Advancing Technology of Medicine: The Da Vinci Robot
Richard Ly
10/18/13
Professor Wolcott
In this paper, it will discuss the advantages of robot-assisted Laparoscopies with the
Da Vinci robot when compared to conventional laparoscopic surgeries or laparotomies. It
will go over the information of the actual surgical procedure; however, it will not go into
great detail as that is not the reason for this paper. Sources used in this will date from 2005
to the present. The reason for this is to briefly show the first model of the Da Vinci robot.
In that article, it states problems and complications the first model went through and most
of the articles most recently published will explain the advancements of the Da Vinci robot
and techniques involving it. Within the sources used for this annotated bibliography, most
of the authors are employees of hospitals, more specifically in the Department of Surgery
or subgroups of Minimally invasive surgeries. Other authors were electrical engineers.
Credibility depended on the authors' degree as well as the institution of their employment.
This paper would best help a person who will be or could be undergoing robot-
assisted laparoscopic surgery as it may help inform the patient to be more knowledgeable
of this new technique used in surgery. It would also be beneficial to students in high school
or college that may interested in general medicine. This paper could also be interesting to
an engineer major that could be specializing in medical technology. This paper, due to the
terms used, decreases the possible audience.
Although difficult, it is not impossible so a high school student would be able to
understand the what each part of the annotation is implying. A few terms that may aid the
reader to have a better understanding of the topic would be laparoscopies-viewing of the
abdomen via fiber optic instrument to aid the surgeon in doing a procedure-, morbidity-
percentage of a patient's chance of receiving a disease- , and carcinoma-cancerous tumor-.
After reading this paper, it gives a broad understanding of the advantages of robot-assisted
surgeries over conventional surgeries.
Anderson, Casandra. Joshua Ellenhorn, Minia Hellan, Alessio Pigazzi. "Pilot Series of
Robot-Assisted Laparoscopic Subtotal Gastrectomy With Extended
Lymphadenectomy For Gastric Cancer." Springer Link. 8 March 2007. 18 October
2013. In this article, a team of four doctors from the Department of Surgical
Oncology of the City of Hope discuss the technique of robot-assisted laparoscopic
surgery to remove carcinogenic tumors of the lymph nodes. For this study, 7 cases
(3 females and 4 males) underwent laparoscopic subtotal gastrectomy with
omentectomy and robot-assisted extended lymphadenectomy. For this, surgery took
approximately 420 minutes and were completed successfully without conversion-
reverting back to the conventional method. There was, however, one complication
due to one of the patients requiring a colon resection for a devascularized segment.
After performing this case study, the team concludes that the technique of robot-
assisted surgery to remove tumors of the lymph nodes is feasible. In result, the
patients have a higher chance of shorter hospital stay post-op and lower morbidity
rate. What becomes a problem with this case study, however, is that the results are
short term and when dealing with carcinomas, long-term results are extremely
important and, at this time, are not available. When comparing the robot-assisted
laparoscopies and the conventional laparotomies, the robot-assisted laparoscopies
provide an improved amount of dexterity for the surgeon as well as increased
freedom within the surgical site, no surgeon tremor, and more precision in the
procedure.
Antoniou, Starvros A. George A. Antuniou, Oliver O. Koch, Rudolf Pointner, Frank A.
Granderath. "Robot-assisted Laparoscopic Surgery of the Colon and Rectum."
Springer Link. 20 August 2011. 18 October 2013. In this article, the authors,
Stavros A. Antoniou, George A. Antoniou, Oliver O. Koch, Rudolf Pointner, and
Frank A. Granderath, review the robot-assisted laparoscopic surgery within the
colon and rectum. These authors are all employed within different hospitals, one of
which works in the Center for Minimally Invasive Surgery. The article focuses on
the improvements in surgery as well as postoperative oncologic outcomes although
since studying the oncologic outcomes are more long-term, the material available is
minimal. The authors explain that the use of the robot had a low percentage of
complications during the procedure of the colectomies. Even with the time to set up
the robotic system, the amount of time to perform the procedures with the assistance
of the robot is reasonable. Robot-assisted surgeries allow the surgeon to take
advantage of numerous benefits: advanced degrees of freedom, the magnifying
camera effect, a stable camera platform, and the 3-dimmensional imaging. With the
potential of increased precision, the surgeon is able to decrease the amount of nerve
loss within certain surgeries. Even with this growing technology becoming a norm
in the surgical field, it still is in its infancy. Certain procedures, such as a splenic
flexure mobilization, are not yet feasible since the robot system is unable to reach
the left upper abdomen. The patients movement during a surgery also becomes
extremely limited, thus limiting the use of the robot in other surgeries where this is
required. Although the Da Vinci Robot is still in its infancy, it still provides many
benefits to the surgeon when performing procedures where increased dexterity will
greatly improve the patient's outcome.
Advincula, A. P. "Surgical Techniques: Robot-assisted Laparoscopic Hysterectomy With
The Da Vinci Surgical System." The International Journal of Medical Robotics and
Computers. Volume 2, Issue 4, 15 December 2006: pages 306-311. In this article,
the author, A.P. Advincula- a member of the Department of Obstetrics and
Gynecology of the University of Michigan- discusses the technique of robot-assisted
surgery with use in laparoscopy hysterectomies. Although using the Da Vinci robot
in performing a laparoscopic hysterectomy provides numerous advantages such as
increased dexterity and precision, laparotomy hysterectomies is still the most
common technique used. Robot-assisted surgeries offers the ability to perform an
almost suture-less hysterectomy due to the improvements in the robot's energized
instrumentation.
Bodner, Johannes. Paolo Lucciarini, John Fish, Reinhold Kafka-Ritsch, Thomas Schmid.
"Laparoscopic Splenectomy With The Da Vinci Robot." Journal Of
Laparoendoscopic & Advanced Surgical Techniques. Volume 15, Number 1, 1
February 2005: pages 1-5. The contributing authors of this journal article are all
Doctors of Medicine. This article explains the early stage of the Da Vinci robot. In
the earlier model of the Da Vinci robot, it required two people to use the robot in
surgery: one at the console and one at the tableside controlling the robot. This study
was based on splenectomies using only the Da Vinci robot by the same surgeon. In
the article, the authors note that a previous paper by Talamini stated that
splenectomies wouldn't be an ideal procedure to be done with the robot since 2 of 7
splenectomies were forced to convert back to the conventional method. However,
the authors of this article report that none of the splenectomies ran into any
complications in surgery. Past research stated that the size of the spleen would
greatly impact the results of the surgery, however, the first splenectomy performed
in their study was an abnormally oversized. Even with this, the surgery was still
done without any complications. In the discussion section, the authors note that,
when studying these 7 consecutive cases, the results were ideal: no surgical
complications and excellent short-term remission rates. The authors also state that
within a few years advancements will occur to the point where only one person will
be needed to operate the robot.
Eisenberg, Dan. Tamas J. Vidoszky, James Lau, Bernadette Guiroy, Homero
Rivas."Comparison of Robotic and Laparoendoscopic Single-site Surgery Systems
in a Suturing and Knot Tying Task." Springer Link. 27 February 2013. 18 October
2013. The authors of this article, Dan Eisenberg, Tamas J. Vidovszky, James Lau,
and Homero Rivas, are all members of the Department of Surgery within their
hospital. In this article, the authors conducted a study based on the comparison
between the two different techniques of laparoscopies: Laparoendoscopic Single-
Site (LESS) surgery and the use of the Da Vinci Robot. To compare the two, the
authors gave five minimally invasive surgeons the task to suture and tie a square
knot with both techniques. These surgeons all have previous experience in LESS
surgery as well as similar single-site surgeries more specialized to their practice.
The surgeons received some formal training with the Da Vinci robot when arriving
at the site; however, before this, none of the surgeons had personal experience
purely with the robot in their practices. To measure the quality of the work, the
sutures were tested with a "leak" test where saline would be injected into the suture
with a syringe and have pressure be put onto it. When performing the test, the
results showed that 100% of the surgeons were able to complete the task within the
20minutes mark when using the robot whereas only 20% of the surgeons were able
to complete it within the 20minutes mark on their first try. Not only that, however,
but the sutures done with the robot actually had no leaks when tested and 90% of the
sutures done without the robots did leak. During this study, the authors noted that
this comparison of the two different techniques was based on the performance of the
task. With that, it is easily shown that the use of the robot did increase time
efficiency as well as quality of the sutures; however, the Da Vinci robot takes a large
amount of time to set up for the procedure and the time that was recorded only
involved the time of the task.
Friedman, Diana W. Thomas S. Lenvay, Blake Hannaford. "Instrument Failures For the Da
Vinci Surgical System: a Food and Drug Administration MAUDE Database Study."
Springer Link. 14 December 2012. 18 October 2013. In this article, the authors,
Thomas S. Lendvay-a member of the Department of Urology at the University of
Washington-, Diana C. W. Friedman and Blake Hannaford- both members of the
Department of Electrical Engineering at the University of Washington- discusses the
instrument failures of the Da Vinci robot. To do this, the team uses the FDA
database to review the reported cases of system failures of the Da Vinci robot. From
what the FDA Database shows, wrist or tool-tipped failures are most commonly
reported, cauterizing instruments follow next, then it would be instrument shaft, and
lastly would pertain to the cable and housing. Although this may be what is shown
on the FDA database, it is not 100% accurate since it is was is "reported"; there is an
unknown amount of cases of system failures that go unreported at the hospital's
discretion. Even if the hospital would report any known malfunctions of the Da
Vinci system, there is still a good percentage of system failures that the surgical
team may not notice. Perhaps the reason the instrument's wrist or tool-tip has the
most failures is because it's what would most be noticeable since the surgeon's
vision is always focused on the instruments.
Hagen, Monika E. Oliver J. Wagner, Ihsan Inan, Philippe Morel, Jean Fasel, Garth
Jacobsen, Adam Spivack, Kari Thompson, Brian Wong, Lauren Fischer, Mark
Talamini, Santiago Horgan. "Robotic-Single Incision Transabdominal And
Transvaginal Surgery: Initial Experience With Intersecting Robotic Arms." The
International Journal of Medical Robotics and Computer Assisted Surgery. Volume
6, Issue 3, 19 April 2010: pages 251-255. In this article, the team of doctors from
the Center for the Future of Surgery of the University of California and the Division
of both the Anatomy and Digestive Surgery of the University Hospital Geneva,
Switzerland review the technique of robot-assisted single-incision in both
transabdominal and transvaginal surgeries. In this case study, the doctors perform
the surgeries on male and female human cadavers. Performing robot-assisted
transabdominal laparoscopy was successful. During this, the surgeon uses the
"chopstick" method, crossing the left and right instruments of the Da Vinci robot to
prevent collision and increase movement within the surgical site. When doing this,
the surgeon notices a slight loss of range with the left instrument due to the third
instrument (the camera). The surgery was successful without any problems in the
cadaver. When performing the robot-assisted transvaginal laparoscopy, it was shown
that it was not feasible due to the constriction of the vagina and the limited space
between the thighs. Although this may not be completely accurate when comparing
to a living human since the cadaver has limited space both inside(inflated bowel)
and outside (between thighs) as well as suboptimal bedding, resulting in difficulty in
the set up of the surgery.
Joseph, R.A. Salas N.A., C. Johnson, A. Goh, S.P. Cuevas, M.A. Donovan, M.G. Kaufman, B.
Miles, P.R. Reardon, B.L. Bass, B.J. Dunkin. "Chopstick Surgery: A Novel Technique
Enables Use of the Da Vinci Robot To Perform Single-Incision Laparoscopic Surgery."
Surgical Endoscopy. Volume 24, Issue 12. December 2010: Page 3224. The contributing
authors to this article explain the improvements of the Da Vinci robot. Before the
"chopstick" technique was incorporated into the Da Vinci robot, the surgeon would run
into minor complications of the instruments of the robot colliding with one another inside
the patient as well as outside. With the use of this technique, not only did it eliminate the
collision of instruments, it also greatly increased the range of motion within the surgical
site of the patient.
Kang, Chang Moo. Dong Hyun Kim, Woo Jung Lee, Hoon Sang Chi. "Conventional
Laparoscopic and Robot-assisted Spleen-Preserving Pancreatectomy: Does Da Vinci
Have Clinical Advantages?" Springer Link. 7 December 2010. 19 October 2013. In this
article, the team of doctors -of the Division of Biliopancreas of Yonsei University
College of Medicine, the Clinic of Pancreatic and Biliary Cancer of Yonsei University
Health System, and the Department of Surgery of Yonsei University Wonju College of
Medicine of Seoul, Korea- discuss results of their case study of the use of the Da Vinci
Robot in Pancreatomy to remove any tumors while preserving the pancreas. In this case
study, the team obtains two group of patients that require this surgery. When asking the
patients of which type of surgery they would want, the younger patients leaned toward
the robot-assisted surgery whereas the older patients were more towards the conventional
route. When the surgeon performed the procedure, the patients that underwent robot-
assisted surgery had a significantly greater amount of their pancreas when compared to
the patients that received the conventional surgery. The better results of the robot-assisted
surgery is because of the advantages it gives the surgeon. With it, it provides a 3-
dimmensional view, wrist-like movement of the instruments, no tremor, and scale
adjustment of the instruments as well. Although the results were much better with the
patients that received robot-assisted surgery, the cost of this technique exceeded twice the
cost of conventional surgery. Before the Da Vinci robot, performing this type of
procedure effectively, the surgeon would need a great amount of experience but now with
the robot, it takes a substantially shorter amount of time to learn this procedure.
Kerbl, David C. Jason Y. Lee, Phillip Mucksavage. "The Da Vinci Surgical System Overcomes
Innate Hand Dominance." Journal of Endourology. Volume 25, issue 8. August 2011:
page 1385. The contributing authors of this article explain the disappearance of innate
hand dominance when using the Da Vinci robot. In this case study, the authors obtain
multiple volunteers of all levels of experience with robot-assisted surgery. Everyone was
given a basic tutorial on operating the robot, regardless of the experience. The volunteers
were then given 30 minutes to practice basic tasks with the robot. Afterwards, their
manual dexterity was tested first, and later was again tested with the robot. When
comparing the results of the tests, the first test showed significant differences with the
majority of the people of the level of dexterity of each person where as the use of the
robot almost completely eliminated the gap between each hand.
Pedraza, Rodrigo. Madhu Ragupathi, Tara Martinez, Eric M. Haas. "Robotic-assisted
Laparoscopic Primary Repair of Acute Iatrogenic Colonic Perforation: Case
Report." International Journal of Medical Robotics and Computer Assisted Surgery.
Volume 8, Issue 3. 20 June 2012: pages 375-378. The contributing authors of this
article are doctors that are part of either the Division of Minimally Invasive Colon
and Rectal Surgery of the University of Texas Medical School or the Colorectal
Surgical Associates LLP of Houston, Texas. In this article, the team of doctors
describe a case study of repairing a perforation that was caused by a colonoscopy
with the technique of robot-assisted laparoscopy. During a colonoscopy, the chance
to have a perforation is 0.016-0.2%. When this does happen, it is very serious and
would most commonly be repaired by doing a laparotomy. Now with the Da Vinci
robot, surgeons are able to repair perforations and, in result to using the robot, the
patient will have less time spent in the hospital post-op with a lower morbidity rate
and lower chance of infection during the procedure. The use of the robot allows the
surgeon to have improved dexterity, stable camera platform, 3-dimensional
visualization with the capability of 10 fold magnification. The surgeon also has
increased range of motion within the site and no "surgeon tremor". The article
describes one situation where the use of the Da Vinci robot is ideal since
conventional techniques of laparoscopies wouldn't be possible with the special
characteristics of the perforation. With the assistance of the robot, the surgeon was
able to maneuver throughout the abdomen with ease. The improved camera allows
the surgeon to spot the problem out quicker and fix anything else around it that the
tear affected.
Pineda-Solis, Karen. Heriberto Medina-Franco, Martin J Heslin. "Robotic Versus Laparoscopic
Adrenalectomy: A Comparative Study In a High-Volume Center." Springer
Science+Business Media (2012) Web. October 9, 2013. A team of doctors -from the
Department of Surgery of both Instituto Nacional de Ciencias Medicas y Nutricion
Salvador Zubiran, Mexico and the University of Alabama, and the Section of Surgical
Oncology of the University of Alabama- compare the two types of laparoscopic
surgeries: robotic-assisted and conventional. The doctors used two groups of patients that
underwent the same type of surgery: adrenalectomy, the removal of the one or both of the
adrenal glands. One group undergoes robot-assisted adrenalectomy (RA), while the other
group of patients receive laparoscopic adrenalectomy (LA). When comparing the two
groups, the group that underwent the RA had a shorter amount of time in the hospital
post-op and a shorter recovery time compared to LA. During LA, there is a higher chance
of infection for the patient since the incision is significantly larger compared to the
incision done in RA. When performing LA, there is also a higher chance of mistakes
since it requires two people to perform this procedure: one to hold the camera and guide
the surgeon and one to perform the actual procedure. LA also has a limitation of
movement for the surgeon. Although in the case study, the lower chance of infection and
other benefits of RA are traded for time of the procedure; RA, when compared to LA,
takes longer.
Ragupathi, Madhu. Diego I. Ramos-Valadez, Rodrigo Pedraza, Eric M. Haas. "Robotic-
Assisted Single-Incision Laparoscopic Partial Cecectomy." The International
Journal of Medical Robotics and Computer Assisted Surgery. Volume 6, Issue 3. 27
July 2010: pages 362-367. In this article, the team of doctors describe a case study
with the use of the Da Vinci robot to perform a single-incision laparoscopic partial
cecectomy. In this case study, the doctors use a 53 year old male. The patient was
presented with a tubulovillous adenoma and provides consent to undergo the
robotic-assisted surgery. The surgery is completed without any complications
occurring within the patient. In this case study, the surgeon uses the "chopstick"
technique to cross the two instruments of the Da Vinci robot to prevent collisions
within or on the outside site of the patient of the surgery. This also increases the
range of movement for the surgeon. Although this technique provides great cosmetic
benefits of a small incision, it benefits the surgeon as well. With the use of the
robot, the surgeon is able to move more freely within the site of the surgery and has
improved dexterity when performing the surgery. The surgeon is also able to
overcome restrictions that conventional laparoscopic surgeries would face.
Spinoglio, Giuseppe. Luca Matteo Lenti, Valeria Maglione, Francesco Saverio Lucido, Fabio
Priora, Paolo Pietro Bianchi, Federica Grosso, Rual Quarati. "Single-Site Robotic
Choecystectomy (SSRC) versus Single-Incision Laparoscopic Cholecystectomy(SILC):
Comparison of Learning Curves. First European Experiences." Springer Link. 17
December 2011. 18 October 2013. In this article, the doctors of the Department of
Surgery of SS Antonio e Biagio Hospital, Unit of Minimally Invasive Surgery of
European Institute of Oncology, and the Department of Oncology of the SS Antonio e
Biagio Hospital compare single-site robotic cholecystectomy (SSRC) and single-incision
laparoscopic cholecystectomy (SILC). When performing SSRC, no major complications
occurred during the procedure and there was no need of a conversion to the conventional
method either. When the surgeon uses the technique of SILC, a major disadvantage is
present that the Da Vinci robot is able to overcome: intuitive control. Unlike SILC, SSRC
gives the surgeon an easier mobility of the instruments, resulting in an improved control.
When comparing the post-op status of the patients, the group of patients that underwent
SILC were required to stay at the hospital longer and also received a higher percentage of
morbidity. The use of SSRC increased satisfaction due to the smaller scar; cosmetically,
this is favorable.
Turchetti, Giuseppe. Ilaria Palla, Francesca Pierotti, Alfred Cuschieri. "Economic Evaluation of
Da Vinci-Assisted Robotic Surgery: A Systematic Review." Surgical Endoscopy.
Volume 26, issue 3. March 2012: Page 598-606. In this article, the contributing authors
use sources of people from the Institute of Medicine of Washington, and numerous
people within the field of health technology. This article discusses the economic side of
robot-assisted surgeries. This specifically focuses on the cost of the operating time and
hospital stay. From the articles the author uses to compare the cost between robot-assisted
surgery and conventional surgery, it shows that the cost of robotic surgery due to a longer
time in the operating room; however, the main factor in the cost would directly correlate
with the experience of the surgeon with the robot. Robot-assisted surgeries also result in
less days in the hospital post-op.