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Maggie McKay (Host): The idea of robotics used in surgery started more than five decades ago, but wasn't actually put into practice until the late eighties. Today, all kinds of surgeries from hip replacement to spine surgery, and many more, are being done this way. Today, we'll find out what's involved in robotic surgery, the benefits, how it differs from traditional surgeries, who's the perfect candidate for this type of surgery and more. To explain robotic surgery, and what you need to know is Dr. Jack Johnston, Surgeon at Tidelands Health specializing in Robotic Assisted Surgery.

Thank you so much for your time and being here today. I know you're busy, so we really appreciate it.

Jack Johnston, MD (Guest): Thank you very much for having me.

Host: Of course. To begin, Doctor, can you tell us what robotic surgery is?

Dr. Johnston: Robotic surgery, is when people first think about it, they think of a robot performing operations on people. It's most common question asked me. Robotic surgery is actually a surgeon, using technology, in whichever fashion they want to, using the machine to perform an operation. So they're controlling the machine and using that machine to again, perform surgery. So that is robotic surgery.

Host: And what's the difference between traditional surgeries and robotic assisted surgery?

Dr. Johnston: In the past, surgeries can be performed what we call open, and that's the most traditional method. And that is making a incision in the body and using your hands at the bedside and basically seeing everything in front of you. Laparoscopic surgery is another form of surgery, and that was an advancement that was made in early nineties, that allowed smaller incisions, but to operate on the patient's body without needing the bigger incisions that were needed prior to that in the open surgery. Robotic surgery takes that one step further and allows the stability and the dexterity and the precision of using the technology as it is advanced, to assist us with surgery.

So it's been a progression of advancements and robotic surgery is on the forefront and the cutting edge of the surgical world today.

Host: What are the benefits?

Dr. Johnston: The benefits of robotic surgery are kind of vast and actually still being discovered on many, different surgeries. But as it stands right now, there's several benefits. There's benefits to the patient. There's benefits to the surgeon. And there's benefits to the system. The benefits to the patient, they have smaller incisions. They have less manipulation. More can be done inside the patient, rather than translating something from by the bedside into the patient if that makes sense. The surgeon is able to have more dexterity to allow them to operate and perform the tasks that they need to perform. That means the patient experiences less pain after surgery. They're able to perform their jobs easier, again, and with more precision, allowing the patient to experience less pain, translating to quicker recovery, and back to their daily lives in a quicker fashion. Robotic surgery also benefits the surgeon, by allowing them to be more comfortable when they're operating, which is beneficial to the patient.

It also increases the surgeon's longevity, by not having them in the uncomfortable positions that they experience when they perform open or laparoscopic surgery. And again, that plays on ergonomics as far as many surgeons have to put their careers on hold or stop their careers due to injuries. And this robotic surgery allows us to have less work-related wear and tear on our bodies and the system will ultimately see a benefit. At this time, the system, technology is expensive as it is introduced, but robotic surgery, isn't new to the surgery world. As technology is introduced and the longer it is around, that specific technology, it becomes cheaper.

I like to tell patients and people that I've talk to about robotic surgery think about computers, they used to be big and bulky. And take a lot of space and they used to be extremely expensive. Now our cell phones are more powerful than computers were just less than a couple of years ago and that fits in the palm of your hand. So I believe that, you know, sky's the limit as far as how we can continue to advance in robotic surgery.

Host: It sounds like a win-win all the way around.

Dr. Johnston: It's a win for the patient. It's a win for surgeons and ultimately it'll be a win for the system. And, and that's why robotic surgery is being implemented and integrated into all of the major health systems across the world. It's definitely not slowing down.

Host: Who would be a good candidate for robotic surgery?

Dr. Johnston: Robotic surgery allows us to perform difficult cases easier. So almost anybody is a candidate for robotic surgery, whether or not it's specific operation is a good candidate for robotic surgery is the best question. And that is best decided in a patient by patient basis, with the surgeon.

So if someone needs surgery, take for instance, if we take out someone's gallbladder 80, 90% of the time, the specific benefits of robotic surgery won't be truly utilized, but in the 20 to 10% of the time, that robotics abilities will be utilized, we won't know until we're actually inside, doing the surgery.

So as I tell patients, would you rather have the capabilities available or would you want them to be available and not have them? So, that's one of the main things that I mention to patients as we're considering whether or not to use robotic surgery for their operation.

Host: You mentioned recovery time earlier. How does it compare? Say if somebody had a robotic surgery compared to traditional, is it significantly faster with robotic surgery to recover?

Dr. Johnston: Robotic surgery is similar to laparoscopic surgery. Again, we are able to perform tasks easier and more difficult dissections easier, but as compared to laparoscopic and robotic versus open surgery, the recovery is drastically different, several days on the upfront. And then as far as getting back to your normal lifestyle, probably a week or two weeks different. But as far as robotic versus laparoscopic, the main difference is what we call conversion to open or having a difficult case that we may have to move to a bigger incision, just for exposure.

We don't actually have to do that as often. It's very rare to have to do that robotically. So that is where the patient receives that significant benefit, but on the everyday daily procedures that robotics are used for instead of laparoscopic, we have seen less pain and quicker recovery, and that recovery is, smaller than the conversion between open to laparoscopic. But it's definitely quicker.

Host: Dr. Johnston what excites you most about robotic surgery?

Dr. Johnston: As I alluded to before, the advancements that we have seen in technology, in the day to day, all around us, are going to be translated to robotic surgery and they already have. The recent developments in just the current robot that we have, very drastic. I think that robotic surgery is only going to improve and we're going to have increased capabilities in the future.

We already are able to do so much more with the robot, as I've described. So the sky's the limit, which is the thing that excites me the most, that we haven't seen the best yet.

Host: Dr. Johnston, are there certain types of surgeries that doctors prefer to use robotics rather than traditional surgery or that robotics are better for that kind of surgery say?

Dr. Johnston: Robotic surgery does allow many benefits. The surgeries that we currently perform using robotic surgery are, many abdominal surgeries. So if a patient has a hernia, whether that hernia is around their belly button or in their groin, there's another hernia that patients can experience with their stomach. We call that a hiatal hernia. Those are excellent procedures to perform with the robot. Other procedures that we can perform are for patients that experience diverticulitis. Also colon masses or colon cancers, are excellent procedures to performed robotically. There's similar procedures that we perform, gallbladder removal or taking out the appendix. Anything in the abdomen, usually general surgeons can use the robot to perform. There are many other variations of the robot that are you used, as you mentioned earlier, spine uses a different robot and neurosurgeons use a different type of robot. But this one we specifically use in general surgery are good for the procedures that I just mentioned.

Host: I imagine when a patient hears that they're going to have robotic assisted surgery, they might be a little hesitant. How do you ease their fears?

Dr. Johnston: So one question that we receive is, is whether or not the robot is performing the procedure. And as I mentioned to them, we are in full control of the robot the entire time, every movement that we make in the real world, the robot can make a three times more precise movement. So doesn't matter how specific surgeon is and how precise the robot is even more precise using the surgeons hands and that's based on scaling. So every movement that the surgeon makes, if they make a three inch movement, the robot only moves an inch and that's how they are more precise. So that is a big benefit.

That we're in full control the entire time, is one way that patients are eased by this. This is not a new technology. Robotic surgery was initially developed to assist in military instances, for our armed forces for us to operate remotely. It was adapted to the civilian world and we have made great advancements.

So this isn't something that has all of a sudden just started. Many operations have been performed. And many operations will be continued to be performed because it is very, very safe. As far as our patients, they usually hear that robotic surgery and they think that well, this seems to be expensive.

So one thing in our institution, and this may be different than other institutions, but the robotic surgery is the same cost impact on the patient as the laparoscopic intervention would be. So, the way that we would normally perform that laparoscopically it's the same impact to them robotically.

Host: That's a good point. Is there anything else you'd like to add that we haven't covered yet Dr. Johnston?

Dr. Johnston: There's obviously, new adaptations that will come in the future. And I'm excited to see how things evolve. But currently we are up and running at Tidelands and excited to take care of the patients and give them the excellent benefit that robotic surgery can offer.

Host: Thank you so much for your time. This has been really fascinating and informative, and we so appreciate you sharing your knowledge.

Dr. Johnston: Thank you for having me. I greatly appreciate it as well.

Host: That's Dr. Jack Johnston, Surgeon at Tidelands Health specializing in Robotic Assisted Surgery. Go to Tidelandshealth.org for more information or call 1-866-TIDELANDS.

If you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. This is the Better Health Podcast. I'm Maggie McKay. Thanks for listening.