Robotic surgery, which was still considered something of a novelty just a decade ago, is swiftly becoming a preferred technique for many common surgical procedures. This approach—in which the surgeon operates on the patient by deftly manipulating the computerized “arms” of a surgical robot, guided by a high-definition camera that offers a magnified view of the surgical site—offers numerous advantages over open and laparoscopic surgery, including excellent visualization, smaller incisions than open surgery (and thus less trauma and faster recovery for the patient), and an ability to smoothly and precisely perform delicate maneuvers such as suturing.


These features are especially helpful in complex procedures like radical prostatectomy (removal of the prostate gland) to treat prostate cancer, and hysterectomy (removal of the uterus), which is done to treat a variety of benign and malignant conditions. In 2009, three-quarters of all radical prostatectomy procedures in the U.S.—about 90,000 operations—were done robotically. That same year, over 70,000 robotic hysterectomies were performed in the U.S., more than twice the previous year’s total. Robotic surgery is also increasingly being used to treat other conditions. Intuitive Surgical Inc., manufacturer of the da Vinci surgical robot (the brand used by the overwhelming majority of medical centers) reports that more than 200,000 surgeries were done in 2009 with the da Vinci surgical robot—in increase of 35% over 2008—and this rate of growth is showing no signs of slowing.


Robotic surgery’s growing popularity reflects several converging factors. First, access to robotic surgery is increasing: More than 1,200 da Vinci robots are now deployed in American medical centers, and more surgeons are getting trained in their use. Demand has grown as well, as the public becomes increasingly aware of the benefits offered by this minimally-invasive, high-precision approach. This trend has been spurred by a growing number of studies showing that outcomes from robotic surgery are as good
or better than other surgical techniques. A large study published last October, for example, found that 87% of men who had robot-assisted prostate surgery were cancer-free five years later.


In addition, robotic surgery is now being applied to a growing number of conditions. Urologic and gynecologic surgery continue to be the areas where it’s used most: In addition to prostatectomy, urologic surgeons are now using robot-assisted surgery to remove benign and malignant kidney tumors (the da Vinci is especially well-suited for partial nephrectomy, in which the tumor is excised while the rest of the kidney is left intact), to treat bladder cancer and adrenal cortex cancer, and to perform pyeloplasty and other urinary tract reconstruction procedures, which require precise suturing of the ureter and other delicate structures.  In gynecologic surgery, the da Vinci is proving highly effective for removing uterine fibroids and endometriosis, for the surgical repair of pelvic-organ prolapse, and for the surgical treatment of endometrial cancer, early-stage ovarian cancer and early-stage cervical cancer.

 
At the same time, the da Vinci is increasingly being adopted by surgeons in other fields. One promising area involves the gastrointestinal tract and liver, where it’s now being used to treat colorectal cancer, liver cancer, bile duct cancer, esophageal cancer and pancreatic cancer, as well as benign conditions like colitis and gall bladder disease. Robots are also being employed for head-and-neck procedures such as thyroid cancer and throat cancer treatment. In addition, cardiothoracic surgeons are discovering the advantages of robotic surgery, which allows them to perform complex surgery on the heart’s arteries and valves through incisions between the ribs—avoiding the need to cut through the patient’s chest bone. The da Vinci Si, Intutive’s most advanced surgical robot, is now being used to perform coronary bypass operations and mitral valve repairs. As more cardiothoracic surgeons learn to use the da Vinci for these widespread procedures, this area of surgery—like so many others—is one where robotic surgery appears destined to become a standard part of America’s surgical repertoire.