An ‘awesome machine’ that helps the surgeon see in high definition
Thoracic Surgeon Jeffrey Spillane, MD, FACS chooses not to refer to Cape Cod Hospital’s new da Vinci® Xi Surgical System as a ‘robot,’ though robotic surgery is what it is called.
“’Robot’ implies autonomy, but I believe it’s a very delicate surgical instrument for the surgeon; I almost feel it’s a surgical microscope,” he said.
Dr. Spillane, who performs several types of thoracic surgery with the da Vinci system at the hospital, was an early adopter of robotic surgery. He has been using the technology for more than 10 years; up until last fall he was using the hospital’s original da Vinci system. While he was a fan of the original system, he is even more delighted with the Xi’s enhanced capabilities.
The da Vinci® Xi system is a tall operating room instrument that has a console at which the surgeon sits and performs the surgery at the bedside. The robot is ‘docked’ to the patient through tiny keyhole incisions, making any surgery done with the system a minimally invasive procedure. The surgeon uses his or her hands and feet to control the robot and its delicate instruments.
The robotic system helps the surgeon, who is viewing the surgical field through a camera view box, see 360 degrees around while inside the body, without needing to make new incisions or adjustments to the system while the patient is under anesthesia.
Because the new system has a much broader operative field, “it has a greater range of motion and yet it’s more precise now,” Dr. Spillane said. “It has better mechanical instruments, better visualization, it’s lighter and smaller, and easier for the operating team to get around. It’s just the next generation. Everything is lighter, faster and more agile.”
The procedures Dr. Spillane typically performs with the da Vinci include lung resections for lung cancer, esophageal, tumors of the mediastinum, thymomas (tumors in the thymus gland), and hiatal hernia.
“With the robot, you can work in a very small space and the machine won’t conflict with itself,” he said. “When I’m working, I’m working with four different instruments.”
He compared the difference between the traditional laparoscopic method and the robotic system, calling the robot a “multiplier for my hands.”
“If I do surgery laparoscopically, I have a right hand and a left hand; one to hold things out of the way and one to do the dissection. I’m not using my feet (as he does to control some of the robot’s instruments) and an assistant is holding the camera (into the surgical area),” he said.
“When I use the robot, I use my foot to switch between four different instruments. So, I can retract (instruments) by myself, I put the camera where I want and its held in a precise location and doesn’t move. And then I have my two hands, so if I want to use (robotic) arms 1, 2, 3 and 4, I can opt back and forth using my feet and hands to control the instruments. And, because the machine is holding the instruments, those instruments can be small and very precisely located, so we can operate in very small spaces.”
While Dr. Spillane does have a bedside assistant in the operating room during robotic surgery, the machine is so agile and easy to maneuver by the surgeon, he can essentially do a lung resection by himself, he said.
“One of the biggest principles with this instrument is that my head is in a camera view box, so everything I see is basically at the end of the scope,’ he said. “However, I’m very actively communicating with the anesthesiologist and other team members, to make sure the patient is doing well otherwise. It really requires a lot of coordination and cooperation.”
Ahead of the Curve
Most new surgeons are now trained in robotic surgery in their residency programs, Dr. Spillane said. He acquired the skills when the da Vinci came to CCH, he said.
“We were ahead of the curve 10 years ago, and now it’s become a very accepted surgical technique. We’ve got the latest generation and it’s a much more advanced platform, thinner and smaller, not as cumbersome and has more capability,” he said. “But, the first thing I noticed when I got on it, compared to the old one, was that the visualization was clearly very high definition – even though I thought the old one had excellent visualization.”
Safety issues are paramount to Dr. Spillane, and the da Vinci system has basically been a non-issue in the past 10 years at Cape Cod Hospital (CCH). But, if something arises during the surgery and the surgeon needs to suddenly switch to an open operation, they can do it in the same room, he said. The CCH surgeons who are using the da Vinci® Xi trained extensively before moving to live procedures, he added.
“We did a great deal of dress rehearsal on the new system just as if you were going to ask a pilot to fly a new, different kind of aircraft. The OR team has been really supportive, and it went really well right from the get-go,” he said.
Certain patients would not be candidates for thoracic surgery using the da Vinci® Xi, Dr. Spillane explained. Very large tumors are still removed using an open surgery, because they require larger incisions, he said. “If you come in and want a robotic surgery, it’s because you want to have small, 8-millimeter incisions. But if I’m doing a lobectomy (removal of a lung lobe), which is a very common surgery for me, and I have a large tumor, at some point you need to get it out, so the incision would be have to be larger.”
Dr. Spillane said his love of surgery has never waned over the years he has been a surgeon, and the da Vinci system allows him to be in even more awe of the human body.
“Human anatomy is fascinating to me and beautiful. And to see that laid out so precisely (by the da Vinci’s enhanced visual field) is truly a privilege,” he said. “I am constantly amazed at what an awesome machine we have for a body.”
