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Robot-Assisted Surgery—Overview by Krisha McCoy, MS

Definition | Reasons for Procedure | Possible Complications | What to Expect | Call Your Doctor

Definition

A doctor guides small robotic arms through several tiny keyhole incisions. This allows for greater range of movement than a doctor's hand.

Reasons for Procedure

Robot-assisted surgery is considered for procedures that:

Require precision
Do not require open access, especially laparoscopic procedures

Performing surgery in this way may result in:

Less scarring
Reduced recovery times
Less risk of infection
Less blood loss
Reduced trauma to the body
Shorter hospital stay
Faster recovery

Many types of surgery, including pediatric surgery, can now be done with the assistance of a robot, including:

General:
- Adrenalectomy (removal of adrenal gland)
- Cholecystectomy (removal of the gallbladder)
- Gastric bypass (procedure to treat obesity and reduce the size of the stomach)
- Heller myotomy (procedure on the lower esophageal sphincter)
- Nissen fundoplication (treatment for severe heartburn)
- Radical prostatectomy (removal of the prostate)
- Colorectal surgery (surgery of the colon)
- Appendectomy (removal of the appendix)
- Nephrectomy (removal of the kidney)
- Hernia repair
Chest:
- Esophagectomy (removal of the esophagus)
- Thymectomy (removal of the thymus gland)
- Mediastinal tumor resection (removal of tumors in the chest cavity)
- Lobectomy (surgical removal of a lung)
Heart:
- Coronary artery bypass surgery
- Atrial septal defect repair
- Mitral valve repair
Gynecologic:
- Hysterectomy (removal of the uterus)
- Myomectomy (removal of uterine fibroids)

Possible Complications

Complications are rare, but no procedure is completely free of risk. If you are planning to have robot-assisted surgery, your doctor will review a list of possible complications, which may include:

Damage to neighboring organs or structures
Infection
Bleeding
Anesthesia-related problems
The need to switch to traditional surgical methods (eg, traditional laparoscopic or open surgery)

Some factors that may increase the risk of complications include:

Pre-existing heart or lung condition
Advanced age
Diabetes
Obesity
Smoking
Excessive alcohol intake
Use of certain medicines

What to Expect

Prior to Procedure

Depending on the reason for your surgery, your doctor may do the following:

Physical exam
Blood tests
Electrocardiogram (ECG, EKG) —a test that records the electrical currents passing through the heart muscle
Chest x-ray
Ultrasound —a test that uses sound waves to visualize the inside of the body
CT scan —a type of x-ray that uses a computer to create images of the inside of the body
MRI scan —a test that uses magnetic fields and radiowaves to create images of the inside of the body

Leading up to the surgery:

Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure, like:
- Anti-inflammatory drugs (eg, aspirin )
- Blood thinners, such as clopidogrel (Plavix) or warfarin (Coumadin)
Take antibiotics if instructed.
Follow a special diet if instructed.
Shower the night before using antibacterial soap if instructed.
Arrange for someone to drive you home from the hospital. Also, have someone to help you at home.
Eat a light meal the night before. Do not eat or drink anything after midnight.

Anesthesia

Depending on the type of procedure that you have, you may be given:

General anesthesia —blocks pain and keeps you asleep through the surgery.
Local anesthesia—just the area that is being operated on is numbed; given as an injection and may also be given with a sedative

Description of the Procedure

Small "Keyhole" Incisions

The doctor will cut several small keyhole openings in the skin near where the surgery will take place. In most cases, a needle will be used to inject carbon dioxide gas into the surgical area. This gas will make it easier for the doctor to see internal structures. Next, the doctor will pass a small camera, called an endoscope, through one of the incisions. The camera will light, magnify, and project an image of the organs onto a video screen. Then robotic arms holding instruments for grasping, cutting, dissecting, and suturing will be inserted through the holes.

While sitting at a console near the operating table, the doctor will look through lenses at a magnified 3D image of the inside of the body. Another doctor will stay by the table to adjust the camera and tools. With joystick-like controls and foot pedals, the doctor will guide the robotic arms and tools. Lastly, the tools will be removed, and stitches or staples will be used to close the area.

How Long Will It Take?

Usually 1-2 hours or less

How Much Will It Hurt?

You will have pain and discomfort during recovery. Your doctor will give you pain medicine. You may also feel bloated or have pain in your shoulder from the gas used during the procedure. This can last up to three days.

Average Hospital Stay

This procedure is done in a hospital setting. The usual length of stay is a few days. Your doctor may choose to keep you longer if you have any problems.

Post-procedure Care

While you are recovering at the hospital, you will:

Be encouraged to walk (with help) soon after surgery
Receive guidelines on what you should eat and what activities you can do—Depending on your procedure, you should be able to go back to your normal activities in a few weeks.

After you return home, be sure to follow your doctor's instructions. Ask your doctor about when it is safe to shower, bathe, or soak in water.

Call Your Doctor

After you leave the hospital, contact your doctor if any of the following occurs:

Signs of infection, including fever and chills
Redness, swelling, increasing pain, excessive bleeding, or discharge from an incision site
Cough , shortness of breath, chest pain, or severe nausea or vomiting
Pain, burning, urgency, frequency of urination, or persistent bleeding in the urine
Pain and/or swelling in your feet, calves, or legs, or sudden shortness of breath or chest pain
Constipation or diarrhea
Other worrisome symptoms

In case of an emergency, call for medical help right away.

RESOURCES:

American College of Doctors http://www.facs.org/
Food and Drug Administration http://www.fda/gov/

CANADIAN RESOURCES:

Canadian Agency for Drugs and Technologies in Health http://www.cadth.ca/
Health Canada http://www.hc-sc.gc.ca/index_e.html/

References:

Computer-assisted surgery: an update. Food and Drug Administration website. Available at: http://www.fda.gov/fdac/features/2005/405_computer.html . Accessed June 20, 2006.
The da Vinci surgical system. University of Southern California, Cardiothoracic Surgery website. Available at: http://www.cts.usc.edu/rsi-davincisystem.html . Accessed September 16, 2009.
Robotic surgery. Brown University website. Available at: http://biomed.brown.edu/Courses/BI108/BI108_2005_Groups/04/ . Accessed September 16, 2009.
Robotic surgery. Thinkquest website. Available at: http://library.thinkquest.org/03oct/00760/ . Accessed September 16, 2009.
Robots lend a helping hand to doctors. Food and Drug Administration website. Available at: http://www.fda.gov/FDAC/features/2002/302_bots.html . Accessed June 20, 2006.

Last reviewed November 2012 by Marcin Chwistek, MD

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