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A surgeon looks through a 3-D monitor and manipulates the robotic "hands" of a da Vinci Surgical System while operating on a patient.

A surgeon (foreground) looks through a 3-D monitor and manipulates the robotic "hands" of a da Vinci Surgical System while operating on a patient (background).

Robots armed for sophisticated surgery

minimally invasive system comes to the U

By Deane Morrison

Published on June 2, 2004

If you're facing complicated surgery, you want the very best surgeon by your side during the operation. Sometimes, however, a surgeon can do an even better job while sitting a few feet way. Thanks to technological advances in surgical robotics, surgeons can now manipulate three or four sophisticated robotic "hands" to perform feats impossible with human hands. In April, Intuitive Surgical of Sunnyvale, Calif., makers of the da Vinci Surgical System, designated the U of M one of 11 U.S. centers for training surgeons in the use of their system. To use the system, the surgeon sits with his or her head in a console and looks at a screen that shows the surgical site. Next to the patient sits the robot, with "arms" that reach to the patient. The arms have "wrists" that provide flexibility, and the hands articulate with each other in all degrees of motion. Those hands can cut, insert, suture--virtually everything human hands can do. And they eliminate much hand tremor. They also have two cameras, giving the surgeon a 3-D view--an advance over traditional laparoscopic surgery.

"The biggest thing is that it enables you to do potentially complex operations that are impossible with a laparoscope," says surgeon Michael Maddaus. "For instance, mitral valve repair requires very delicate sewing in the heart. You couldn't do it with a regular laparoscope."

University surgeons have performed about 60 operations with the system so far. Dr. Michael Maddaus, co-director (with Dr. Sayeed Ikramuddin) of the University's Center for Minimally Invasive Surgery (CMIS), says that although robotics is in its infancy, the da Vinci system is already proving its worth. "The system allows much finer suturing, for example, in a prostatectomy," says Maddaus. "The urethra is a fine tube, and sewing it with regular laparoscopy is hard. But with [the da Vinci system], you can sew it back much better. It's also easier to avoid cutting nerves. "The biggest thing is that it enables you to do potentially complex operations that are impossible with a laparoscope. For instance, mitral valve repair requires very delicate sewing in the heart. You couldn't do it with a regular laparoscope. The new system also allows you to remove the esophagus in a way you couldn't before--you couldn't get up high enough to a delicate area of the esophagus where it was hard to see." The University has a da Vinci system, for training purposes only, in the basement of the Variety Club Heart Hospital. A second system is used in the operating room. So far, about 15 University surgeons have been trained to use the system; they hail from the departments of surgery; urologic surgery; obstetrics, gynecology and women's health; and pediatrics. The system is expected to produce better outcomes for patients, including reduced trauma to the body, less anesthesia, smaller risk of infection, shorter hospital stays, faster recoveries, and less scarring.

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