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Future of Thoracic Surgery

Talking with William Serpa about the da Vinci robot

As we look towards the future of thoracic surgery, at emerging technologies and procedures – one technology stands apart from the rest: robot-assisted surgery.  Love it or hate it – all thoracic surgeons have heard of it. So you can imagine my excitement this week when I had the opportunity to sit down and talk to one of the representatives of Intuitive Surgical, the makers of the best-known robotic surgery device, the da Vinci robot.

William ‘Al’ Serpa sat down with me to discuss robotic technology and the growing use of robotic technology in thoracic surgery.  While the da Vinci robot is used fairly frequently in urological and gynecological surgery, it is just now making inroads into other specialties.  The robot, which costs in excess of one million dollars, is more than a financial investment; it is an investment into the future of modern surgery – and Intuitive Surgical understands this.  The company maintains a long term mentoring relationship with surgeons trained on the da Vinci, and they take the training process seriously.

Interested surgeons of facilities with da Vinci equipment participate in multiple in-services, high-level on-site observations, and on-line training modules prior to beginning actual training on the robot in a 1 to 2 day skills lab.  After completing this initial training, surgeons are mentored through several cases, increasing in complexity as they become more familiar with the robot.

Mr. Serpa reports that most surgeons demonstrate surgical proficiency with the da Vinci system after completing about twenty cases.  This is also the minimal volume of annual cases required to be listed on the da Vinci website as a specialty provider.

Mr. Serpa and I discussed the perceptions that many physicians have of the difficulty of the learning curve for robotic surgery.  We discussed multiple published reports that robotic surgery lengthens case times, and the realities behind robotic surgery.  “Actually, after surgeons become familiar with using the robot, it doesn’t take more than a moment to re-position it.”  That’s sounds similar to what several previous surgeons [using the robot] have reported – so I guess the only way to find it is to see for myself.

Hopefully, my next post about the da Vinci robot will come to you from the OR.

Additional References

Giulianotti PC, Buchs NC, Caravaglios G, Bianco FM.  Robot-assisted lung resection: outcomes and technical details.  Interact Cardiovasc Thorac Surg. 2010 Oct;11(4):388-92.

Ninan M, Dylewski MR.  Total port-access robot-assisted pulmonary lobectomy without utility thoracotomy.  Eur J Cardiothorac Surg. 2010 Aug;38(2):231-2.

Kajiwara N, Kakihana M, Usuda J, Uchida O, Ohira T, Kawate N, Ikeda N. Training in robotic surgery using the da Vinci® surgical system for left pneumonectomy and lymph node dissection in an animal modelAnn Thorac Cardiovasc Surg. 2011 Oct 25;17(5):446-53.

Palep JH.  Robotic assisted minimally invasive surgeryJ Minim Access Surg. 2009 Jan;5(1):1-7.  Indian article – gives nice overview of robotic surgery.

Bodner J, Augustin F, Wykypiel H, Fish J, Muehlmann G, Wetscher G, Schmid T.  The da Vinci robotic system for general surgical applications: a critical interim appraisal.  Swiss Med Wkly. 2005 Nov 19;135(45-46):674-8.

Obasi PC, Hebra A, Varela JC.  Excision of esophageal duplication cysts with robotic-assisted thoracoscopic surgery.  JSLS. 2011 Apr-Jun;15(2):244-7.

Schmid T, Augustin F, Kainz G, Pratschke J, Bodner J.  Hybrid video-assisted thoracic surgery-robotic minimally invasive right upper lobe sleeve lobectomy.  Ann Thorac Surg. 2011 Jun;91(6):1961-5.

Melfi FM, Viti A, Davini F, Mussi A.  Robot-assisted resection of pulmonary sequestrations.  Eur J Cardiothorac Surg. 2011 Oct;40(4):1025-6.

Spaggiari L, Galetta D.  Pneumonectomy for lung cancer: a further step in minimally invasive surgery.  Ann Thorac Surg. 2011 Mar;91(3):e45-7.  Case reports of two pneumonectomies with the daVinci robot.

Kajiwara N, Kakihana M, Kawate N, Ikeda N.  Appropriate set-up of the da Vinci Surgical System in relation to the location of anterior and middle mediastinal tumors Interact Cardiovasc Thorac Surg. 2011 Feb;12(2):112-6. [this article has been cited in previous articles on the da Vinci robot.

Augustin F, Bodner J, Wykypiel H, Schwinghammer C, Schmid T.  Initial experience with robotic lung lobectomy: report of two different approaches.  Surg Endosc. 2011 Jan;25(1):108-13.

Al-Mufarrej F, Margolis M, Tempesta B, Strother E, Najam F, Gharagozloo F.  From Jacobeaus to the da Vinci: thoracoscopic applications of the robot.  Surg Laparosc Endosc Percutan Tech. 2010 Feb;20(1):1-9. Review.

Campos JH.  An update on robotic thoracic surgery and anesthesia.  Curr Opin Anaesthesiol. 2010 Feb;23(1):1-6. Review.

In-press:

Kajiwara N, Taira M, Yoshida K, Hagiwara M, Kakihana M, Usuda J, Uchida O, Ohira T, Kawate N, Ikeda N.  Early experience using the da Vinci Surgical System for the treatment of mediastinal tumors.  Gen Thorac Cardiovasc Surg. 2011 Oct;59(10):693-8. doi: 10.1007/s11748-010-0790-9.

History of Robotic Surgery – link to website

More about robotic surgery and the da Vinci surgical system

History of Intuitive Surgical and the da Vinci robot

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