Robotic Surgery > MultiCare Health System

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12:54 PM

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12:55 PM

Today’s topic is robotic-assisted surgery. Dr. John Lenihan will provide information about robotic-assisted surgery and how it can be a good alternative to traditional surgery.

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12:56 PM

John Lenihan, MD is the Medical Director for MultiCare’s Robotic-Assisted Surgery Program. Dr. Lenihan has performed hundreds of robotic procedures and is considered an expert in his field.

Dr. Lenihan

1:00 PM

Good Afternoon. I'm glad to be here today.

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1:01 PM

Explain if you will exactly what robotic surgery is?

Dr. Lenihan

1:02 PM

Robotic surgery is essentially using computers to help surgeons do minimally invasive surgery.

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1:03 PM

So, how is minimally invasive surgery different from "regular" surgery?

Dr. Lenihan

1:04 PM

Minimally invasive surgeries use smaller incisions, and have less pain, less bleeding, and a faster recovery time. Wouldn't everyone want to have that kind of option?

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1:04 PM

What does robotic-assisted surgery entail?

Dr. Lenihan

1:06 PM

Robotic surgery uses special instruments, cameras, and technology to enable surgeons to do the same surgeries that they are trained to do in a more precise and efficient fashion. Imagine the difference between a regular telephone and a cellphone and a typewriter and today's computer.

Adrienne

1:06 PM

What is done to make sure the computer is working properly?

Dr. Lenihan

1:07 PM

Before every case many tests are done to calibrate and ensure the computer is connected and operating safely. If not, the surgeon can always default to traditional surgery. But that is rare.

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1:08 PM

So, throughout the surgery, you are right there in the room, behind the controls? Will you be in the same room with me?

Dr. Lenihan

1:09 PM

Yes. Today the surgeon is in the same room controlling the robot from a special console, similar to a video game in an arcade. In the future technology is being developed to allow surgeons to operate remotely at distant sites.

Lee

1:09 PM

Is the robot always controled by the doctor?

Dr. Lenihan

1:09 PM

Yes and the robot can't do anything without the surgeon controlling it. The doctor is doing the surgery, the robot is assisting.

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1:10 PM

How large is this equipment? Remember when computers first came out, they took up an entire room. Is this how the robot is?

Dr. Lenihan

1:11 PM

The first robots were very large in the year 2000. Now we are using our third-generation robot, and it's about 30% smaller. The incisions are somewhat smaller, too.

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1:11 PM

What type of surgeries can be done with a robot?

Dr. Lenihan

1:13 PM

The robot was initially designed for battlefield use and trauma surgery. Civilians used the robot early on for cardiovascular and thoracic applications. Treatment of prostate disease became very advanced with robotics. And now, gynecology is the surgical field that is using robotics the most. Robots are also being used by general sugery and ear, nose and throat (ENT) physicians.

Debbie

1:13 PM

I hear a lot about the DaVinci robot and have seen it on TV shows. What is special about it?

Dr. Lenihan

1:14 PM

daVinci is the name of the surgical robot system made by Intuitive Surgical in California. At this time, it is the only robotic system approved by the FDA for doing surgery on patients.

Dr. Lenihan

1:15 PM

We have three daVinci robots at MultiCare Health System -- one at Tacoma General, one at Good Samaritan and one at Allenmore.

Karen

1:15 PM

What makes a doctor qualified to do robotic surgery? What should I look for?

Dr. Lenihan

1:17 PM

Good question, Karen. To do surgery with robotics, the surgeon needs to undergo extensive specialized training, building on their existing skills for doing surgery. To get good at robotics requires 50 to 200 cases, depending on the kind of surgery being done. Physicians aren't listed as being qualified by hospitals or robotic websites until they have done at least 20 cases. But the more the better. Make sure you ask your doctor how many they've done.

April

1:17 PM

What types of procedures are often done with the robot?

Dr. Lenihan

1:19 PM

The most common procedures done across the country are hysterectomies. The next most common procedures are prostate surgeries on men. We're seeing a lot of other OB/GYN procedures as well as thoracic procedures, or chest surgeries.

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1:19 PM

How is this different from typical laparoscopic surgery?

Dr. Lenihan

1:21 PM

In laparoscopic surgery, which is considered minimally invasive, as well, the surgeon holds straight, long instruments that go through the abdominal wall to do surgery. The range of motion is very limited and the surgeon usually has a hard time seeing with normal, 2-dimensional laparoscopic cameras. It also requires extensive training and skill, which many surgeons don't have.

Dr. Lenihan

1:22 PM

With robotics the robot holds the instruments which articulate, or bend, in the same dimensions as the human wrist within the abdomen, the surgeon can see much better in stereo, 3-D, high definition (think Avatar), and the outcomes for the patient are almost always better.

Kimberley

1:22 PM

What happens if the robot breaks during my surgery?

Dr. Lenihan

1:23 PM

Well that hasn't happened to us in over 1,000 cases. If it did, we would default to completing the surgery using normal laparoscopic techniques.

Gerrie

1:23 PM

Is the risk of infection after surgery different with the robot?

Dr. Lenihan

1:24 PM

The risk of infection is already very low with laparascopic surgery and it remains low with the robot, especially in comparison with traditional surgery. The risk of infection is related to the size of incisions.

Gerrie

1:24 PM

Can this be done for cancer patients?

Dr. Lenihan

1:26 PM

Absolutely. In fact, that's a great use for the robot, both in men, with prostate cancer, as well as women with uterine and cervical cancers. Traditionally these are some of the most difficult surgeries to recover from when done with open incisions. But with robotics, patients recover very quickly. And the surgeons, with the 3D, HD view, can be more precise in removing all of the tumor and not injuring other vital structures, such as nerves and blood vessels.

Sandy

1:26 PM

My friend was going to have a robotic hysterectomy but during the surgery they had to change and do it another way. How often does this happen?

Dr. Lenihan

1:27 PM

In the hands of experienced surgeons that should be rare. Perhaps she was one of her surgeon's first cases.

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1:28 PM

Will there come a time when robotic surgery replaces ALL forms of surgery?

Dr. Lenihan

1:29 PM

Good question. Robotic or computer-assisted surgery will probably not replace many minor procedures that we do. But certainly with advancements in computers and the way they can be designed to help surgeons, almost all surgeries will be improved with computers and/or robots in the future.

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1:29 PM

Who isn't a candidate for robotic-assisted surgery?

Dr. Lenihan

1:31 PM

First, the surgery has to be one that we are currently using the robot for. We aren't doing any orthopedic robotic surgery at this time, for example. Second, the patient has to be a good candidate physically to tolerate the anesthesia requirements, which are somewhat more demanding. Some older or sicker patients may not, at this time, be a candidate. Finally, extremely obese patients may not be suitable for the current instrumentation.

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1:32 PM

I understand that MultiCare is now helping teach others remotely? Explain that.

Dr. Lenihan

1:33 PM

Since we were the first hospital in the Northwest to perform GYN robotics, and have the most experience, we have been designated as an epicenter site for robotics. In fact, we're the only one on the west coast. This designation encourages other physicians learning this technique to come here to see how we, as regional experts, perform these surgeries.

Dr. Lenihan

1:33 PM

Since we are using computers, using the web to help teach surgery seemed like a logical step.

Dr. Lenihan

1:34 PM

Working with Intuitive Surgical, who make the daVinci, we have pioneered a web-based teaching system that not only allows other surgeons in other areas to watch us live and interact with us during surgery, but also enables us to reach out and help other facilities getting started by interacting with them in the OR in real time.

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1:35 PM

Who are the the hospitals and physicians you have mentored?

Dr. Lenihan

1:36 PM

We have had physicians watching us from hospitals in Michigan, Ohio, New Jersey, Florida, Colorado, California, Idaho, Utah, and Alaska. We have done remote proctoring, or teaching, for a surgeon in Alaska who was performing a difficult surgery.

Jason

1:36 PM

Do robotic surgeries cost more?

Dr. Lenihan

1:37 PM

They don't cost the patient any more than laprascopic surgery. In fact, since they are considered outpatient surgery, they often cost the patient less than traditional, inpatient surgery.

Lucy

1:37 PM

Is it possible for the public to ever see the robot?

Dr. Lenihan

1:38 PM

Yes. They can see robotic surgery by searching YouTube. They can also go to the Intuitive website and see surgeries done there: www.intusurg.com.

Chat Host

1:39 PM

Why isn't robotic-assisted surgery in the forefront of people's mind?

Dr. Lenihan

1:41 PM

While most men who require treatment for prostate cancer are certainly aware of robotics because of the advantages it offers, a recent Gallup poll showed that only 28% of women knew of the availability of robotic and other minimally invasive surgical options. Hopefully future health care consumers will be more aware.

Greer

1:41 PM

Robot ever used in emergency situations?

Dr. Lenihan

1:42 PM

Not yet. The set up requires a full team to get it organized and working. But in the future, just like we saw with laparoscopy, it may be used in emergent conditions.

Chat Host

1:43 PM

When will robotic-assisted surgery be available for heart surgery?

Dr. Lenihan

1:44 PM

The robot is currently being used in a few centers across the country to replace heart valves and do other heart surgeries. Most centers, like ours, are using the robot just to treat diseases in the chest, but not to fix hearts yet. That is a rapidly developing area in robotics.

Anna

1:45 PM

What about kids? Is the robot able to do surgeries on kids?

Dr. Lenihan

1:46 PM

Yes, but just like hearts, there are only very few centers around the country doing that. And the types of procedures are rapidly evolving. Currently there is a robotic pediatric program at Children's in Seattle, which is one of the few in the western half of the US.

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1:47 PM

How would a patient find out if robotic-assisted surgery is right for them?

Dr. Lenihan

1:48 PM

It's important when discussing options with your health care provider to make sure that you are getting information on all of the available options in your community. Second opinions are always recommended, and doing your homework on websites such as multicare.org, webmd, hystersisters, and so on, are also excellent sources of information.

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1:48 PM

We would like to thank Dr. Lenihan for joining us today!

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1:49 PM

Thanks for participating in today's chat. To learn more about Robotic Surgery at MultiCare, visit multicare.org/home/robotic-technology-2