Most surgeries involve a doctor’s hand working inside the body. But each year more doctors and patients are opting for a robotics-assisted approach. There’s more precision and greater visibility for doctors with 3-D imaging, plus less scarring and faster recovery for patients. But the approach has its critics.
Dr. Kemp Kernstine talked about this in a KERA Health Checkup. Dr. Kernstine chairs UT Southwestern’s thoracic surgery division and has a strong research interest in robotic surgery.
Dr. Kernstine: It’s really not a true robot, it’s a computer –assisted surgical system. We’re popping these slow robot arms through small incisions and doing major operations with a lot of manipulation, because the robot arms can move at the very location where they’re doing their work. So what’s outside the patient isn’t moving very much. The chest wall or abdomen isn’t moving very much, where you make the skin incisions. It’s the inside where all the movement occurs, where you don’t have pain fibers. So therefore you can do a lot of surgery through very little incisions.
Sam Baker: How far away or how close to the patient is the doctor when this procedure is going on?
Dr. Kernstine: That’s part of the expense. Typically there is an educated surgeon or surgeon person, so it could be a physician’s assistant or a trained nurse practitioner at the bedside who could be the surgeon if necessary. The surgeon doesn’t have to even be in the room, but in most every place in the U.S.., the surgeon is in the room with the patient and the surgeon is sitting at a console just sitting ten, five feet away from the patient.
Sam: How precise can you get?
Dr. Kernstine: I had one patient who had a small mass in his esophagus, and it would have required a thoracotomy which is a big incision in the chest, open up the chest, push the lung away. With this technology, you can precisely go in exactly where that patient has a problem, so the esophageal mass, go right into the esophagus, make a small hole in it, remove the mass, sew it up. The patient can go home possible that day. In this patient’s case, he went home the next day. This is something we used to keep the patients in the hospital for a week and a half to two weeks. These things may be able to be done as an outpatient in the future. Even without putting patients to sleep, a lot of the reasons we did a lot of those things, is that we had to do big incisions. I think the evolution of this, as we get better and better, we put more research funding into this, this is going to be even better for the future.
Sam: You get a more precise procedure. Do you get a better procedure overall? There are some naysayers who will suggest that robotic surgery is certainly more expensive but that you don’t necessarily get a better procedure.
Dr. Kernstine: Of course you don’t. It’s because they’ve invented it, they’re producing the machines. It’s up to us to learn how to use these machines. The more we use them, the more companies start to get involved. There will be more competition, the machines will be cheaper and better and faster. We’re just at the beginning. I think this robotic technology, we’re just scratching the surface of where this is going to go. We can’t say that it’s better right now.
Sam: As opposed to a more traditional approach.
Dr. Kernstine: We don’t know that information. We’re evolving to that, and what I think the government needs to do is require us to prove it and to have more clinical trials, like we would a new drug.
Sam: Where is the insurance history on this? Are they supportive of this approach?
Dr. Kernstine: In some aspects they are. I think for things like prostate, they’ve actually done a very good job. 85 percent of all prostate ops are now done robotically. The need is getting well-trained surgeons so there are now training programs across the county where surgeons can take anywhere from six months, twelve months, even 24 months to be trained in how to do a robotic prostatectomy, or nephrectomy, or bladder operation.
Sam: Is there a line where you don’t consider robotic surgery?
Dr. Kernstine: We’re not there yet in some things – orthopedics. There’s a robot that has been made for orth surgery, we don’t use it here in this country. It was studied and found to be no better in the open approach, so it’s just not sold. I think there’s a lot of opportunities in neurosurgery, orthopedics, as technology improves.
Sam: So in health do you think this is definitely the way of the future?
Dr. Kernstine: There’s no question in this going smaller. There are units the size of red blood cells and smaller that are working machines. We’ll be able to draw machine parts into a syringe, inject them into a patient and reassemble them inside the patient. So the possibility of doing major surgery literally through needle holes I think is imminent. This is an exciting time.
Dr. Kemp Kernstine is chairman of the Division of Thoracic Surgery at U.T. Southwestern Medical Center.
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