Standards of Care Are Changing, and Robotic Surgery Is an Anchor of Advancement

Photograph of two surgeons using robots controls as they look at an operating table with robotic arms that hover over a patient who is on the operating table.

By Kendra A. Kabasele

In just under two decades, the landscape of surgical care has undergone a profound transformation, propelled by the advent of robotic surgery. A paradigm shift towards minimally invasive procedures has redefined what treatments are available, offering a spectrum of approaches and hybrid applications that prioritize precision and expedited recovery.

There are now a host of new options that eliminate the need for large incisions and extended time under anesthesia, reducing invasiveness and healing times. A tool with advancing potential, and the trajectory appears poised for continual ascent.

Beyond the benefits like smaller scars, abbreviated hospital stays, diminished pain, and accelerated recovery, in some specialties, robotic surgery expands the repertoire of treatable conditions. 

Arnar Geirsson, MD, cardiac surgeon and head of the Robotic Cardiac Surgery Program at Columbia has been an advocate for robotic advancement in heart surgery since his days as a resident fifteen years ago and a pioneer in the field since. “I always had an interest and I think if you can cause less injury to the patients whenever you do an operation, less physiological stress, faster recovery, we should aim to do that,” says Dr. Geirsson.

There are certain anatomical complexities in the heart that limit the use of robotic surgery. Sometimes, malformations make it infeasible to operate from such a confined space, through only a few small incisions. “If you have other valve diseases, or especially if you have coronary artery disease, and you need to do another operation on that also — you shouldn’t do a robotic operation,” he says. “You should do them through a sternotomy.”

Aside from identified reasons to avoid robotic surgery, surgical complications with the robot are extremely rare. “Things go very well,” says Dr. Geirsson. “You actually change people’s lives for both survival and quality of life dramatically.” He is full of gratitude when he sees patients in the post-op clinic and hears reports that they are more active than ever just two or three weeks after the operation.

A trailblazer in minimally invasive robotic hepatobiliary and transplant surgery, Jason Hawksworth, MD, has made robotic liver surgery his passion due to the challenges posed by traditional open liver surgeries. The inherently vascular nature of the liver makes laparoscopic control of bleeding a daunting task, often requiring specialized expertise for procedures like removing a large tumor or doing a blood vessel reconstruction. “Robotics is sort of an answer to that problem because the robotic technology makes it much easier to operate minimally invasively on the liver,” says Dr. Hawksworth. “I would say that when I was doing laparoscopic liver surgery, there were a lot more cases that felt safer doing open than laparoscopically. Whereas with robotic surgery, because the technology is better, I can do much more minimally invasively than I’m used to.”

The outcomes are so good that it has totally transformed his surgical focus. “Over 90 percent of my practice is actually performed robotically, and only 10 percent is open surgery right now,” says Dr. Hawksworth. “So, it’s a big difference.”

In hernia repair, the enhanced visualization, flexibility, and movement within the body are game-changing. “Robotic surgery has allowed hernia surgeons to complete complex abdominal wall and groin surgery through small incisions,” says hernia surgeon Dina Podolsky, MD, of Columbia’s Hernia Center. “Meaning patients get all the benefits of minimally invasive surgery while surgeons have access to advanced surgical technology.” 

Those enhanced features for surgeons can make a huge difference. “You can see really well. The camera is like a 10x microscope, so the detail is better even than you can see open,” explains Dr. Hawksworth. “The robot ergonomics are very good for surgeon longevity, whereas that’s not the case with laparoscopy. Laparoscopy puts a lot of ergonomic strain on the surgeon.”

Enhancement and expansion of ergonomics and mechanics drew bariatric surgeon Abraham Krikhely, MD, to robotics. Making the Metabolic and Weight Loss Center at Columbia one of the early adopters of robotic weight loss surgery. “During my residency training, I jumped at the opportunity to spend time on the robotic simulator,” says Dr. Krikhely.  “I was blown away. I knew that this would be the future of surgery. The technology wasn’t quite as advanced at the time, but I had a vision of what it could become, and I wanted to have a hand in inventing that future.”

Dr. Krikhely punctuates the fact that it makes challenging cases easier to do, especially when it comes to more complex bariatric revisions and operations in patients with higher BMIs. “The future of weight loss surgery will be defined by the impact that surgery has on patients,” says Dr. Krikhely. “And we aim to add years to people’s lives and quality of life to those years.”

While major medical institutions advance cutting-edge techniques and offer myriad options to patients, receiving the latest in robotic care is still a challenge in many parts of the country. Robotic techniques remain quite limited in large swaths of the United States and even more so internationally. While medical technology advances more rapidly than ever, there is no question that access to quality care must, too.

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