May 27, 2015 | by Valerie Nelson
Minimally invasive surgery at City of Hope is performed using robots with “wrists” that provide greater dexterity and range of motion than a human hand. These advanced “surgical assistants” enable surgeons to access hard-to-reach areas of the body through incisions no larger than a penny.
“Surgical robotics is a rapidly maturing field that represents both the present and the future at City of Hope, one of the largest centers of minimally-invasive and robotic surgery in the world,” says Yuman Fong, M.D., chair of the Department of Surgery.
The less-is-more approach has dramatically altered the way patients experience and recover from surgery. A smaller incision often means less postoperative pain, fewer side effects, quicker recovery and a shorter hospital stay.
City of Hope surgeons have performed more than 10,000 robot-assisted surgeries since 2003, when the cancer center began performing prostatectomy using the da Vinci Surgical System, the first robotic surgery system approved by the Food and Drug Administration for general laparoscopic surgery.
An early adapter to robotics, the cancer center has played a key role in the development and refinement of the technology. From a console, the surgeon manipulates four robotic arms — three grip laparoscopic tools, while the fourth holds a pencil-sized video camera that is inserted through the incision to provide three-dimensional, magnified vision of the site.
“Instrumentation has gotten spectacularly better in the last decade. They now have binocular vision and curved instruments that we can guide around obstacles via computer, giving us finer control,” Fong said. “We now understand how to use instruments in the most complex of operations.”
As the tools have become a more natural extension of the surgeon’s eyes and hands, robotic-assisted surgery at City of Hope has expanded to include head and neck surgery, esophagectomy, bladder removal, lung biopsy and lung resection, colon surgery, liver resection, rectal surgery, pancreatic surgery and stomach surgery.
“You name it, and it has been tried, and often very, very successfully,” Fong said.
Minimally invasive techniques don’t necessarily require a state-of-the-art surgical robot in the operating room. Less-invasive therapies delivered by needle and catheter, for example, can greatly simplify treatments. “There are many ways that we can get at cancer without making giant incisions, yet still give the patients good outcomes,” said Fong, one of many City of Hope researchers focusing on developing new surgical tools to make treatments simpler.
Two areas that hold great promise in the near future are the evolution of robotics and research into how to direct needles to do their work, Fong said.
“Almost every part of the body can be reached with a needle,” he said. “John Park, our chief of interventional radiology, and I are working on how to better guide it, see it and apply to it the energy that will kill cancer cells.”
“We are now able to remove very advanced cancers through small incisions, allowing patients to make a quick recovery and live longer lives and into old age,” Fong said. “Many cancers once thought to be terminal are now curable, and many people don’t realize that. From a research standpoint, we are constantly trying to perfect ways that will allow us to extend the possibility of surgery — and good outcomes — to more and more people.”
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