Robotics Aid Surgeons in Operating Room

On December 5, 2002, urologist Arieh Shalhav, MD, performed the first robotic operation at the University of Chicago. He used a new device, called the Da Vinci Surgical System, to remove a cancer-bearing kidney from Christine Fulara, a 70-year-old Chicago woman.

She went home two days later and in four days was out walking around her block, trying to convince her doubting neighbors that she really did have major surgery.

"It seems like a snap, so far," she said. "The scars are tiny. If my stomach didn't hurt, I wouldn't know I had surgery."

Her results, and the operation itself, look very different from traditional surgery. Fulara emerged with four small holes on her belly rather than a long surgical scar. And during surgery, instead of a team of doctors and nurses gathered around the table, she had a large cluster of robotic arms positioned over her abdomen. Her surgeon, Dr. Shalhav, was 15 feet away, off in one corner of the operating room, inside the Da Vinci console and his wrists and hands connected to glove-like sensors, which guide the tools on the robot's arms.

A pioneer in minimally invasive urologic surgery, Shalhav appreciates the improved visibility, precision, and comfort that the robot brings to the OR.

Dr. Shalhav operating the Da Vinci Surgical System. Dr. Arieh Shalhav performs minimally invasive surgery using the Da Vinci Surgical System.

"Laparoscopic techniques speed recovery but they are a bit unnatural to the surgeon and difficult to master," he said. "Many of your movements are reversed, so you have to think twice about each action, plus you are looking at a two-dimensional monitor, and your body and arms are in an awkward and uncomfortable position."

The robotic approach, on the other hand, is much more intuitive. "It does whatever my hands do, and I can see in three dimensions," said Shalhav, "thanks to a separate camera image for each eye."

He plans to use the robotic device routinely and is preparing to perform prostate cancer surgery with the Da Vinci, a procedure he already does laparoscopically. Studies suggest that minimally invasive prostate removal provides tumor control similar to open surgery, with no increase in complications, such as incontinence and impotence. It decreases blood loss and allows faster recuperation. Shalhav believes the robotic system can bring even greater precision and control to the procedure.

"It may take years to learn to do difficult procedures laparoscopically," he said, "but I can teach urologists to perform them like an expert with the robot in a few months." The eventual goal, he says, is to do "all urologic surgery this way."

The cardiac and vascular surgery teams are also using the Da Vinci system for certain procedures.

December 2003

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