It may sound like science fiction, but physicians at UI Hospitals and Clinics are using robots to perform surgery. Howard Winfield, MD, urologist and director of the robotic and minimally invasive surgery program at University of Iowa Hospitals and Clinics, offers these comments:

You led the effort to bring robotic surgery to UI Hospitals and Clinics and were the first surgeon here to use the technique. Tell us how robotic surgery works .

Essentially the patient is brought to the operating room and positioned in the normal fashion for the planned surgery. Then we place small ports, the ports vary anywhere from 5-12 mm in size, into the abdominal, or if you're a cardiothoracic patient, into the thoracic cavity. We then bring the robot system into the operative field and we dock it with three of the small ports. The primary surgeon sits at a workstation console and is able to move the instruments attached to the smaller ports. At the tableside, by the patient, are one to two assistant surgeons.

What types of surgeries can robotic surgery be used for?

In the urologic field, we use it for robotically-assisted radical prostatectomy for men who have prostate cancer for the removal of their prostate gland. We're also using it for reconstruction of the urethral pelvic junction. Patients who are born with narrowing at the junction point of the tube draining from the kidney can actually have this reconstructed and we find that the robot works very well in this particular arena.

In gynecology the surgeons are using the robot for tubal reinastimosis, for women who have had their tubes tied and then want to have further pregnancies. They're also using it for women who have fibroids, what's called myomectomies. Over the last year or so they've been progressing into using the robot for hysterectomies and pelvic and abdominal lymph node dissections.

Our cardiothoracic  surgeons have used it for mitral valve replacement as well as assistance in coronary artery disease repair. And they're also using it for esophageal reflux repair procedures.

We have a pediatric surgeon who has used it for a whole host of congenital bowel and abdominal, as well as chest, abnormalities and I believe, in this arena, he's leading the world in many of the procedures that he's performed.

What are the benefits for the surgeon of using robotic surgery?

The big advantage is the visualization. With the robot unit, we get 10 to 12 times magnification, so everything is really large in our operative field. Using the instruments that are passed down six   degrees of rotation. So we're able to do almost super human movement. We can turn those instruments about 520 degrees, or 160 degrees beyond the 360 of a circle. The movement of the instruments as well as the visualization allows for a much finer dissection and hopefully better treatment results.

What are the benefits to patients of having robotic surgery?

Speaking from my field, which is urology, what we're finding is that in a radical prostatectomy, removing the prostrate, we're finding considerably less blood loss. Patients are getting out of the hospital within 24 to 48 hours of the procedure and generally back to their normal activities within two to four weeks. We're also finding that the continence return, or their ability to be able to hold urine after this type of operation, seems to be very quick, very comparable if not considerably better than with open surgery.

What is important in patients who have prostrate surgery is their ability to regain their potency following the procedure. We're finding that being able to regain normal erections for intercourse the results are as good as with open surgery.

In the other fields of gynecology, cardiothoracic, and general surgery, I guess you'd have to speak directly to those surgeons, but what I'm hearing is that the results are certainly as good if not better than other minimally invasive forms of treatment.

Are there other surgeons at UI Hospitals and Clinics using robotic surgery? What specialties do they represent?

• In urology, in addition to me, Fadi Joudi, MD
• In gynecology, Brad Van Voorhis, MD, and David Bender, MD
• In cardiothoracic surgery, Mark Iannettoni, MD, and Jeff Everett, MD  
• In pediatric surgery, John Meehan, MD

In the future, will robotic surgery totally replace traditional surgery?

I think I would be pressing it pretty hard to say it would completely replace traditional surgery, but there's no question that patients are asking for more minimally invasive procedures.

They're not really interested in the big flank or chest open incision where the recovery is really delayed. They really would like to have the procedures done using very, very small openings or no openings at all. So there's no question that our utilization of the robot, as well as other minimally invasive procedures here at the University of Iowa Hospitals and Clinics, is increasing exponentially and the number of general surgical procedures, open surgery, is going down. It will be interesting to see what happens over the next five to 10 years.

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