Overview
Definition
Definition
A doctor uses robotic arms to operate through small keyhole incisions in the abdomen.
The robotic arms are able to do surgical tasks with an increased range of motion. They also can filter out hand tremor. The special tools translate the doctor’s larger hand movements into smaller ones. This allows delicate work to occur in small spaces.
Laparoscopic CholecystectomyClose-up view of laparoscopic tools used to remove the gallbladder (green structure).
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Reasons for Procedure
Reasons for Procedure
Some laparoscopic surgeries that have been successful using robotic techniques include:
- Adrenalectomy —removal of adrenal gland
- Appendectomy —removal of the appendix
- Bariatric surgery —surgery of the stomach to treat obesity
- Cholecystectomy —removal of the gallbladder
- Colectomy—removal of the colon
- Hernia repair
- Nephrectomy —removal of a kidney
- Nissen fundoplication —surgical reinforcement of the valve between the esophagus and stomach
- Prostatectomy —removal of the prostate
- Hysterectomy —removal of the uterus
- Myomectomy —removal of fibroids, which are noncancerous tumors in the walls of the uterus
Compared to more traditional procedures, robotic-assisted laparoscopic surgery 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
Possible Complications
Possible Complications
Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:
- Damage to neighboring organs or structures
- Infection
- Bleeding
- Anesthesia-related problems
- The need to switch to traditional surgical methods such as traditional laparoscopic or open surgery
Factors that may increase the risk of complications include:
- Smoking
- Pre-existing heart or lung condition
- Obesity
- Diabetes
- Excessive alcohol intake
- Previous abdominal or pelvic surgery
- Use of certain medications
Be sure to discuss these risks with your doctor before the procedure.
What to Expect
What to Expect
Prior to Procedure
Depending on the reason for your surgery, your doctor may do the following:
- Physical exam
- Blood tests
- Urine tests
- Electrocardiogram (EKG)
- Intravenous pyelogram (IVP)
- X-ray of kidneys, ureter, bladder (KUB)
- Abdominal or pelvic ultrasound
- CT scan
Leading up to the procedure:
- Talk to your doctor about your medications. You may be asked to stop taking some medications up to one week before the procedure.
- Take antibiotics if instructed.
- Take a laxative and/or use an enema to clean out your intestines 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
Several small incisions will be made. They are called keyhole incisions. Carbon dioxide gas will be passed into the abdomen to expand it. This will make it easier for the doctor to view the area.
A small camera will be passed through one of the incisions. This tool is called an endoscope. It lights, magnifies, and projects an image of the organs onto a video screen. The endoscope will be attached to one of the robotic arms. The other arms will hold tools that are able to grasp, cut, dissect, and suture. These may include:
- Forceps
- Scissors
- Dissectors
- Scalpels
Laparoscopic ToolsCopyright © Nucleus Medical Media, Inc.
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The doctor will sit at a console, looking at the images on the screen. Joystick-like hand controls and foot pedals will help to guide the tools. Another doctor will stay by you to adjust the tools as needed. In some cases, organs or tissue might need to be removed. When the procedure is done, the tools will be removed. The incisions will be closed with sutures or staples and a sterile dressing will be applied.
How Long Will It Take?
About 1-2 hours, depending on the type of procedure
How Much Will It Hurt?
Anesthesia will prevent pain during surgery. Pain and discomfort after the procedure can be managed with medications. You may also feel discomfort from the gas used during the procedure. This can last up to 3 days.
Average Hospital Stay
This procedure is done in a hospital setting. The usual length of stay is 1-2 days. Your doctor may choose to keep you longer if you have any problems.
Post-procedure Care
When you return home, do the following to help ensure a smooth recovery:
- Wash the incisions with mild soap and water.
- Limit certain activities, such as driving and strenuous activity.
- Participate in any physical therapy or rehabilitation.
Depending on the procedure, you should make a full recovery within a few weeks.
Call Your Doctor
Call Your Doctor
It is important for you to monitor your recovery after you leave the hospital. Alert your doctor to any problems right away. If any of the following occur, call your doctor:
- Signs of infection, including fever and chills
- Redness, swelling, increasing pain, excessive bleeding, or discharge from an incision site
- Abdominal swelling or pain
- Severe nausea or vomiting
- Persistent diarrhea or constipation
- Blood in the stool
- Pain and/or swelling in your feet, calves, or legs
- Cough, shortness of breath, chest pain
- Being unable to eat or drink liquids
- Headache, feeling faint or lightheaded
- Excessive vaginal bleeding after a gynecologic procedure
- Persistent or foul smelling vaginal discharge after a gynecologic procedure
- New or worsening symptoms
If you think you have an emergency, call for medical help right away.
RESOURCES:
National Heart, Lung, and Blood Institute http://www.nhlbi.nih.gov
CANADIAN RESOURCES:
References:
http://www.cts.usc.edu/rsi-davincisystem.html
Accessed July 25, 2013.
Robotic surgery. Brown University website. Available at:
http://biomed.brown.edu/Courses/BI108/BI108_2005_Groups/04
Accessed July 25, 2013.
Ruurda JP, van Vroonhoven ThJMV, et al.. Robot-assisted surgical systems: a new era in laparoscopic surgery. Ann R Coll Surg Engl. 2002;84:223-226.
What is robotic surgery? The Robotic Surgery Center at NYU Langone Medical Center website. Available at:
http://robotic-surgery.med.nyu.edu/for-patients/what-robotic-surgery
Accessed July 25, 2013.
6/3/2011 DynaMed’s Systematic Literature Surveillance
http://www.ebscohost.com/dynamed:
Mills E, Eyawo O, et al. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.
Last Updated: 5/29/2014