Single-Site Robotic Assisted Surgery

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The Latest Revolution in Laparoscopy: Robotic Single-Site Surgery


Laparoscopic surgery exploded onto the scene in the early 1990's and revolutionized the way surgery is done in America. Large, painful incisions no longer were necessary to perform operations on the abdomen. Laparoscopic surgery uses a number of small punctures of one half inch or less to introduce a video camera and long narrow instruments into the patient's abdominal cavity to accomplish the operation. The result was that operations like removal of the gallbladder that typically required 5 to 7 days in the hospital and four to six weeks off of work now could be done as out-patient surgery with return to work in just one to two weeks. The advantages to patients were dramatic. As time passed more and more operations were able to be performed using these minimally invasive surgical procedures.

Before long, however, surgeons reached the limit of operations that could be done using the long skinny instruments inserted through access tubes into the abdomen required for laparoscopic surgery. The instruments were straight and rigid and relatively immobile except for simple open and close movements. This limited the types of operations a surgeon could do, especially in tight spaces like the confines of the pelvis. It prevented the twisting and bending movements that surgeons typically use to dissect, cut and sew tissues inside the body using their natural wrist movements. The result was that many larger, more complicated operations were prevented from being performed laparoscopically.

To overcome this obstacle a new revolution in surgery is now taking place with the introduction of robotic surgery. During robotic surgery a robotic system is positioned next to the patient and special instruments are attached to the robot for use during the operation. These instruments are inserted into the patient by the surgeon who then controls the instruments sitting at a special surgeon consol. At the console the surgeon moves hand pieces that tell the robot how to move the instruments inside the patient while the surgeon views the movement of the instruments through a high definition, magnified, three dimensional video system. By controlling the instruments in the surgeon console surgeons can bend and twist their wrists while the robot reproduces these movements inside the patient in a way that could not be accomplished with the standard, rigid laparoscopic tools. The result is that more complex procedures can be done. Now even more patients can have access to the advantages of laparoscopic surgery for bigger, more complicated operations than could be done previously. The age of robotic surgery has begun!

Dr. Gerhart is at the forefront of the robotic surgical revolution. He has one of the highest volume robotic general surgical practices in the northeast region of the nation. He performs a wide variety of robotic operations and he trains robotic surgeons across the country. The latest robotic surgical advancement released in 2012 is single-site robotic surgery. With single-site robotic surgery, new instruments have been designed that allow multiplerobotic instruments to enter through one small puncture in the belly button. Through the amazing abilities of robotic engineering, these instruments will then spread out and be used to perform laparoscopic surgery. Surgeons no longer need to make multiple punctures in the patient to perform surgery. The entire operation is reduced down to one small opening, roughly one inch in length, hidden in the belly button. Less cutting results in less pain and since the one incision is hidden in the belly button there is no visible scar at all. You can look at the abdomen of a person who has had single-site robotic surgery and see no evidence of surgery giving dramatic cosmetic benefits.

We are now at the cutting edge of the revolution of single-site robotic surgery. Dr. Gerhart is one of the first surgeons in the nation to be trained in the use of this exciting new technology and only the second surgeon in Pennsylvania to do single-site robotic surgery. Dr. Gerhart has performed almost 400 single incision laparoscopic cholecystectomies using standard laparoscopic instruments before the introduction of the robotic techniques. He now finds the robotic single-site cholecystectomy to be much better with much clearer and more stable visualization using the robotic video system. He also finds that the dissection and handling of tissues during the operation are much more precise and controlled using the robotic instruments that are designed to bend and move into positions that that could not previously be done during the removal of the gallbladder through a single incision with standard laparoscopic instruments.

As single-site robotic surgery continues to expand we will likely see a similar adaptation to more and more procedures in years ahead just as we did with laparoscopic surgery. Eventually, larger and larger operations will be able to be done using one small incision hidden in the belly button giving more and more patients the benefits of single-site surgery.

Easing the Pain with Single-Site Robotic Surgery

WNEP Report - May 31, 2012



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