Robots and minimally invasive surgery represent a whole new generation of surgical options

What seemed like futuristic fantasy only a few years ago is becoming reality with two different robotic surgical systems at University of Iowa Hospitals and Clinics.

Both first-generation systems allow surgeons to perform complex, intricate surgical procedures from outside the patient's body:

• The FDA-approved da VinciTM Surgical System, which enables the surgeon to get closer to the surgical site than human vision will allow and work at a smaller scale than conventional surgery. As a component of the planned new Minimally Invasive Surgery Center at UI Hospitals and Clinics, it will be one of about 100 da Vinci systems worldwide when it comes into use later this year.
• The investigational Stereotaxis SystemTM, invented by Matthew Howard, M.D., chairman of neurosurgery at UI Hospitals and Clinics, and brought to University of Iowa Health Care by UI radiologist Michael Vannier, M.D. The magnetic stereotaxis navigation system--one of only four of its kind in the world--is being upgraded to all digital imaging with a more advanced magnet design, so the first of this "new generation" magnetic surgery system should be operational this Fall.

Vannier said the innovative Stereotaxis system represents a technological breakthrough for interventional medicine and image-guided surgery. It features computer-controlled magnetic fields capable of remotely steering a catheter and other instruments needed to perform procedures beyond the capability of human hands.

The system will be used by physicians from several specialties, including radiology, neurosurgery, and cardiology.

"Robots and minimally invasive surgery represent a whole new generation of surgical options," Vannier said. "We are playing a leadership role in applying these technologies to patient care, research, and teaching applications."

Urologist Howard N. Winfield, M.D., and surgeons James W. Maher, M.D., and Jeffrey Everett, M.D., are leading advocates for the planned Minimally Invasive Surgery Center, where the da Vinci robotic system has been approved for many surgical procedures of the abdomen and pelvis, such as radical prostatectomy, in which the cancerous prostate is removed, or Nissen Fundoplication for patients with a hiatal hernias.

In addition, many cardiac and chest surgical procedures are approved or in the process of being approved by the Federal Food and Drug Administration.

Winfield said robotic technology is expected to revolutionize laparoscopic surgery, potentially enabling patients to recover faster and spend less time in the hospital.

In standard laparoscopic surgery, surgeons pass a laparoscope, a rigid telescopic instrument, along with a variety of long, specially designed instruments into the body cavities through small incisions. With these instruments, a wide variety of operations may be performed. Because the body wall injury is minimized, patient hospitalization and recovery is markedly reduced. It is still major surgery but performed in a "minimally invasive" fashion.

The da Vinci system uses robotic arms controlled by a surgeon seated at a separate console. It provides the surgeon with a three-dimensional view of the operating area, magnified up to 12 times. The surgeon uses tweezer-like controls to manipulate the surgical instruments, which through computerized electronic signals are made to move in sync with the movements of the surgeon's hands.

"While conventional laparoscopic surgical techniques have improved in recent years," Winfield said, "various inherent limitations, such as lack of depth perception, inhibit further development, making robotic surgery a very attractive alternative."

The introduction of surgical robots with true three dimensional vision, as well as articulated instruments, allow surgical procedures to be more precise and less traumatic, he said. "Furthermore, it opens up the opportunity for new surgical procedures, including certain heart procedures that would no longer require the breastbone to be split," Winfield said. "It's going to revolutionize surgery as we know it. The patient will now have the opportunity to experience a more gentle and kinder form of surgery."

Glimpse of the future

Even the simplest of today's surgical procedures typically requires two or three surgeons, an anesthesiologist, and several nurses. Surgical robots may eventually reduce the number of people required to complete the task. Future procedures using advanced robotic surgical systems may require only one surgeon, an anesthesiologist, and one or two nurses. Even so, medical science is still far removed from the day when autonomous robots will operate on people without human interaction.