Surgeons: Robotic surgery shortens recovery time, less painful

The hospital bought its first da Vinci Surgical System 15 years ago and bought another two years ago. The Decatur Morgan Hospital Foundation has helped pay off the most recent acquisition through fundraisers like the dragon boat race.

The robots can perform colon resections, epididymectomies (removal of an anatomical tube in male reproductive organs), cholecystectomies (gallbladder removal), hernia surgeries, as well as urologic and gynecological surgeries.

The hospital purchased its first robot, a da Vinci XI, in 2007, and purchased a da Vinci X about two years ago. The X cost $1.7 million.

Since 2007, various features have been added to the hospital's da Vinci XI such as laparoscopic surgical staplers, and the more recently purchased da Vinci X robot comes with some of these features. 

Thousands of surgeries have been performed on the hospitals' two da Vinci Surgical Systems, said Noel Lovelace, development director at the hospital.

Dr. Tyler Harney, a general surgeon at Decatur Morgan Hospital, has been a practicing surgeon for six years and trained with da Vinci robots while still a medical student at the University of Alabama at Birmingham. He used the X robot to perform a colon resection, or colectomy, on a woman last week.

“Pre-robot, she would have spent seven or 10 days in the hospital. Even laparoscopically the national average is five to seven days in the hospital,” Harney said. “She went home the next day.”

Conventional surgery requires large incisions to facilitate the surgeon's hands. Laparoscopy, which uses a small camera inserted into the patient's body, is less invasive than conventional surgery but requires larger incisions than those used with robotic surgery. 

Dr. Mitch Schuster, an OB-GYN at the hospital and adjunct professor of urogynecology and reconstructive surgery at the UAB School of Medicine, said patients also experience faster recovery times after undergoing robotic pelvic reconstruction surgery.

“Instead of having a large incision, you’ve got (five small holes) using the robot,” Schuster said. “We can get up under the pubic bone which is deeper in the pelvis and get better corrections. There’s less blood loss. … The cure rate is in the mid 90%, 10 years out after surgery.”

Harney said his patients’ narcotic use after surgery is “essentially zero.”

“(Robotic surgery) helps minimize the opiate crisis,” Harney said. “It still blows my mind; you can take out a third of a patients’ colon or half their colon and they seem to hurt less than when we take their appendix out.”

Harney said because patients who have had colon resections through robotic surgery are not using narcotics, their intestines return to normal function more quickly.

“Instead of having to get intravenous morphine or a pain pump where they’re hitting it every 15 minutes, they’re taking Tylenol which allows their bowels to wake up much faster,” Harney said. “Not to mention, they’re up moving the night of surgery versus just lying around for a few days from an open colon resection because it just hurts to move.”

Harney said now that the hospital has two da Vinci robots, they can schedule more surgeries and patients are not having to wait for weeks or months like they were when the hospital had only one robot.

“There were weeks where we had to delay surgery because of that,” Harney said.

Each robot has four mechanical arms that surgeons control in a booth located in a corner of the operating room. They install a camera in one of the robotic arms which livestreams video that the surgeon can view in the control console.

Surgical staff insert small plastic tubes called cannulas into the patient at the start of the surgery and the camera is attached to one of the instruments that is inserted into the cannula. Staff then attach an instrument equipped with surgical tools to arms of the robot. The surgeon uses two hand controls that enable the instrument to open and close and grasp hold of organs, while using a foot pedal to adjust the camera during the operation.

Schuster, who has been in practice for 30 years, said he uses the robots for pelvic reconstruction, sacrocolpopexy (to repair a weakness in the pelvic floor) and hysterectomies. He said robotic surgery is a huge surgical advance, but surgeons still need to be knowledgeable about traditional open surgery.

“Everyone has to know open surgery, because sometimes things go wrong,” Schuster said.