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A robot arrives in the operating room

Medicine@Yale, 2007 - Jan Feb

Da Vinci System adds precision, clearer vision to surgical procedures

Operating room nurse Elizabeth Lasorso, R.N., did a double take when she walked into the operating room in late August and saw four robotic arms looming over a patient undergoing a radical prostatectomy. “I saw those arms just moving away, and nobody touching them,” she recalls, “and I thought, ‘Wow!’ ”

Seated across the room was Associate Professor of Surgery John W. Colberg, M.D., his face pressed to a screen, his hands inserted in gloved controls and his feet on pedals that manipulated the arms of Yale-New Haven Hospital’s newly acquired da Vinci Surgical System. To remove the patient’s prostate gland, Colberg controlled three of the da Vinci System’s arms for cutting and suturing; the fourth held a tiny binocular camera inserted into the patient’s pelvis.

“The experience was phenomenal,” says Colberg, the first physician to use the new $1.8 million device manufactured by Intuitive Surgical of Sunnyvale, Calif. Since then he has performed more than a dozen urological procedures using the da Vinci System.

As with other minimally invasive surgical procedures, robot-assisted surgery has distinct advantages, Colberg says. In the minimally invasive prostatectomy developed in the early 1990s using laparoscopic techniques, incisions are smaller than in open surgery and patients recover more quickly. According to Colberg the robotic version is even better, causing “virtually no bleeding.”

The da Vinci device increases the surgeon’s dexterity and improves the ability to see. The magnification of the operating field provided by the da Vinci System’s camera is four to eight times greater than that provided by a standard surgeon’s loupe, the viewfinder on the robotic console provides surgeons with a three-dimensional view. The equipment’s “wristed” robotic arms can rotate 360 degrees, far greater than the human arm, which is limited by the shoulder joint to about 270 degrees. And robotic “hands” never shake.

Physicians train by observing three surgeries, practicing for two days and then doing cases proctored by a physician credentialed in robot-assisted surgery. Colberg says that his patients have sought out the robotic procedure after hearing about it from their physicians, from friends or on the Internet.

Although the first robot-assisted prostatectomy was performed just six years ago and there are only about 400 such machines nationwide, Colberg says that 32,000 of the 80,000 radical prostatectomies performed in the United States in the next year will be robot-assisted.

Robert Udelsman, M.D., M.B.A., M.S.B., chair of the Department of Surgery and Lampman Professor of Surgery, calls the da Vinci System a major innovation: “The optics and the coordination that the surgeon gets with his hands are unbelievable.”