More Change Coming for Surgeons, Patients


robert-thomasBy Robin Williams Adams
Published: Tuesday, March 3, 2015 at 10:22 a.m.

BARTOW | Before robotic surgery there was minimally invasive laparoscopic surgery. It let surgeons use smaller incisions to get instruments into the body and led into robotic-assisted surgery.

Doctors doing robotic surgeries sit at consoles to guide small instruments, put into the body through tiny incisions, for cutting, suturing and other procedures. That brought 3-D where there had been 2-D.

Changes keep coming, say two veteran local surgeons who rode the curve from open to minimal to robotic.Dr. Rafael Quiñones has his eye on the da Vinci XI, which will have instruments coming down from the ceiling instead of from the side.
The model he uses now at Bartow Regional Medical Center, da Vinci Si high definition, is programmed to “recognize” him, adjusting the console to his height.

Dr. Robert Thomas of Bond Clinic in Winter Haven said, only half jokingly, he’s waiting for the little wand from Star Wars to scan a body, diagnose or cure.Failing that, he’s anticipating improvements that will give robotic instruments more of the flexibility of a human wrist and he’s awaiting a wristed stapler. With that stapler device added to other tools, he said, entire operations could be done inside the abdomen.

In 2016, Quiñones said, surgeons will have access to robotic instruments mobile enough to enter straight into an incision and rotate up to 270 degrees. “Changes are occurring faster and they are all positive,” Quiñones said.Technology changes so fast that surgeons and institutions often can’t get there fast enough, he said, citing economics as one delaying factor.

Both surgeons made it clear robotic-assisted surgery, while exciting, needed laparoscopic techniques to make it possible. “The biggest ‘wow’ moment for general surgery was use of laparoscopic instruments,” said Thomas, surgical section chairman on Winter Haven Hospital’s medical staff.*

Patients whose gallbladders were removed with open surgery used to spend a week in the hospital and have eight-week recovery periods.Now removal that is done laparoscopically usually is an outpatient procedure. Patients recover in days, Thomas said.

The procedure goes much more quickly. Quiñones said one of his recent gallbladder removals took 18 minutes.For some surgeries there’s single-site robotic surgery, which uses one small cut to get instruments held by robotic arms into a patient’s body.

One incision, through the belly button, has government approval in the United States for some gallbladder removals and hysterectomies. Will incision-less surgery someday replace single-site surgery? First, Quiñones said, instruments would need to be developed to make it possible. Right now, he said incision-less surgery generally is time consuming, expensive and hasn’t proved to be better.

Will robots someday push surgical assistants from the operating room? Inventors are working on robot assistants to do basic things like take temperatures and lift patients, but replacing medical staff in operating rooms seems unlikely any time soon. Suturing does needs some attention, Thomas said.*

Different materials are used to close incisions now, he said, but the method is the same as it was many years ago. Although da Vinci has become almost a household word in Polk County for robotic-assisted surgical systems, it isn’t the only company producing them.

The systems’ uses have expanded and specialized, Quiñones said, with some designed specifically for ear-nose-throat and others for orthopedics.