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Melanie Cole (Host): The advanced robotic platform of the DaVinci Surgical System allows doctors to perform complex procedures using smaller incisions than standard surgery with tiny precision tools operated robotically. This may result in less pain, scarring, trauma, and blood loss than other surgical procedures so that the patients can potentially return to work and daily activities more quickly. My guest today, is Dr. Richard Conner. He’s a Urologist and a member of the Medical Staff at Southwest Healthcare System. Welcome to the show, Dr. Conner. What types of conditions can be treated with robotic surgery?

Dr. Richard Conner (Guest): Well, thank you for having me. As far as urology goes, the best application for the DaVinci Robot is probably prostatectomy – removal of the prostate for prostate cancer. And then also, a great application is the removal of kidney tumors – mostly malignant, but some benign kidney tumors that can be removed from the kidney and spare the kidney. Those are probably our two greatest applications in my specialty. And then, of course, there is some reconstructive surgery that we can do of the urinary tract, as well, that the DaVinci Robot is well-suited for.

Melanie: Is this considered minimally invasive surgery, using the DaVinci Robot?

Dr. Conner: Yes, it is. I think that term is pretty widely used, minimally invasive.

Melanie: It is, yes.

Dr. Conner: I think more precisely, we like to call it minimal access surgery because the amount of work that we do on the inside is still a pretty large amount of work. Some would say it’s pretty invasive, but it’s just how we get in is far less morbid and far less side effects because of the small incisions that are made. That’s a nuanced distinction, but I think it might be helpful for people to understand.

Melanie: So what are some of the benefits of the surgery itself and using that DaVinci Robot for the patient?

Dr. Conner: For the patient, the incisions are much smaller. It is essentially a robotic-assisted laparoscopic surgery. Most people are aware of laparoscopic surgery, which has also been called band-aide surgery or keyhole surgery where just small incisions are made to put instruments and a camera in the abdomen primarily. We can do a lot of surgery through those. The gallbladder removal is probably one of the most well-known applications of laparoscopic surgery. That’s the benefit.

Essentially, when using a DaVinci Robot, we can use a lot more advanced instruments through these small openings. The smaller openings allow patients to have probably less pain and quicker recovery after surgery, and therefore, that’s one significant benefit for patients. They can get back to a normal level of activity sooner than if we make a large incision.

Melanie: Tell us about your dedicated DaVinci Robotic surgery room and what you see is the benefits of that?

Dr. Conner: One thing that Southwest Healthcare is committed to is to have a dedicated DaVinci Robot room and a team of OR personnel that allows things to run more streamlined and also produce better outcomes. We have a very busy robotic surgery program at Southwest Healthcare. The dedicated room that you mentioned is real important because there are two or three large components of the robot that can be moved around, but with that, there’s risk of things breaking or not functioning as well, so it’s important to have room that’s setup the same we for every surgery for consistency, for patient safety, and to keep the equipment in good working order.

Melanie: And tell us about your staff and your team at Rancho Springs, and how they assist, and how they’re trained to help you with these types of procedures?

Dr. Conner: The staff is critical. A good DaVinci Robotic surgery program is critical to have staff that are specifically trained for robotic surgery. That starts not only with the surgeon, of course, and the assistant – any assistant that we use for the surgery does have to go through a rigorous robotic training and certification program. And then, of course, we have anesthesiologists that are well-versed in robotic surgery. That’s important because there’s a lot of anesthetic considerations that are required for patient positioning and what’s required to successfully perform surgery.

And of course, we have the operating room nurse and the surgical technologist. Those two members are critical of a successful program. All of those have required or performed specialized training and certification, and they maintain a large volume of experience. There’s a small group of people that do those jobs, and so they have a high volume of experience, which provides excellent outcomes.

Melanie: Dr. Conner, not all procedures can be done robotically, correct? And not all patients are necessarily candidates for these procedures. Speak about how you help a patient figure out and how you decide whether a patient is a candidate for this type of procedure.

Dr. Conner: That’s a good question. I think probably just about any surgery could be done robotically. The question we ask ourselves is, “Is the robotic surgery platform a better application for a particular surgery and a particular patient?” I think some operations that we do, it is very well-suited for that. Some operations, it’s probably not necessary, and that’s up to the surgeon and up to the patient. It’s important for us to choose what operation is best for the patient if, in fact, surgery is the best treatment option. It’s a mutual decision between the patient and the surgeon, and I think that it’s a constantly changing field in surgery, learning what operations are best. Is it excessive or unnecessary to use a robotic surgery, or in fact, is this the best application for it? That’s a constant area of study amongst all surgical disciplines, and there are different opinions about that, but we certainly want to apply the technology where it’s best suited for the patient.

Melanie: Is there any advantage for the patient in the case of say prostatectomies. You’re dealing with men; maybe they have prostate cancer, something’s going on, BPH, something – tell us about the benefits for them. Are there some side-effects, complications that you discuss with them if they are going to go through with this type of procedure?

Dr. Conner: Certainly, we do discuss the complications. Even though this is advanced technology and it has a lot of benefits, certainly any procedure, no matter how minor, has certain risks of complications and patients need to be aware of that before they proceed. We use the robotic surgery for typically prostate cancer and sometimes for prostate enlargement and BPH, although that’s a pretty rare area, and it’s more of an area of study at this point. I wouldn’t say it’s widespread use, but specifically for the entire prostate removal for prostate cancer.

What we do know from the studies that have been done is there’s clearly less blood loss for patients for the robotic approach versus an open approach. There is probably less pain afterward and quicker recovery, although that’s not a huge difference, it’s significant enough to be an appeal for many patients. And then also, there are some qualitative things that a lot of people feel they can do better with the robotic surgery, such as sparing the nerves that go by the prostates, which control erections. That’s one side effect that a lot of men get concerned about after surgery is if they’ll be able to have some sexual function. The robot might allow us to preserve those delicate nerves a little better. There may be better precision with reattaching the bladder back to the urethra at that point of the surgery, which is critical for continence and good recovery with low complications after that.

It appears that robotic surgery for prostatectomy is as good as and probably a little better than the open approach, but there’s not a consistent opinion across all experts that it’s clearly the only way to go. Having said that, it is probably – approximately 90% of prostatectomies these days are done robotically versus the open technique.

Melanie: In just the last few minutes, Dr. Conner, and it’s such great information, tell the listeners what you would like them to know about robotic surgery and the benefits of it.

Dr. Conner: Sure. I think the great thing is it’s a constantly developing technology. What we have is a quantum leap better than what we had in the past, and there’s a lot of development and research being done for even better robotic surgery platforms. I think as time goes on, we’re going to have better and better instruments and devices for patients for various conditions. It’s certainly a mainstay and a staple of a lot of what we do nowadays, and I think it’s going to continue.

Melanie: Thank you, so much, for being with us today. You’re listening to Southwest Health Talk with Southwest Healthcare System, building relationships that touch the heart. For more information, you can go to SWHealthcareSystem.com, that’s SWHealthcareSystem.com. Physicians are independent practitioners who are not employees or agents of Southwest Healthcare System. The hospital shall not be liable for actions or treatments provided by physicians. Individual results may vary. There are risks associated with any surgical procedure. Speak with your physician about these risks to find out if robotic surgery is right for you. This is Melanie Cole. Thanks, so much for listening.