Robotic-assisted laparoscopic surgery has become the next major stage of advancement for a range of operations. The field of surgery has long worked to improve skills and tools to minimize the invasiveness of operations and to overcome the limitations of human surgical dexterity and access.
It has done so while dealing with the challenges of visualizing internal structures and controlling the variability inherent in even the best human hand-eye-brain decisions and coordination. Robotic surgery is helping to surmount these factors.
Listen in as Dr. Louis Fares explains that since launching its robotics program, Our Lady of Lourdes Medical Center has gained a depth of experience in delivering robotic surgery.
Robotic Surgery: The Next Major Stage Of Advancement For A Range Of Operations
From the Show: Lourdes Health Talk
Summary:
Air Date: 9/24/16
Duration: 10 Minutes
Transcription:
Melanie Cole (Host): Robotic surgery is a method to perform surgery using very small tools attached to a robotic arm. The surgeon controls the robotic arm with a computer. Robotic assisted laparoscopic surgery has become the next major stage of advancement for a range of operations. My guest today is Dr. Louis Fares. He’s the Chair in the Department of Surgery at St. Francis Medical Center, a sister hospital to Lourdes, both a part of Trinity Health. Welcome to the show, Dr. Fares. Tell us about what’s going on with robotic assisted laparoscopic surgery today ,and what conditions are you using it for most commonly?
Dr. Louis Fares (Guest): Thank you, Melanie. I appreciate the opportunity to talk to your fans that are out there. Basically, robotic surgery is the next step in minimally invasive surgery. I started doing minimally invasive surgery back in 1990, so I’m kind of dating myself a little bit there. We saw immediately that minimally invasive surgery was a big advance for the patient. Rather than doing a big incision, these tiny little holes made the operation go exactly the same way, but the patient’s recuperation, recovery time, getting back to their normal activities was so much faster than open surgery. Robotic surgery has been around for approximately 15 years now. It’s been slowly getting more into the mainstream. What happened is that we saw the advantages of robotics because it took minimally invasive surgery to the next step. We are able to go in and do the exact same operations but even more precisely because of the ability of the robotic arms to be able to mimic the hands of the surgeon. So, now, we’re able to do all types of minimally invasive surgery but probably more precisely. From my standpoint, I’m doing anything in the abdominal area that requires surgery like I would do with an open operation. We do anything from the stomach all the way down to the rectum. We do all types of solid organ surgeries and even up to the diaphragm including hiatel hernia repairs and the like. So, minimally invasive surgeries like that of the hernias, gallbladders, intestinal, colorectal--all those surgeries now are done robotically.
Melanie: Dr. Fares, how do you doctors learn to use these robotic arms? What’s involved?
Dr. Fares: Obviously, there is self-training that we have to do. Some of the newer doctors that are coming out are learning in the residency programs. I went through various courses and looked at the robot, went to labs and trained on the robots to get myself familiar with it, but, basically, it’s the same as minimally invasive surgery but a little bit more so. The nice thing about it is that it takes the standing and pressure off of the surgeons so the surgeon fatigue factor is taken out. The surgeon is more comfortable in doing the operation especially somebody whose operation may take three, four or five hours, having to stand the entire time in the same position, obviously, you get surgeon fatigue, and you don’t want that for the patient. So, having the surgeon more relaxed, able to do things and persist and be more precise, makes it better for the patient overall. All surgeons will do things that they feel comfortable with and are trained for. So, getting the labs, doing the simulations and the like, will make us very comfortable doing the operations that we do.
Melanie: Tell us about the da Vinci that features the three-dimensional imaging. Tell us what that is.
Dr. Fares: Well, when you’re doing a laparoscopy, you’re having a tiny camera that goes inside the abdomen, inside the body, and it gives you an image. Now, with da Vinci, what that’s taken to is a high-definition 3D image that you’re actually looking at. So, the surgeon is seeing everything inside as though he was actually inside the body. So, it makes it easier to look at different organs, get perception, depth and the like, and be able to do things that, with normal laparoscopy, are very difficult.
Melanie: So, it’s really giving you a better view as well, and you can see thing a little closer than you might have even otherwise been able to do.
Dr. Fares: Correct. As I said, it’s just making things more precise and it’s just the next step in the minimally invasive revolution. Where we started out with simple gallbladders back in the 1990s, we are now advanced to where probably a good 60-70% of all surgeries are being done minimally invasively. Now, you’re going to take it, I think, to the next level where doctors that weren’t very comfortable with doing minimally invasive surgery will see that the robot helps them be even better at the surgeries that they do.
Melanie: And, how does it feel for the patient, as far as recovery and shortened hospital stay or risk of infection?
Dr. Fares: Well, because there isn’t any big incision, and especially with the patients that I deal with a lot which are the morbidly obese, they are at extreme risk for wound problems, infections, hernias, that develop after any open operation. So, doing a minimally invasive operation on them is much more beneficial to them in the long-term. Most of my bariatric patients, for example, are home within 24 hours after a major gastric bypass or a sleeve gastrectomy or anything like that. The national average is usually three to four days in the hospital. So, we are getting our patients out quickly, and most importantly, they are staying home. There are very minimal re-admission rates, very minimal complications, and I believe this is because with the minimally invasive, with the robotics specifically, we’re keeping the complication rate down significantly because of the more precision that we have, and the more visualization we have with these patients.
Melanie: And, you mentioned morbidly obese and that you do bariatric surgery. So, this type of surgery makes it more accessible to more patients whereas before maybe it wasn’t as easy for you to work with elderly or obese patients?
Dr. Fares: Correct. The classic thing is patients will come in and they’re significantly overweight, and they’re told by another surgeon, “Lose 100 pounds and then I’ll operate on you for your hernia,” or whatever it is. If it were that easy to lose 100 pounds, hell, we’ll all be doing it. But, this is one of those things where now with this type of operation, we’re able to help these patients to avoid the complications that they develop by having to wait too long for surgeries that they need. The minimally invasive helps them to get the operations done, it helps them to get home faster, and it avoids all the risk factors that normally go along with an open operation.
Melanie: Dr. Fares, in just the last few minutes, where do you see robotic assisted surgery going? What is on the horizon? What’s exciting?
Dr. Fares: Well, what’s exciting is that right now it’s a one pony show by da Vinci. They have all the robotic stuff in their corner, but now there are a number of companies that are seeing the benefits of robotic surgery. They are all developing new types of robot-based procedures. Google and Ethicon, J and J have developed or are developing their own robotic systems presently over in China. We’re excited to wait and see what this may be coming in the next two years. Covidien and Netronix are also working on their type of robotic systems. Competition is always good. It just makes it better for the surgeon and, therefore, it’s better for the patient. Our whole thing is that we’re waiting to see how this is going to advance. I think it could only be better and more minimally invasive for the patients going forward.
Melanie: Thank you so much. It’s really great information and a fascinating topic, Dr. Fares. Thank you so much for being with us today. You’re listening to Lourdes Health Talk. For more information, you can go to www.lourdesnet.org. That's www.lourdesnet.org. This is Melanie Cole. Thanks so much for listening.
Melanie Cole (Host): Robotic surgery is a method to perform surgery using very small tools attached to a robotic arm. The surgeon controls the robotic arm with a computer. Robotic assisted laparoscopic surgery has become the next major stage of advancement for a range of operations. My guest today is Dr. Louis Fares. He’s the Chair in the Department of Surgery at St. Francis Medical Center, a sister hospital to Lourdes, both a part of Trinity Health. Welcome to the show, Dr. Fares. Tell us about what’s going on with robotic assisted laparoscopic surgery today ,and what conditions are you using it for most commonly?
Dr. Louis Fares (Guest): Thank you, Melanie. I appreciate the opportunity to talk to your fans that are out there. Basically, robotic surgery is the next step in minimally invasive surgery. I started doing minimally invasive surgery back in 1990, so I’m kind of dating myself a little bit there. We saw immediately that minimally invasive surgery was a big advance for the patient. Rather than doing a big incision, these tiny little holes made the operation go exactly the same way, but the patient’s recuperation, recovery time, getting back to their normal activities was so much faster than open surgery. Robotic surgery has been around for approximately 15 years now. It’s been slowly getting more into the mainstream. What happened is that we saw the advantages of robotics because it took minimally invasive surgery to the next step. We are able to go in and do the exact same operations but even more precisely because of the ability of the robotic arms to be able to mimic the hands of the surgeon. So, now, we’re able to do all types of minimally invasive surgery but probably more precisely. From my standpoint, I’m doing anything in the abdominal area that requires surgery like I would do with an open operation. We do anything from the stomach all the way down to the rectum. We do all types of solid organ surgeries and even up to the diaphragm including hiatel hernia repairs and the like. So, minimally invasive surgeries like that of the hernias, gallbladders, intestinal, colorectal--all those surgeries now are done robotically.
Melanie: Dr. Fares, how do you doctors learn to use these robotic arms? What’s involved?
Dr. Fares: Obviously, there is self-training that we have to do. Some of the newer doctors that are coming out are learning in the residency programs. I went through various courses and looked at the robot, went to labs and trained on the robots to get myself familiar with it, but, basically, it’s the same as minimally invasive surgery but a little bit more so. The nice thing about it is that it takes the standing and pressure off of the surgeons so the surgeon fatigue factor is taken out. The surgeon is more comfortable in doing the operation especially somebody whose operation may take three, four or five hours, having to stand the entire time in the same position, obviously, you get surgeon fatigue, and you don’t want that for the patient. So, having the surgeon more relaxed, able to do things and persist and be more precise, makes it better for the patient overall. All surgeons will do things that they feel comfortable with and are trained for. So, getting the labs, doing the simulations and the like, will make us very comfortable doing the operations that we do.
Melanie: Tell us about the da Vinci that features the three-dimensional imaging. Tell us what that is.
Dr. Fares: Well, when you’re doing a laparoscopy, you’re having a tiny camera that goes inside the abdomen, inside the body, and it gives you an image. Now, with da Vinci, what that’s taken to is a high-definition 3D image that you’re actually looking at. So, the surgeon is seeing everything inside as though he was actually inside the body. So, it makes it easier to look at different organs, get perception, depth and the like, and be able to do things that, with normal laparoscopy, are very difficult.
Melanie: So, it’s really giving you a better view as well, and you can see thing a little closer than you might have even otherwise been able to do.
Dr. Fares: Correct. As I said, it’s just making things more precise and it’s just the next step in the minimally invasive revolution. Where we started out with simple gallbladders back in the 1990s, we are now advanced to where probably a good 60-70% of all surgeries are being done minimally invasively. Now, you’re going to take it, I think, to the next level where doctors that weren’t very comfortable with doing minimally invasive surgery will see that the robot helps them be even better at the surgeries that they do.
Melanie: And, how does it feel for the patient, as far as recovery and shortened hospital stay or risk of infection?
Dr. Fares: Well, because there isn’t any big incision, and especially with the patients that I deal with a lot which are the morbidly obese, they are at extreme risk for wound problems, infections, hernias, that develop after any open operation. So, doing a minimally invasive operation on them is much more beneficial to them in the long-term. Most of my bariatric patients, for example, are home within 24 hours after a major gastric bypass or a sleeve gastrectomy or anything like that. The national average is usually three to four days in the hospital. So, we are getting our patients out quickly, and most importantly, they are staying home. There are very minimal re-admission rates, very minimal complications, and I believe this is because with the minimally invasive, with the robotics specifically, we’re keeping the complication rate down significantly because of the more precision that we have, and the more visualization we have with these patients.
Melanie: And, you mentioned morbidly obese and that you do bariatric surgery. So, this type of surgery makes it more accessible to more patients whereas before maybe it wasn’t as easy for you to work with elderly or obese patients?
Dr. Fares: Correct. The classic thing is patients will come in and they’re significantly overweight, and they’re told by another surgeon, “Lose 100 pounds and then I’ll operate on you for your hernia,” or whatever it is. If it were that easy to lose 100 pounds, hell, we’ll all be doing it. But, this is one of those things where now with this type of operation, we’re able to help these patients to avoid the complications that they develop by having to wait too long for surgeries that they need. The minimally invasive helps them to get the operations done, it helps them to get home faster, and it avoids all the risk factors that normally go along with an open operation.
Melanie: Dr. Fares, in just the last few minutes, where do you see robotic assisted surgery going? What is on the horizon? What’s exciting?
Dr. Fares: Well, what’s exciting is that right now it’s a one pony show by da Vinci. They have all the robotic stuff in their corner, but now there are a number of companies that are seeing the benefits of robotic surgery. They are all developing new types of robot-based procedures. Google and Ethicon, J and J have developed or are developing their own robotic systems presently over in China. We’re excited to wait and see what this may be coming in the next two years. Covidien and Netronix are also working on their type of robotic systems. Competition is always good. It just makes it better for the surgeon and, therefore, it’s better for the patient. Our whole thing is that we’re waiting to see how this is going to advance. I think it could only be better and more minimally invasive for the patients going forward.
Melanie: Thank you so much. It’s really great information and a fascinating topic, Dr. Fares. Thank you so much for being with us today. You’re listening to Lourdes Health Talk. For more information, you can go to www.lourdesnet.org. That's www.lourdesnet.org. This is Melanie Cole. Thanks so much for listening.
