Technology continues to advance exponentially. This rapid advancement in the health care armamentarium has resulted in technology that reduces the invasiveness and hypothetical recovery times of a variety of surgical procedures. Robotic surgery can be defined as the use of a microchip that intervenes in a dexterous manner between the surgical operator and the patient. While robotic surgery may sound a bit unnerving at first, the surgical robot never performs any movements independent of the surgeon. Surgeons employ robots as surgical tools to attempt to help improve the precision of surgery. Surgical robots are controlled on a computer in a relationship that is categorized not as one requiring an autonomous robot, but rather a telemanipulator.

When surgeons use a robotic telemanipulator, they physically perform the movements required for surgery, but do not manipulate the tools directly inside of the patient. A microchip translates the console surgeon’s movements into computer signals which then control the robotic device that performs the surgical movements inside the body. The machines are able to provide smoother motions than are physically possible with the human hand, allowing for precise procedures that may allow for more efficient procedures and quicker recovery time.

Thymectomy

Robotic Removal of the Thymus Gland (Thymectomy)

When considering the removal of the thymus gland it’s notable that the ancient Greeks knew of its existence but could only guess at its purpose. Possibly because of its central location in the upper chest between the lungs and next to the heart, they thought it might be the seat of the soul or the emotions.

Paraesophageal

The hiatus is a normal opening in the muscle that separates the chest cavity from the abdomen which moves up and down with breathing. Although the hiatus is a normal opening, there are occasions when this opening enlarges and the stomach or other organs can slip up inside the chest. This occasion of an abnormally large opening of the hiatus is called a hiatal hernia. Paraesophageal hernias account for only 5% of all hiatal hernias. A paraesophageal hernia is a type of hiatal hernia where the junction of the stomach and the esophagus remains in place, but part of the stomach is squeezed up into the chest beside the esophagus.

Diaphragmatic hernia showing opening in hiatus

Nerve Grafting

Robotic Assisted Nerve Grafting to Relieve Compensatory Sweating

In the polite form we say that people perspire. In a little less polite form but well understood – people sweat. As is usually the case in medicine there is a precise term, hidrosis. Excessive sweating is hyperhidrosis. At one time or another everybody sweats too much.

Lobectomy

The use of surgical procedures to treat lung cancer depends a great deal on the type of cancer, its stage (progression of the disease), location of the tumor(s) and the general health of the person.There are two common types of lung cancer, small-cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC). Small cell lung cancer is notorious for spreading early in the disease, which usually indicates that radiation or chemotherapy treatment is the most effective approach. With non-small cell lung cancer the spread of tumors is generally slower and more localized, which makes this type of cancer a candidate for surgery. Since non-small cell lung cancer accounts for more than 80% of all lung cancer cases, surgery is the most common treatment.

Brachytherapy

Not all patients with NSCLC are physically capable of safely undergoing the procedure. For example, patients who are suffering from various types of heart disease or whose breathing is already compromised by a lung problem such as chronic obstructive pulmonary disease (COPD) may not be able to tolerate a full lobectomy.One of the solutions for such patients is to combine limited lung surgery, where small portions of lung tissue are removed, plus radiation therapy of a type that is applied during the same surgical operation. In long-form medical terminology this is called sublobar resection and brachytherapy.

Achalasia

Achalasia means “failure to relax” and refers to a disorder of the muscle at the end of esophagus that doesn’t open normally during swallowing. It is also known as also known as esophageal achalasia, achalasia cardiae, cardiospasm, and esophageal aperistalsis. During achalasia, the smooth muscle that is responsible for swallowing looses its normal muscle tone and the lower esophageal sphincter does not relax correctly. Achalasia is a relatively rare condition with a prevalence estimated at less than 0.001%. A Laparoscopic or Robotic modified Heller myotomy is considered the standard of care for palliation of this incurable but benign disease.

Robotics

The wonders of technology can be truly impressive and sometimes daunting. The idea of a robot operating on a human being (for example, on you) could certainly be considered intimidating. So when doctors say they would recommend a procedure using the da Vinci Surgery robotic system, does that sound like a robot is going to perform the operation? Actually the da Vinci system is an ‘Intuitive Surgical Endoscopic Instrument Control System.’ That means the da Vinci system is a combination of computers, electronics and machinery that provides a surgeon with an intuitive tool for seeing and controlling surgical instruments during an operation.

Team and Collaboration

The Robotics program started at St. Luke’s – Roosevelt Hospital Center approximately 10 years ago. Surgeons at St. Luke’s – Roosevelt performed the first thymectomy for Myasthenia Gravis in the United States, the first robotic bi-ventricular lead placement for heart pacing in the world, and one of the first three-hole robotic esophagectomy for esophageal cancer in the United States.

Scott Belsley working port-side with robot

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