Frequently Asked Questions

Robotic surgery is quickly changing the surgical experience for urology patients, enabling local surgeons to perform highly technical procedures laparoscopically, meaning a smaller incision and quicker recovery time than with open surgery. We asked urologists BRIAN MALLOY and MARK SEAL with Benefis Medical Group, to talk about the da Vinci Robotic Surgery System at Benefis.

What is Laparoscopic Surgery?

Dr Seal: Laparoscopic surgery is a non-invasive surgical technique in which we make three or four small incisions, roughly 8 to 12 mm in size, instead of a single, large incision. One of the incisions is used to direct a camera to the surgical site.

Can You Explain How da Vinci Robotic Surgery Differs From Traditional Laparoscopic Surgery?

Dr. Malloy: In a traditional laparoscopic procedure, the surgeon looks up at a video monitor while he works above the patient with long instruments, almost like knitting needles. With da Vinci, he operates the robot from a console that provides a 3D image of the surgery site.

What Are the Advantages?

Dr. Malloy: With da Vinci you have increased optics and control. The robot compensates for natural human hand tremor and allows fine movements that are extremely difficult to achieve with traditional laparoscopic surgery. The 3D image is actually better than the human eye, and the robot has a jointed wrist with more range of motion than the human hand. That allows us to perform extremely technical procedures with less tissue damage, less blood loss and better reconstructive ability. Traditional laparoscopic surgery was developed to be exterpritive, meaning it's good for removal of tumors or organs, like the gallbladder. da Vinci surgery gives us the dexterity and precision to do more technical procedures that require reconstruction, like removal of the prostate gland for prostate cancer patients.

Is da Vinci Really a Robot?

Dr. Malloy: I like to describe the robot as a master/servant system. The surgeon is in control and the robot is not doing anything automatically. There are safety measures built in so if the surgeon is not doing anything the robot cannot move on its own.

Dr. Seal: The da Vinci is really a tool and like with anything, you want to use the best tool for the job at hand. I'd liken it to an artist who uses a fine horsehair brush, not a house-painting brush, to paint a landscape. The doctor is using a surgical tool which he 'drives' via the console. He is in complete control of the procedure the entire time.

What if Something Goes Wrong? Can the Robot Malfunction?

Dr. Malloy: Remember that the surgeon is always steps away from the patient's bedside. Like with any laparoscopic surgery, a da Vinci procedure can be converted to an open procedure quickly and safely if there's any emergency situation.

Dr. Seal: And this technology has been stringently tested and has multiple check systems that were mandated by the FDA before it came to market. If something technically happens to the robot, it's a lot like troubleshooting a computer. Usually the operation resumes. The worst-case scenario is that the patient will have the traditional open surgery they would have had a year ago before we had da Vinci.

What types of surgeries do you perform with da Vinci?

Dr. Malloy: As urologists, we use the da Vinci robot mostly for prostatectomies for prostate cancer and kidney procedures, including partial or total nephrectomies, which is removal of the kidney.

Prostatectomies are a fast-growing da Vinci procedure, with 80 percent of prostatectomies in the United States now done robotically. How is da Vinci changing the surgery experience for prostate cancer patients?

Dr. Seal: Before da Vinci, only a small number of surgeons used laparoscopy to perform highly technical procedures, like prostatectomies. Most patients had open surgery that required a large incision and a much longer recovery time. To perform a prostatectomy, the surgeon must disturb normal tissues, including the tiny, delicate nerves that control continence and potency. And reconstituting the integrity of the urinary tract after removal of the prostate gland is one of the biggest challenges. What the 3D capability of the robot allows us to do is to sew in 3D as you would normally, reducing damage to the urinary tract. The optics are so good that we can also see the thin, veil-like nerves that are involved in potency and try to prevent damage. And there is an equivalent, if not better, ability to treat cancer than with the open procedure.

How Did You Train for Your First da Vinci Surgery?

Dr. Seal: Again, this is just a tool and so you're already bringing a wealth of experience and training to the table, so to speak. There is a training course that must be taken that includes reading and hands-on lab time. Before I did my first robotic case, I spent about 100 hours practicing. And we still do practice. Even yesterday I spent an hour just sewing with it. The first five cases you perform as a da Vinci surgeon are done with the assistance of a proctor and that is someone who is on site and is an experienced robotic surgeon.

Are There Cases Where a Patient Cannot Have da Vinci Surgery?

Dr. Seal: I just had to tell a patient he could not have a da Vinci procedure because he was significantly overweight. There are anatomic limitations, similar to those that raise concerns with open surgery or traditional laparoscopic surgery. Common limitations include cardiac disease and respiratory problems.

Dr. Malloy: Other selection criteria specific to da Vinci include prior abdominal surgery with mesh, like with a hernia operation, or a prior abdominal infection such as peritonitis.

What Do You Tell Patients Who Are Deciding Whether to Have Robotic Surgery?

Dr. Seal: I was actually in that position myself 4 years ago, when I was diagnosed with prostate cancer. After studying the options, I wanted the level of precision that da Vinci offers. And as a busy surgeon, a quick recovery time was very important to me. I had my procedure on a Friday afternoon and was released from the hospital Saturday morning. I walked three blocks to a restaurant and I flew home from New York on Sunday. I missed one week of work and then I worked in the office a week and was operating again by the second week.

What Have You Enjoyed Most About Offering da Vinci Surgery?

Dr. Seal: I've been fortune that about every 10 years in my practice something technologically has come along that really changes the way you do things and this is one of the most exciting. I think what I've enjoyed most is just seeing how well people do. I had a female patient who had four kids and went home the same day from a major kidney surgery and worked the following week. And I recently did a successful operation where the tube that drains the kidney had been blocked. Before da Vinci, that patient would have been in the hospital for four to five days and would have spent five or six weeks away from work after that. She was home the next day.”

Dr. Malloy: With da Vinci we can offer urological procedures that patients, especially prostatectomy patients, would have traveled for previously. We can offer state-of-the art cancer care to our community, and I've really appreciated the team concept we have applied to da Vinci. We have a team of surgeons, anesthesiologists, OR nurses, OR technicians and surgical assistants who are all dedicated to the robotic program.