve the angle of workability.”
Robotic systems, though, have yet to show that they are always worth the
extra money they cost. Such proof will take time, said Allison Okamura, an
associate professor of mechanical engineering at Stanford who directs the Collaborative Haptics and Robotics in Medicine Lab. “The jury is still out because of the longevity of the
studies that are required,” she said. Dr. Tomaszewski agreed. “We surgeons love
using the robot,” he said. “But the question is, and what we all have to fight
hard to do, is to determine for what procedure the robotic approach provides
the best benefit.” Dr. Hsieh says he hopes that single-site robotic systems
will someday bring a benefit he’s long dreamed about. “We may get to the point
where we do outpatient, scarless robotic surgery,” he said. “That’s what I’m
shooting for.”
Source: NY Times
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