July 27 meant a typical day at the office for surgeon Guilherme Cantuaria. Robotic arms manipulated tools through tiny incisions on a woman’s abdomen. Cantuaria manipulated those tools remotely, peering through special cameras to see inside.
Several TV monitors in an operating room at Northside Hospital gave the nurses the visual play by play. Pop music whispered softly in the background. The monitors showed small tools inside the patient delicately danced around the Fallopian tubes to seize a cyst. Cantuaria explained that the robotic surgery helped him avoid damage to the tubes. That would protect his patient’s fertility.
After dispatching with the troublesome cyst, Cantuaria took a look at the woman’s appendix and decided he needed to use those same tools to remove it as well. All in a day’s work.
All completely average. Ordinary.
Cantuaria, a gynecological oncologist who lives in Sandy Springs, has been working with the da Vinci Robot since 2005 to perform surgeries. Saeid Khansarinia, who lives in Buckhead and is a thoracic surgeon at Piedmont Hospital, started using the technology six months ago. Jeffrey Miller, a cardio-thoracic surgeon at Saint Joseph’s Hospital who lives in Sandy Springs, has been working with robotic-assisted surgery for eight years. He said he did the first robotic lobectomy for lung cancer in the state of Georgia.
“I like using the robot because it makes the operation easier,” Miller said. “It provides us better visualization of the structures we’re trying to see. It has a 3-D camera. It provides greater surgical precision, increased range of motion, improved dexterity and better access to the heart and lungs, compared to the traditional open surgery.”
The robotic surgery is said to be less painful and allows patients to recover more quickly, doctors say.
Curently, da Vinci is the only robot of its kind, doctors say. While the robot is unique, there are 31 surgeons in Atlanta using the technology, according to the da Vinci website. The robots are used to treat gynecological cancer, in thoracic surgery, urology, cardiology, treatment of obesity and kidney cancer, among other applications.
But the physicians make clear that they’re the ones in the driver’s seat of these machines, which can cost $2 million, according to Saint Joseph’s. Machines aren’t replacing the study of traditional methods of surgery, just making the surgery better.
“The robot is yet another instrument,” Khansarinia said. “Every surgeon who learns to do gallbladder operations [learns the standard way]. Most of us learn to do a big incision to take out a gallbladder.”
There is a difference of opinion about whether the robots can make improve the skill level of surgeons.
Cantuaria thinks it can. He said the machines make stitching much easier for doctors to master.
“To sew with regular laparoscopic instruments is harder,” he said. “To sew with the robot is a lot easier. It has allowed more surgeons to do more difficult things.”
Doug Murphy, chief of cardio-thoracic surgery at Saint Joseph’s Hospital and lives in Buckhead, thinks it doesn’t. He says it’s a tool that can only enhance the abilities of surgeons who already are highly skilled.
Khansarinia thinks the robot wouldn’t boost the skill level of a surgeon out of medical school to that of one with more experience, but he thinks it does give surgeons the ability to do minimally invasive surgery if they couldn’t otherwise.
“If you took two surgeons and asked, ‘Does the robot make it easier?’ No. But it could give certain new skill sets that you didn’t have otherwise,” he said.
On the flip side of that question, he said a younger surgeon is more likely to pick up the robotic method very easily as opposed to an older surgeon with a more established routine, he added.
The surgeons said there are some things that the robots can’t offer them. The da Vinci Robot gives the user no real sense of tactile sensation. They said they’ve had to rely more on eyesight.
“The only people who complain about that are people who haven’t done this,” Murphy said. “We know what tissue looks like when you cut it. We know what tissue looks like when you put a stitch in.”
In the future Cantuaria predicts robotic-assisted surgeries will routinely be performed on patients who are a long distance away.
“You don’t have to be in the same town, be in the same state or the same country,” Cantuaria said. “You can be in the U.S. and operate on a patient in France.”
The background for this article
When I began looking into robotic surgery, I had no idea how common it was. I thought it would be something from The Jetsons or involving those little “droids” from the Star Wars movies.
How wrong I was. Doctors at our local hospitals use robots every day. Some have been using them for years.
When Northside Hospital offered to let me sit in and watch a surgery, I thought I would have to confront the kind of dramatic gore you see on television and in movies. But after I donned blue scrubs and was shown where I could and couldn’t go, I observed more than an hour of surgery without ever feeling squeamish. I happily would’ve watched more if I had had the time.
Thanks to the folks at Northside for giving me an up-close-and-personal look at the future of medicine.