Ask the Expert
From Top: Dr. Bart Radolinski, and Dr. Carolynn Young.
Urology and Gynecology: Tomorrow's Robotic Technology in Today's Operating Rooms
Suburban Hospital has a long-standing reputation as one of the leading surgical hospitals in the region. With the addition of state-of-the-art robotic capabilities in fall 2008, physicians can offer a broader range of treatment options to meet their patients’ specific needs.
Two experienced surgeons—Dr. Carolynn Young and Dr. Bart Radolinski—share their insights about Suburban Hospital’s robotic surgical systems and other new technologies used in their fields of urology and gynecology.
How do you describe the robotic surgical system to an inquiring patient?
The robotic surgical system provides patients with an alternative to both traditional open surgery and conventional laparoscopy (also known as minimally invasive surgery). A surgeon performs the surgery by sitting at an ergonomically designed console through which she controls four robotic arms, which only require approximately 1cm abdominal incisions. One robotic arm holds and positions a high-resolution endoscope (camera). The second, third, and fourth arms precisely control miniaturized, fully articulated (wristed/hinged) instruments. The surgeon views a vivid, 3-D, magnified image of the operative site at the control console. Through computer technology, the surgeon’s hand movements are scaled and seamlessly translated into microscopic movements of the instruments. The robotic surgical system allows for unparalleled precision, dexterity, and control for delicate and complex procedures.
How do you use this sophisticated technology in your field?
When applicable, I use the robotic surgical system as an alternative to conventional laparoscopic surgeries. For example, I use the system to perform total hysterectomies (removal of the uterus and cervix), and supracervical hysterectomies (removal of the uterus only). I plan on using it in the future for abdominal myectomies (removal of tumors called fibroids within the uterine wall).
I primarily use the system for radical prostatectomies (removal of a cancerous prostate) and partial nephrectomies (removal of portions of a cancerous kidney).
Robotic surgery can be a better option than conventional laparoscopic surgery because the prostate is located deep in the pelvic region. While the primary goal of prostatectomy is removal of the cancer, a secondary goal is to preserve urinary function and—when possible—erectile function. A prostatectomy through robotic laparoscopic surgery attempts to safeguard critical nerves so that the patient may return to his prior functionality.
It can also be more beneficial to perform robotic surgery with partial kidney removal. During a partial nephrectomy, we are required to cut off blood supply to the kidney temporarily. The use of the robotic system allows the doctor to work more efficiently, which enables the kidney to be without blood for a shorter period of time.
What are the benefits of utilizing the robotic surgery? How do these benefits compare to those of conventional laparoscopic surgery?
The system combines the benefits that come with open surgery with those of minimally invasive surgery. For example, the high resolution, stereoscopic view of the operative site gives us an immersed perspective—greater than you would have in open surgery—while also translating the hand movements the surgeon would do in open surgery but on a tightly controlled, microscopic level.
Robotic surgery overcomes the limitations of traditional laparoscopic technology through superior visualization and control. With typical laparoscopic instruments, you are limited in the choices of approaching and manipulating tissue. The versatile instrumentation enables unmatched precision to work with the target tissue with minimal damage to it or the delicate blood vessels that run alongside. This results in decreased blood loss and potentially lowers the risk of complications.
Additionally, what the system does is take advantage of computer assisted procedures and robotic technology and integrates them with the skills of an experienced surgeon. The computer-assisted procedure incorporates tremor reduction and multiple, redundant safety features to further refine the surgeon’s movements. This enables us to do certain laparoscopic procedures in a more relaxed manner with less difficulty.
Are all types of patients eligible for robotic surgical procedures?
Not everyone is a candidate for laparoscopic surgical approaches. Patients who are less likely to be eligible are those who have had previous surgery and those who are obese. Even so, we’ve seen weight issues become less of a deterrent over time. Patients should consult their physician to learn if they may be a qualified candidate.
Are there times you would perform traditional laparoscopic surgery or open surgery instead of using the robotic system?
I perform radical nephrectomies primarily using a pure laparoscopic technique as it is a more straightforward procedure. Forgoing the robotic set-up typically translates into a shorter surgery and the patient being under anesthesia for a shorter duration.
Patients can expect to undergo pure laparoscopic surgery to treat gynecological conditions involving endometriosis, for the removal of ovarian cysts, and to have their tubes tied. These are procedures that do not require the precision or visual magnification of the robot. Patients requiring uterine prolapse surgery can expect to undergo a laparoscopic assisted vaginal hysterectomy (LAVH). With an LAVH, the vagina is the site of entry and requires no external incisions.
What is some advice you would give patients interested in undergoing robotic laparoscopic surgery?
I use the system for myomectomies to remove fibroids (also called uterine myomas), but only when applicable. Benign fibroids are common in women; malignant fibroids are rare. Fibroids do not have to be removed unless they are causing symptoms such as heavy periods, irregular bleeding, severe cramps with periods, or pelvic pain. Hormonal therapy may be used to temporarily reduce the fibroids if the size alone is causing discomfort.
I agree that surgery is not always necessary or recommended to remove tumors that are very slow growing and not causing complications, particularly with patients in late adulthood.
What are some possible additional innovations that may be applied to further advance robotic surgery for the future?
The robotic surgical system we use is a clear step toward the future of surgery. While this system has taken the specialty of surgery to the next level, additional enhancements to the computer and robotic technology will take us even further.
A surgeon is able to feel sensations such as pressure and resistance while performing pure laparoscopic and open surgery. I foresee similar tactile and sensational feedback being available in robotic surgery in the future. I also predict even further miniaturization of the instrumentation that will increase the speed of positioning and orienting the instruments.
TO LEARN MORE | For more information about how Suburban Hospital is advancing the standards of surgical care, please visit our robotics surgery page. For a referral to a skilled surgeon, call 301.896.3939.
About the Physicians
Dr. Bart Radolinski is a urologist who specializes in robotic and laparoscopic surgery; prostate, kidney and bladder cancer, voiding dysfunction and stone disease. As a physician with Washington Robotic Surgery (http://www.WashingtonRoboticSurgery.com), Dr. Radolinski has offices in Bethesda andGermantown. To schedule a consultation, call 301.530.1700.
Dr. Carolynn Young is a board certified gynecologist and laparoscopic surgeon. She specializes in the treatment of uterine fibroids and abnormal bleeding, and provides contraception management services and treatment of abnormal pap smears. She is a member of the American Association of Gynecologic Laparoscopists and the American College of Obstetricians and Gynecologists. She works at Rockville Gynecology in Rockville, MD (www.rockvillegynecology.com). To schedule a consultation, call 301.770.4967.