When Vanessa Smiley had her gallbladder removed at Inova Loudoun Hospital in June, her surgeon was not standing by her side at the operating table. Instead, he was positioned in a console across the room, operating the controls of a state-of-the-art system that uses robotic technology to perform the surgery.
The hospital has been using the technology since 2009, when it invested in a costly da Vinci robotic surgery system. The system was then used mainly by urologists performing prostate removal surgery. But an upgrade in the da Vinci system last year has enabled surgeons at the hospital to use the robotic technology for a growing variety of surgical procedures for patients. As a result, the system is being used for nearly 10 times as many surgeries as it was a year ago.
C. Bernard Cross, a senior surgeon at the hospital who performed Smiley’s surgery, said some patients have misconceptions about the robotic technology.
“People worry about the robot, like it’s going to do something itself,” he said. “It has no artificial intelligence. It only does what you tell it to do with your fingers and hands.”
Cross, a strong proponent of robotic technology, said that it was first developed by the U.S. military so that a highly skilled surgeon could operate on a patient without being in a battle zone. The surgeon could even be in another part of the world, he said.
At Inova Loudoun Hospital, the surgeon is in the operating room but does not look directly at the patient during the surgery. Instead, the surgeon sits in a console and operates the instruments remotely, viewing a magnified, high-definition, three-dimensional image of the procedure on a monitor.
“Until you put your head in the console and have that binocular vision, you don’t really see the biggest advantage,” Cross said. “Now the anatomy just jumps out at you, and you’re seeing little fibers that you didn’t necessarily see before, and you can cut those fibers so they don’t bleed.” The result, he said, is cleaner surgery.
Another advantage of the robotic surgical system, Cross said, is that it is minimally invasive, performed using cuts as small as one to two centimeters in length. The instruments are wristed, meaning that they have more flexibility than the rigid instruments used in laparoscopic surgery, an earlier technique of minimally invasive surgery. For gallbladder surgery, the miniaturized instruments — including curved tubes and the camera — are inserted through just one cut instead of three or four.
“The advantage for the patient is, you have one spot that hurts instead of four,” Cross said. The chances of infection are also reduced, and the patient can usually go home sooner, he said.
The da Vinci surgical system — named after Leonardo da Vinci, who designed an early robot — costs more than $1 million, said Lisa Dugan, the hospital’s chief nursing officer. Dugan said that Inova initially invested in the system in 2009 because urologists wanted to use it for prostate removal surgery. Some of the urologists had used the technology in other hospitals and thought that it was effective in avoiding the nerve damage that can occur during the procedure. Now, the robotic system is used in 90 percent of the prostatectomies performed at the hospital, she said.
“It was important for many reasons, from a hospital perspective, to be able to offer the surgeons the latest state-of-the-art technology that’s going to enhance their ability to do surgery and have better outcomes,” Dugan said. “Less pain, less blood loss, less length of stay, better visualization — all those things are good.”
The 2012 system upgrade allows the hospital to use the da Vinci system for many more procedures, including hysterectomies, colon resections and hernia surgeries. The system was used about 50 times a year beginning in 2009, and it is now being used for 120 surgeries every three months, Dugan said.
Cross first heard about the da Vinci system at a conference and decided to learn more about it. Like many surgeons, he is generally suspicious of new technology, he said.
“Surgeons are exacting people. We’re trying to be perfect every single time,” he said. “And there was a moment like the bell went off. It was like, ‘I have to do this. This is a game-changer.’ It can really be helpful to allow me to do things I can’t do, and it helps the patient.”
Smiley, 26, said that she was somewhat nervous before her gallbladder operation because she had never had surgery before. “But I was not nervous about that fact that it was a robot,” she said.
Because she is a park ranger, a quick recovery was one of Smiley’s priorities. She said that she went home the day of her surgery and was back on the job at full speed a week later. “It was like textbook,” she said. “Everything was seamless, and there weren’t any issues during the surgery. And because it was just that one simple incision, I was back up on my feet very quickly.”