The surgeon sits at a console across the room from the patient, who lies anesthetized on an operating table surrounded by surgical staff and -- understand this -- the four mechanical arms of SAL the surgical robot.
A robot is doing the physical surgery under the complete control of the trained surgeon.
In one of the robot's hands is affixed a camera, in another a scalpel or a pair of scissors.
At the console, the surgeon looks into a pair of binoculars that show a 3D image of the area on which he is operating. The surgeon's hands are on a pair of devices, the movements of which control the robot's arms with a precision that defies previous ideas of surgical accuracy.
Yes, it's virtual reality, and it's at Niagara Falls Memorial Medical Center -- the only center for robotic surgery in Niagara County.
Dr. Brian Rambarran, who is an urologist with Western New York Urology Associates, practices surgery at Memorial about three days a week. He has just come from an operation in which he and SAL removed a patient's cancerous prostate.
"There are actually two consoles," Dr. Rambarran explained. "One is the surgeon's console, where the surgeon sits to do the procedure. There's an instrument there that mimics the surgeon's hand movements. So if I move my right arm to the right, the robot will move its arm to the right. Everything is scaled.
"There's then a (second) console that has the actual robotic arms that are working on the patient. The patient is lying on a table. The second console is actually a drivable robot and it has four arms: one that controls a camera, and three that control robotic arms that help us in doing the surgery."
What are the advantages of using a robot rather than your hands?
"Number one, there's less postoperative pain," Dr. Rambarran explained. "It's a minimally invasive surgery. So when we used to do surgeries -- taking out prostates, taking out kidneys -- we used to have to make a large incision, either removing ribs or cutting through a lot of muscles. Patients would stay in the hospital for upwards of seven to 10 days, and be fairly incapacitated afterward.
"The robot allows me to take prostates and kidneys out through incisions that are very small. It's also known as laproscopic surgery."
In addition, the robot's camera gives the doctor 10 times the visualization, giving the doctor a chance to see up close the area under incision that surgeons in the past could never have seen.
"The robot has fine small arms and fingers that help aid in dissection, and also with the 10 times magnification, we can see fine, small vessels and nerves better than we would with our normal eyes," Dr. Rambarran explained. "In addition, there's also (less) blood loss. The need for transfusion has been shown to be significantly less with robotics."
So robotics have come to Memorial, and in a seriously helpful way.
Memorial President and CEO Joseph A. Ruffolo said, "At Memorial, robotic surgery is becoming the standard of care for a number of the procedures we already perform, so being able to do them robotically is a tremendous convenience to our patients.
"The availability of robotics has attracted new surgeons and allowed us to expand our capabilities to include such procedures as kidney, uterine, prostate and colorectal cancer surgery. Now, patients who previously would have gone to Buffalo can have those surgeries in Niagara Falls."
Although cancer surgeries are performed robotically at Memorial, most robotic surgeries are non-cancer related gynecological procedures. Nationwide, robotic surgery is used most frequently in urology, gynecology, cardiothoracic surgery, colorectal, and weight loss surgery.
"Having the robot has been a tremendous addition to our women's services," Ruffolo said.
Dr. Rambarran explained in more detail how the robotic system works.
When doing surgery, he is looking at the computer screen, not directly at the patient.
"You're looking into a screen," Dr. Rambarran explained. "It's actually a 3D image, which is why we're able to get into areas that we couldn't even see before.
"The 3D camera has two eyes, and each eye corresponds to the surgeon's eye. It re-creates that image and makes it a 3D image on the screen in front of you."
By the end of last week, 20 robotic surgeries had been performed at Memorial. SAL has been in operation, so to speak, for about four weeks.
"It's the cutting edge," Dr. Rambarran said. "This is the only (surgical) robot in Niagara County."
Obviously, surgery is a team effort. At Memorial, there's a specially trained robotic team. Along with the surgeon, there is a core group of nurses and support staff trained to work with the robot.
"The robot can suture," Dr. Rambarran said. "Anything we can do with open surgery, we can do with the robot. In fact, you can do even finer suturing with the robot than you can with your own hands."
Dr. Donna Feldman is director of robotic surgery at Memorial. She is a gynecologist and obstetrician who, when we met, had just finished a hysterectomy for endometrial cancer.
She was there to greet SAL at the hospital's loading dock when it first came off the truck on Feb. 28.
Dr. Feldman explained the dexterous ability of the robot to move its hands with "seven degrees of freedom" is a major advantage of robotic surgery. The human hand has just three degrees of freedom, she said.
"You can reach into smaller areas, because the instrument tips are smaller," she said.
Graspers, cauterized instruments for cutting, scissors, needle drivers for suturing, and instruments for stopping bleeding can all be affixed to the robot, she said.
SAL can use the same types of instruments that are used in other types of surgeries.
"They're a little bit smaller and more intricate," Dr. Feldman said. "Most commonly, in gynecology, the robot is used for hysterectomies and for gynecological cancer surgeries. For the patients, the risk of complications from surgery are much lower."
One of the major benefits is decreased pain, both during and after surgery.
"The operative time is also considerably shorter than it is with traditional surgical techniques," she said, "and the risk of infection is reduced by use of the robot due to smaller incision sites."
Patrick Bradley, director of marketing and public relations for Memorial, and our frequent guide to the inner workings of what is becoming increasingly known as a premier hospital, summed it up nicely, especially for those who might be a little timid about the non-human element of their operation.
"These are very highly qualified surgeons who use the robot as a way to enhance their ability to treat their patients," Bradley said. "People ask this question all the time: 'Is the robot going to be doing my surgery?' No. The surgeon is doing the surgery. The surgeon is using the robot to perform that surgery."
"The robot does not do anything on its own," Dr. Feldman agreed. "It's all under the manipulation of the surgeon, who makes every decision regarding anything that's going on in the case."
"It only moves if we move it," Dr. Rambarran added.
As was reported earlier, Memorial's Robot was given the name SAL which stands for "Save A Life." Niagara Gazette Publisher Peter Mio and a panel of students from the robotics program at Gaskill Preparatory School selected the name that Gabriella Baratta, a fifth grade student at Niagara Street Elementary School, submitted in a contest.
And named well it is. Save A Life SAL.
Less blood loss, shorter length of stay, better post-op recovery, faster recovery. Dr. Rambarran, Dr. Feldman and the robotic surgical team offer a compelling case that SAL will live up to its name.
E-mail Ron Churchill at ronchurchill@yahoo.com.
| Niagara Falls Reporter | www.niagarafallsreporter.com | April 10 2012 |