A 68-year-old male with advanced prostate cancer lies on the operating table. A 1,500-pound contraption looms over him, its metal arms extending like tentacles into tiny holes in his abdomen. At the opposite side of the room, his surgeon sits with face pressed into a large console, hands and feet manipulating controls. As the surgeon moves, so do the tentacle arms, deftly cutting tissue, removing the cancer, and sewing the patient whole again.
It’s not a sci-fi movie. It’s robotic surgery, and it happens every day at Vanderbilt. Since the first robotic prostatectomy was performed seven years ago, Vanderbilt University Medical Center has become a leader in robotic surgery with procedures ranging from uterine fibroid removal to gastric bypass.
The principal device for robotic surgery is the da Vinci Surgical System, manufactured by Intuitive Surgical. Vanderbilt has four of these $1 million-plus machines, and the vast majority of robotic procedures are performed with them. Laparoscopic surgery is often described as “operating with chopsticks,” but the da Vinci offers remarkable dexterity and delicacy of movements.
“With removal of uterine fibroids or infiltrative endometriosis, for example, I do not want to compromise fertility,” says Dr. Ted Anderson, PhD’85, MD’93, associate professor of obstetrics and gynecology and director of the Minimally Invasive Gynecologic Surgery program. “With the robot I can achieve excellent repair, and [patients] usually go home the same day.”
“Operating with the da Vinci is really no different than operating with your hands,” says Dr. Willie Melvin, associate professor of surgery. Melvin performed Tennessee’s first robotic gastric bypass surgery last year, and now averages two to three robotic procedures per week. Instead of stapling the new stomach and bowel connections, as is standard in laparoscopy, Melvin is able to sew them, which reduces scarring and minimizes leaking at the connection.
One of the four arms of the da Vinci has a camera with 12-times magnification and true binocular vision, giving surgeons a sense of depth perception. It also has a powerful light source that illuminates the surgical field. The other arms have interchangeable tools such as forceps, needles, scissors and scalpels. The surgeon controls two arms at a time, but can use the third for static activities, such as clamping.
Dr. Joseph Smith, professor and chair of urologic surgery, performed Vanderbilt’s first robotic surgery in 2003. He has done more than 3,000 prostatectomies since then and says Vanderbilt’s volume of this procedure is as much as any hospital in the world.
“The radical prostatectomy—being a very precise dissection—requires some difficult suturing, and a pure laparoscopic approach is difficult,” says Smith. “The robot overcomes those difficulties.”
Although the da Vinci Surgical System seems like cutting-edge technology, surgeons say it’s a first-generation device—the Ford Model T of its kind. Collaborations among Vanderbilt surgeons and engineers are helping develop the next generation of surgical technology.
“A lot of places are interested in capitalizing on robotics, but not many of them are working to make it better,” says Dr. Duke Herrell, associate professor of urologic surgery. “One of the things I love about Vanderbilt is that we have this great undergraduate and graduate campus next door.”
Herrell collaborates with Dr. Bob Galloway and Michael Miga, both professors in the Department of Biomedical Engineering. Their current focus is image-guided surgery that shows the surgeon the tissue structure in the operating field and where instruments are in relation to it. The group’s work won Best Research Paper at the World Congress on Endourology last year, and they say the close partnership between engineering and surgery is key to their success.
One area with major potential for robotic innovation is neurosurgery because the da Vinci is too large to fit in many areas around the brain. “We have many orifices, like the nose and mouth, to access the brain,” says Dr. Reid Thompson, the William F. Meacham Professor of Neurological Surgery and chair of the department. “It’s just a matter of developing the next technology to get us in there safely and accurately.”