Robotic Overview at SLRHC The da Vinci Surgical System represents the latest development in minimally invasive surgical technology and provides surgeons with an alternative that uses the same small incisions as conventional laparoscopy and thoracoscopy. The difference with robotics is that it provides the advantages of better visualization and control that were previously realized only with traditional open surgery. The da Vinci System enables surgeons to perform even the most complex and delicate procedures through very small incisions with unmatched precision. The specialized instruments of the robotic system provide dexterity that rivals that of the human hand. The robotic joints move in a manner not only better than laparoscopic instruments but actually better than the human wrist. Technically speaking, there is increased number of degrees of freedom which facilitate complex motion tasks and in the execution of more natural circular wristed movements. The robotic system also provides 3-Dimensional imaging. This stereoscopic vision and robotic end wrist technology provides the best of both laparoscopy and regular open surgery.
Certification and Firsts The robotic surgeons at Mount Sinai St. Luke’s–Roosevelt Hospital are not only certified robotic surgeons but they are also trained in the latest technologies and minimally invasive techniques. The robotic surgeons at Mount Sinai St. Luke’s–Roosevelt Hospital are unique in their spirit of collaboration and innovation. Our center has performed some of the world’s first robotic procedures including the thymectomy and three hole esophagectomy. We created the robotic biventricular pacing procedure as well as robotic seed implantation for lung cancer. We currently use robotic surgery to treat disorders in the entire body, from the neck all the way to the rectum.
Disorders the occur in the chest cavity A variety of disorders which affect the esophagus are treated at Mount Sinai St. Luke’s–Roosevelt Hospital with robotic technology. Surgeons at our institution are using robotic technology that allow maximal dexterity but with small incisions. Instead of large cuts through the chest wall (thoracotomies), these smaller incisions allow quicker post-operative recovery, are less painful for the patient, and do not compromise lung function. The visualization and increased dexterity of the robotic system are ideal for many operations that treat the esophagus. Robotic surgery for benign (non-cancerous) disorders include the treatment of achalsia and esophageal diverticulum. Achalasia means ‘failure to relax’ and is a condition when the muscle between the esophagus and the stomach, the lower esophageal sphincter, does not relax and exists in a chronic contracted state. This chronic contraction causes problems with swallowing. Although it can be treated with dilation and botox injection, for those patients who fail medical management, surgical treatments can provide a cure. Esophageal diverticulum is an outpouching of the esophagus which requires surgical therapy to remove the diverticulum and treat the underlying cause of the diverticulum. Robotics can provide a manner to resect the outpouching, sew up the hole and then provide a definitive treatment of the underlying condition. The SLR physicians with their training and collaboration are ready to offer combined laparoscopic, thoracoscopic, and robotic techniques, to provide an individualized approach to their disease process. Gastroesophageal reflux disease (GERD) is another condition of the esophagus that can be treated by robotics and minimally invasive surgery. Presently, our surgeons perform minimally invasive anti-reflux surgery through small incisions in the abdomen. Patients' hospital stay is decreased to 1-2 days and they are able to return to full activity within 2 weeks after surgery.
Robotic Lung Cancer Treatment A majority of procedures now performed on the lung are done using video-assisted thoracoscopy (VATS). Using small,1 cm incisions, a camera and surgical instruments are placed into the chest to enable surgeons to perform everything from simple biopsies to complete lobectomies. Robotics combines the small incisions of VATS procedures but with increased ability to flex and extend the operative wrist in the tight confines of the extremes of the thorax. Lung cancer is the leading cause of cancer death in this country. Surgery is one of the main therapies for the treatment of lung cancer. Because patients with lung cancer already have compromised lung function, surgical techniques that limit the respiratory compromise of a large thoracotomy are optimal. Surgeons at Mount Sinai St. Luke’s-Roosevelt provide many different robotic options for treating lung pathology. One procedure that is performed for patients with limited respiratory function is the treatment of Stage I NSLC with minimally invasive resection and the robotic placement of brachytherapy seeds.
Robotic Thymectomy Also located in the chest, the thymus gland is situated under the sternum. The thymus may need to be removed when conditions such as thymoma and myasthenia gravis are present. Previously, surgeons needed to cut all the way through the sternal bone in order to remove the thymus gland. Minimally invasive incisions and robotic technology now allow our surgeons to routinely remove the thymus gland for tumors or in the treatment of myasthenia gravis through smaller incisions and a less invasive manner. Our surgeons performed the world's first complete endoscopic robotic thymectomy for myasthenia gravis.
Intestinal Procedures The robot is also used for abdominal procedures located further along the gastrointestinal tract. Complex bariatric procedures that are not suited for traditional laparoscopy can be augmented by the use of robotic technology. The dissection of tissue planes that have been distorted because of prior operation is facilitated with the improved dexterity and visualization. The robot is also optimal to operate on organs that are typically difficult to access with traditional laparoscopic techniques and require exact movements between blood vessels. For this reason, the robot is also used to treat endocrine disorders and to operate on the pancreas as well as liver. An operation that is being performed at increasing frequency is the robotic total mesorectal excision. This operation combines laparoscopic and robotic techniques to perform cancer operations on the rectum located deep down into the pelvis.
Collaboration Mount Sinai St. Luke’s–Roosevelt Hospital has a team of robotic physicians. Please also visit the websites of our gynecologists and urologists who share our spirit of collaboration and technical expertise.