The da Vinci Robot* gives the surgeon new tools for minimally invasive (laparoscopic) surgery. The robotic system was originally developed by the Department of Defense for use as a robotic surgeon for the battlefield and is approved by the FDA. The system replicates the surgeon's hand movements realtime in laparoscopic instruments. It cannot be programmed, nor does it make any independent decisions, but rather it does only what the surgeon inputs in realtime.
The da Vinci 3D Camera
Standard laparascopic viewing utilizes one single camera and limits surgeon's vision to a 2-D view similar to watching your
television.The da Vinci robotic camera consists of TWO high resolution fiber optic cameras. Like your eyes they produce a true 3 dimensional color picture available to the surgeon seated at the da Vinci console by viewing the twin high resolution, high frame-rate eyepieces.
Magnification of up to 10-12x can be achieved with these cameras. These components constitute the Insite Vision System, by Intuitive Surgical, one of the most advanced vision systems available. A central robotic arm positions the camera and lighting exactlly where the surgeon wishes it, because it is operated by the surgeon by foot pedals as he/she is comfortably seated at the console. Also note the camera can be placed within 2 inches of the prostate during surgery. Two different cameras are also available: straight, and 30 degree oblique. The oblique camera can allow the surgeon to peek around the corners and to partially see underneath the prostate.
The da Vinci Surgical Instruments
Although visually similar to standardlaparascopic instruments, the robotic instruments have the additional advantage of being articulated. The allows the instruments not only
to open and close but to fully turn and twist, allowing more natural mimicry of the human hand and wrist. Unlike your hand these intruments are much smaller. Many of the jaws of the tools are similar or shorter in length than your fingernail. This allows very small and precise incisions to carefully dissect out the prostate.
Manipulations of da Vinci Surgical Instruments
Standard laparascopic instruments are manipulated counter-intuitively or 'backwards'. The surgeon operates one end of the instrument which acts like a lever-push one end down and the other end goes up. Push right to make the instrument go left. This is similar to a teeter-totter, where the center is the port or entrance to the body cavity. Thus for standard laparoscopic procedure, the surgeon has learned to operate essentially backwards. Although difficult, a highly qualified surgeon can
master this process. The Da Vinci robot does NOT have these limitiations. The robot-slave technology translates a surgeons hand movements exactly as he/she does them. Turn your wrist right and the articulated robotic wrist turns right; go up, the robot wrist move up, etc. in three dimensions. The robot also allows the surgeon to 'scale' their hand movements. A large hand movemement at the console can be translated into a micro precise dissection or exposure. The robot can also filter out hand tremors, enhancing precision. Another of the many benefits of this system is that it significantly reduces surgeon fatigue associated with traditional laparoscopic prostatectomy by allowing the surgeon to remain in a natural, comfortable position while operating.
Minimizing Blood Loss With The da Vinci System
Similar to standard laparascopic procedures, patients are insufflated in the lower abdomen. This gas pressure acts like an invisible hand to suppress blood loss and it also gently sweeps bowel away from the surgical target site. The gas is exhaled away after surgery. The enhanced visibility and magnification of the robotic cameras aid the surgeons in finding small 'bleeders', which translates into lower blood loss. Now surgeons can keep blood loss to a minimum, which means an increased clarity of vision to more carefully identify essential anatomy of the prostate: the edges of prostate (margins), the urethra (continence), and nerves and blood vessels which may aid potency.
Common Questions
How safe is the da Vinci Surgical System for radical prostatectomy?
The system is FDA approved for radical prostatectomies and is being used routinely in a great number of hospitals across the country. (see intuitivesurgical.com for a current listing.) Each da Vinci system is rigorously maintained, tested, and upgraded as necessary by Intuitive Surgical. In our experience at UCI with both of our two da Vinci Systems, we have not seen nor heard anything that would give us cause for concern.
What happens if there is a malfunction in the da Vinci System?
In the unlikely event of malfunction, or if the surgeon feels that it is not safe to continue with the robot, the da vinci system will be withdrawn and the surgery can proceed either via traditional laparoscopic means or via traditional open radical prostatectomy. The instruments and supplies necessary are kept on hand such that conversion, if necessary, can occur seamlessly. Dr. Ahlering was previously an expert in open radical prostatectomy such that good surgical results can still be obtained in this unlikely event.
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The di Vinci Robot by Intuitive Surgical
