Within the past two decades, minimally invasive robotic surgery has become an incredible advancement in surgical medicine—and it has led to so much innovation in cancer treatment. Instead of surgeons placing their hands inside the patient to perform surgeries, they control robotic arms while viewing the surgical site via a high-definition, 3D computer screen.
“The robotic arms can turn, pivot, roll—they can do everything your hands can do,” says Craig Rogers, M.D., a urologic oncologist who specializes in robotic surgery at Henry Ford Health. “It makes surgery more precise because surgeons have a natural tremor. The computer eliminates that.”
Before robotic surgery, minimally invasive surgery done with what’s called laparoscopic surgery was the new thing. It eliminated the need to create large incisions for surgery. The smaller the incisions, the easier it can be on the patient. Minimally invasive surgery helps reduce pain, blood loss and scarring. Patients are out of the hospital faster and back to work faster.
“But laparoscopic surgery still requires the surgeon to perform the surgery with their hands, manipulating instruments in a small working space,” says Dr. Rogers. “The surgeon is holding instruments that are stiff with no wrist motion to help with precise movements. Imagine trying to build a ship in bottle with chopsticks—there’s only so much you can do with instruments that won’t turn. Similarly, with laparoscopy, it was challenging to get at the right angles to cut and sew using rigid instruments.
“Some of the most talented laparoscopic surgeons in world—who spent decades refining their skills—eventually started using the robot and liked it so much they didn’t want to go back.”
Misconceptions About Robotic Surgery
Dr. Rogers says some people may initially have questions about robotic surgery. They might ask, is my surgeon just going to press a button? Are they even in the room? And yes, the surgeon is physically present. “Robotic surgery is not automated,” Dr. Rogers says. “The surgeon is still in control and is moving the instruments.”
Some also wonder what would happen if the robot were to malfunction. “We have the option to pull the robot away and continue surgery by hand. It’s very rare that this would happen—it happens in far less than 1% of cases—but we are prepared to manage these issues safely in the extreme unlikelihood of a technical malfunction,” he says.
What Procedures Is Robotic Surgery Currently Used For?
When the robot first came out, it was used mainly for prostatectomies (or surgery to remove the prostate gland). Then robotics expanded to kidney surgery.
“There was a realization that the robot can make many different minimally invasive surgeries easier, not just prostate surgery,” says Dr. Rogers. “Gynecology started using it to perform hysterectomies. ENT (ear, nose and throat) started doing robotic surgeries through the mouth—called trans-oral surgeries. And now, many other specialties are jumping in: general surgeons are using it for hernia repairs and gallbladder removals; colorectal surgeons and reconstructive surgeons are also using it for surgery. The robot is being used to treat thoracic cancers, such as lung and esophageal tumors. And it’s also being used for bariatric surgery.”
Advancements In Robotic Surgery
Today, more companies are entering the robotic space. “One company dominated the robotic market for over 20 years,” says Dr. Rogers. Now, as many of their initial patents have expired, new companies are making their own robotic surgical systems. Robotic surgery is only becoming more widespread—and the technology just keeps getting better.
For example: The new single-port robot leads to even fewer incisions.
“Historically, robotic surgery has involved inserting different robotic instruments through three or four small incisions,” says Dr. Rogers. “But the single-port robot puts all of the instruments through one incision that’s about three centimeters long. Once the instruments—including the robotic camera—get into the body, they can spread out inside the body, like the arms of an octopus.”
Henry Ford Health currently has the only single-port robotic systems in the state of Michigan, and they are mainly being used for prostate, kidney and some ENT surgeries.
“Although it’s not quite prime time yet, what’s also up-and-coming is robotic-assisted endoscopy,” says Dr. Rogers. “In urology, robots are being developed that can drive into the bladder or up to the kidney to help remove small tumors or stones. Robotic systems for endoscopic thoracic procedures are being used at Henry Ford.”
Robotic-assisted surgery for colonoscopy is also being examined. “If someone gets a colonoscopy, the doctor has to drive a flexible scope through the colon. If an abnormal polyp is found, they have to manipulate instruments to remove that polyp,” says Dr. Rogers. “Companies are working on robotics that can robotically drive through the turns in the colon to help locate polyps and use precise instruments to remove them.”
And while these are exciting advances, there will inevitably be more. “We’re likely to see an explosion in the field of robotics in the coming years,” says Dr. Rogers.
To find a cancer specialist, visit henryford.com/cancer or call 1-888-777-4167.
Craig Rogers, M.D., is a urologic oncologist and the chair of urology at Henry Ford Health. He specializes in robotic surgery for prostate cancer, kidney cancer, adrenal tumors, testis cancer, penile cancer and bladder cancer. Dr. Rogers sees patients at Henry Ford Cancer—Detroit, Henry Ford Hospital and Henry Ford West Bloomfield Hospital.
