Over the last decade, the da Vinci robot, developed by California-based Intuitive Surgical, has appeared in hundreds of operating rooms around the world. It offers a new approach to laparoscopic procedures, which involve threading surgical tools through small holes in the body rather than making large incisions. Traditional laparoscopy uses tools with limited movement and offers surgeons a flat, 2-D view, but the $2.5 million da Vinci has a sophisticated imaging system and incorporates more flexible tools.
In an operating room at Children’s Hospital Boston, surgeons use the robot to repair a three-year-old patient’s bladder. The surgeons sit across the room from the patient, manipulating surgical tools through a console.
The robot has three arms, two of which can be tipped with a number of different tools, such as a scalpel, scissors, forceps, or a needle driver for suturing. The third arm holds the imaging endoscope, which lets surgeons see inside the body.
Four rotating discs control the tools’ movement, enabling fine precision and multiple degrees of freedom.
A hollow port is inserted into the abdomen so that the small tools can be fed into the patient.
A surgeon uses a tool in the patient.
Once the tools are attached to the arms, which are covered in plastic to maintain sterility, the large machine is wheeled over to the patient.
The robot’s endoscope holds two small imaging devices that capture two independent images. These are sent to the console, where the surgeon views them as a single stereoscopic image.
This view makes it easier for the surgeon to accurately gauge the position of the tools relative to fragile tissue. Surgeon Hiep Nguyen controls the tools by means of two multijointed handles on the console.
His swift movements resemble those of an expert video gamer. Nguyen jokes that today’s gamers will make tomorrow’s best surgeons.
The surgeons’ progress can be seen on a number of screens placed around the room.
And in the minute movements of the robot’s hulking arms.
After the procedure, surgeons sew up the small incisions and cover them with bandages.
Nguyen says the system saves his hospital money because patients can go home sooner than they do after conventional open surgeries. However, the benefits of operating with the robot are less clear in procedures, such as prostatectomy, that are routinely performed with traditional laparoscopic tools already. Nguyen, a strong advocate for robotic surgery, would like to see the technology advance faster and become less costly. “The system is very expensive because only one company makes it now,” he says. “We need more competition to drive down the price.”