I Use a Robot to Perform Surgeries

My practice began in 2004, doing minimally invasive surgery—or laparoscopy—where you’re doing advanced surgery through small incisions in the abdomen. In laparoscopic surgery, there’s a camera that goes through one incision and instruments that go through separate small incisions. I could hold two instruments, and then I’d need someone else to hold another, and another person still for the camera—so multiple people doing all kinds of things, with everybody trying to read my mind in the operating field, where things can change rapidly. And the instruments were ridged straight sticks that didn’t bend, and the ends of the equipment could only open and close and twist. This type of surgery surpassed the open method and gave patients shorter healing time and less pain.

When robotics came out, it was another game changer. I got a machine with four arms that I could control myself, all simultaneously, in real time—and the instruments were wristed, allowing rotation and 360-degree movement, which allowed me to address very complicated angles and work in very small spaces. I was in control of all aspects of the procedure, including the camera. I was trained in robotic surgery, using the da Vinci Si, in 2011. And since then, the technology, instrumentation, and visualization have improved dramatically.

The patient experience has changed substantially over the last 10 or 15 years. Patients get a minimally invasive operation. This translates to less pain, minimal bleeding, and discharge to home much quicker than open or even laparoscopic surgery.

There are so many problems that patients avoid with robotic surgery. There’s a decrease in postoperative hernias and bowel obstructions as well as a need for blood transfusions.

The lack of blood transfusions alone removes the concern for getting HIV or hepatitis from the transfusions, which you had to worry about 15 years ago. And the risk of infection is much lower too. Infection risk is proportional to the size of the incision and the duration that the incision is exposed to air. The smaller the cuts you can make—and the fewer—the less likely they are to get infected. And the most important thing I hear from patients is that it doesn’t hurt as much. Robotic procedures are by far the least painful method of surgery.

I was recruited to come to Our Lady of the Lake, in Baton Rouge, Louisiana, because of my robotics expertise. As of this writing, I’ve done 5,015 robotic surgeries, making me one of a handful of U.S. surgeons with this level of experience. In my current role, along with performing surgery, I’m developing pathways that allow other surgeons to have open access to this technology throughout our hospital network.

I also train surgeons in robotic surgeries. I physically go into the operating room with them or can proctor them via telepresence. The most recent da Vinci design lets you log in to another surgeon’s console with them as they operate. I can actually see what they see and talk with them in real time to help guide them. This can happen from anywhere in the country. I’m like a coach; I can give instructions on port placement, or say, “Hey, arm one, lift up,” or I can draw on their screen and tell them, “This is the structure you need to be worried about.”

The da Vinci machines have really evolved over time. When I was first working on the Si machine, it did not have vessel sealers, staplers, or very elegant ways to handle blood vessel work. As technology advanced, so did our capabilities. We could use fluorescents to identify blood flow to organ and biliary anatomy along with advanced stapling and vessel sealing. This was the Xi machine.

Today, the computing power of the da Vinci 5 is 10,000 times that of the Xi. It has its own insufflation system to blow carbon dioxide into a body cavity, which makes it easier for the surgeon to see everything within the cavity. The new machines even have “forced feedback,” so I can actually feel tension on the tissue, whereas before I had to learn what they call visual haptics, meaning that I had to “see” the feel of the tissue. Today, video of my surgery uploads to my phone within a few minutes after I’ve completed the operation. So when I go into the waiting room to update the family, I can show them a video of the operation.

Going into surgery, I put my head into a headpiece that has multiple lenses and cameras that provide stereoscopic 3D 4K high-definition views. My arms go on an armrest, and my fingers go through two loops that are spring-loaded and attached to an arm with a sort of elbow that I can move freely. When I sit down and take over four arms of the robot, I can move them—opening and closing the instruments, cutting or closing, closing and sealing, or grabbing and retracting. At the same time, I have seven pedals on the floor with a variety of functions, such as energy application for sealing blood vessels or closing staplers, all while controlling each aspect of the instruments. If I want a knife to go through a sealed piece of tissue, it’s controlled by one button, then another; if I want to grab a piece of tissue, I can grab it weakly, or, hitting a different button, I can grab it firmly. With the camera pedal, I can manipulate the camera for precise views of the operative field.

Today there are so many surgeries that were previously done with open incisions that are now done robotically—emergency appendectomies, bowel perforations, esophageal perforations, duodenal perforations, hysterectomies, gallbladder surgeries, and lung resections, to name a few. And now people go home within a couple days—possibly the same day—whereas before they were in the hospital for a week. From a surgeon’s perspective, this is about as good as it’s ever been in terms of patients’ surgical experience.

Using this robot as extensions of ourselves, surgeons are going where no one has gone before for the benefit of our fellow man. And it will only get better from here.