Robot-Assisted SurgeryOverview

General Adrenalectomy (removal of adrenal gland) Cholecystectomy (removal of the gallbladder) Gastric bypass (procedure to treat obesity and reduce the size of the stomach) Heller myotomy (procedure on the lower esophageal sphincter) Nissen fundoplication (treatment for severe heartburn) Radical prostatectomy (removal of the prostate) Colorectal surgery (surgery of the colon) Appendectomy (removal of the appendix) Nephrectomy (removal of the kidney) Hernia repair Chest Esophagectomy (removal of the esophagus) Thymectomy (removal of the thymus gland) Mediastinal tumor resection (removal of tumors in the chest cavity) Lobectomy (surgical removal of a lung) Heart Coronary artery bypass surgery Atrial septal defect repair Mitral valve repair Biventricular resynchronization epicardial leads (surgical implantation of ventricular leads to improve the hearts function) Gynecologic Hysterectomy (removal of the uterus) Myomectomy (removal of uterine fibroids)

Risk Factors for Complications During the Procedure A risk factor is something that increases your chance of having complications during your procedure. Obesity is a risk factor. What to Expect Prior to Procedure Depending on the reason for your surgery, your doctor may do the following: Physical exam Blood tests Electrocardiogram Chest x-ray Ultrasounda test that uses sound waves to visualize the inside of the body CT scana type of x-ray that uses a computer to create images of the inside of the body MRI scana test that uses magnetic fields and radiowaves to create images of the inside of the body The days before and the day of your procedure, you will: Review your medications with the surgeon; you may need to stop taking some drugs Follow a special diet, if recommended by your surgeon Take antibiotics, if prescribed by your doctor Shower the night before your procedure using antibacterial soap, if your doctor asks you to Need to arrange for someone drive you to and from the procedure, and for help at home afterwards Eat a light meal the night before Not eat or drink anything after midnight unless otherwise instructed by your doctor Need to wear comfortable clothing Anesthesia General or local with sedation

Description of the Procedure The surgeon cuts several small (approximately one centimeter) keyhole openings in the skin near where the surgery will take place. In most cases, a needle is used to inject carbon dioxide gas into the area around the surgical site, making it easier for the surgeon to see internal structures. The surgeon passes a small camera (endoscope) through one of the incisions, which lights, magnifies, and projects an image of internal organs onto a video screen for the surgeon to see. The endoscope is attached to one of three or four robotic arms that form part of surgical system. (There are currently two robotic surgical systems approved by the Food and Drug Administration for use in the United States: the da Vinci Surgical System and the ZEUS Robotic Surgical System.) The other two or three arms hold other instruments such as dissectors, scissors, scalpels, and/or forceps. These instruments are able to grasp, separate, cut, and sew tissue during the operation. While sitting at a console several feet away from the operating table, the surgeon looks through lenses at a magnified three-dimensional image of the inside of the body. Another surgeon will stay by the patient during the procedure, where he can adjust the camera and instruments as needed.

With joystick-like hand controls and foot pedals, the surgeon at the console guides the movement of the robotic arms and surgical instruments. By filtering out hand tremor and translating the surgeons larger hand movements into smaller ones, the robotic arms are able to perform surgical tasks with increased range and dexterity than would be possible using traditional surgical techniques. After the endoscope and other instruments are removed, the surgeon closes the incisions with stitches or staples, and applies a sterile dressing. After Procedure Depending on the reason for the procedure, some of the tissue that was removed may be sent to a pathologist for examination. How Long Will It Take? Usually 1-2 hours or less, but this depends on the type of procedure being done. Will It Hurt? Anesthesia prevents pain during surgery. Patients typically experience pain and soreness during recovery, but receive pain medication to relieve the discomfort. You may also feel bloated or have pain in your shoulder from the gas used during the procedure. This can last up to three days. Possible Complications Damage to neighboring organs or structures Infection Bleeding Anesthesia-related problems Open surgerysometimes it becomes necessary during the procedure to abandon the robotic method and perform the surgery using traditional methods Average Hospital Stay A benefit of robotic surgery over traditional surgery is that it permits shorter stays in the hospital. Depending on the procedure, most patients usually require only a few days of hospital care.

Postoperative Care If all goes well, you will likely be encouraged to get up and out of bed the same day of or the day following your procedure. You will receive instructions on when and what you can eat, and to what extent you need to restrict your activity. You will to limit your activities for the first days or weeks of your recovery. Outcome Depending on your procedure, you should be able to resume regular activities within a few weeks after your procedure. Based on evidence available to date, the risks of robotic surgery appear to be less than the traditional surgeries it is designed to replace. Some benefits of successful robotic surgery over traditional surgery include: Reduced trauma to the body Reduced risk of blood transfusion Shorter hospital stay Faster recovery Call Your Doctor If Any of the Following Occurs It is essential for you to monitor your recovery once you leave the hospital. That way, you can alert your doctor to any problems immediately. If any of the following occur, call your doctor: Signs of infection, including fever and chills Redness, swelling, increasing pain, excessive bleeding, or discharge from an incision site Cough, shortness of breath, chest pain, or severe nausea or vomiting Pain, burning, urgency, frequency of urination, or persistent bleeding in the urine Pain and/or swelling in your feet, calves, or legs, or sudden shortness of breath or chest pain Nausea, vomiting, and/or diarrhea Headache, muscle aches, feeling faint or dizzy Other worrisome symptoms RESOURCES:

American College of Surgeons http://www.facs.org Food and Drug Administration http://www.fda/gov CANADIAN RESOURCES: BC Health Guide, British Columbia Ministry of Health http://www.bchealthguide.org Canadian Agency for Drugs and Technologies in Health http://www.cadth.ca References: Computer-assisted surgery: an update. Food and Drug Administration website. Available at: http://www.fda.gov/fdac/features/2005/405_computer.html. Accessed June 20, 2006. The da Vinci surgical system. University of Southern California Keck School of Medicine website. Available at: http://www.cts.usc.edu/rsi-davincisystem.html. Accessed June 20, 2006. Robotic surgery. Brown University website. Available at: http://biomed.brown.edu/Courses/BI108/BI108_2005_Groups/04/. Accessed June 20, 2006. Robotic surgery. Thinkquest website. Available at: http://library.thinkquest.org/03oct/00760/. Accessed May 1, 2008. Robots lend a helping hand to surgeons. Food and Drug Administration website. Available at: http://www.fda.gov/FDAC/features/2002/302_bots.html. Accessed June 20, 2006. Last reviewed May 2008 by Rosalyn Carson-DeWitt, MD Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.