LEXINGTON, Ky. (March 17, 2022) – When JR Bell, MD, assistant professor of urology at the University of Kentucky College of Medicine, describes the da Vinci SP Surgical System, you get the feeling it’s the pinnacle of surgical technology. This machine, with its single arm, gives surgeons the ability to perform complex surgical procedures through a single inch-long incision.
Robotic surgery isn’t new, but this machine is. When people hear “robotic surgery,” they may conjure up images of robots in a factory, performing complex tasks without any human intervention. But robotic systems are tools, used the same way a surgeon would use a scalpel. The da Vinci SP is a recent acquisition by UK HealthCare for urologic and oropharyngeal surgical procedures and is the only such machine in Kentucky. According to Bell, an expert in minimally invasive urological surgery, using a robot for surgery has improved patient outcomes with less pain and a reduced risk of complications compared to traditional surgery.
“For patients, the benefits are fewer incisions, less post-op pain, and hopefully a shorter recovery time,” Bell said. “There is a reduced risk of complications and patients can recover faster.”
As an example, Bell described prostate surgery using SP for men with benign prostatic hyperplasia (BPH). The SP stands for “single port”, which means that the robot has a single arm which contains the camera and the surgical instruments which only require a single three centimeter incision. Previous iterations have multiple arms, which would require multiple incisions.
“With this machine, we can go straight through the bladder to dig out the prostate,” Bell said. “Before, it had to go through the abdomen. That way we don’t have to worry about moving the intestines and risking injury to them. It really mitigates potential complications.
The direct access point allows the single arm to have multiple orientations so surgeons can have different views of the surgical site.
“The camera is really flexible,” Bell said. “So if you need a 12 degree or 30 degree view, you can change that in real time and get angles that aren’t possible with the current instrumentation.”
Patients aren’t the only ones who benefit from a stay in a hospital with this kind of technology. Medical students and residents have the opportunity to gain skills and experience not offered by many institutions.
“It’s a pretty low percentage of places overall that have that,” Bell said. “Urology residency is five years and you have to start that process a year or two before you even start your residency. So they are looking at programs that they want to take at least six years before they graduate. Looking at programs that have this technology – where they can get this experience during their residency – they don’t have to spend a year in a post-residency fellowship to get this training. They can go straight to training.
“It will be an excellent resource for education and training,” said Vince DiCarlo, MD, resident in the Department of Urology. “For future graduating residents getting to grips with the system, this could be a very marketable aspect of their training when looking for their first job.”
Training on a robot like the da Vinci SP is valuable but intense. Students and residents first start out on a simulator, doing basic technical exercises that almost look like video games. The goal is to first understand what the tools do and how to move them. On a screen near the simulator are displayed three cones, one of which has a ring. Focused on the commands, a user moves the ring from cone to cone, slowly mastering how to move the robot’s arms. The exercises become more complex – rotating the camera, moving the instruments and doing several things simultaneously.
“There is definitely a learning curve with ‘docking’ the robot to use it, as well as intraoperative mobility,” said Nick Friedberg, MD, a member of the robotic surgery program. “But the continuity between the da Vinci systems with respect to the surgical console allows surgeons to utilize previous robotic surgical experience, even with this innovative new tool.”
“Then they will progress to simulating different surgeries,” Bell said. “For example, during a hysterectomy, they will identify the relevant anatomy in a simulator. Then I will ask them to point out where they would make the incision. From there, after “cutting out” this part, they will show how to sew the two anatomical pieces back together. He guides them through each step of the procedure and the different levels of complexity until they have enough skills and understanding to begin to engage in patient care under the supervision of an attending surgeon.
“I think the amount of robotic experience is a big draw for any program and something applicants frequently ask for,” said Rohail Rashid Kazi, MD, resident in the Department of Urology. “Urology, like many other surgical specialties, is a field that is constantly evolving and it is important that any training program keeps up with the evolution of our practice.