Frequently Asked Questions - Multispecialty Robotic Surgery Center
What colorectal conditions can be treated using the da Vinci System?
The robotic system is used to treat colon and rectal cancer, diverticulitis, inflammatory bowel disease and rectal prolapse.
How is a robotic colorectal procedure performed?
4-6 small (one or so centimeter) incisions are made in the abdomen for placement of the camera and operating instruments. Using robotically controlled laparoscopic instruments and a high definition 3-D camera, the surgeon is able to have an excellent view of the surgical field and perform detailed and precise dissection to provide enhanced oncological results (in case of cancer) and to preserve normal anatomy.
What are the benefits of using the robotic system versus straight Laparoscopy?
The potential benefits are reduced blood loss, better preservation of nerves to the bladder and sexual function, better oncological outcome and improved anal sphincter preservation.
What is the usual recovery?
Most patients spend 2-4 days in the hospital. The majority of patients can return to usual activities in 2-6 weeks.
What are the benefits of robotic surgery to the patient?
Robotic surgery allows for greater surgical precision. It's also less invasive than traditional surgery because instead of using one large incision, it uses several dime-size incisions. It also decreases blood loss, reduces the risk of infection and decreases hospital stay and recovery time.
What criteria does the patient have to meet to be a candidate for robotic surgery?
Not every patient is a candidate for robotic surgery. Severe medical problems may mean that a patient cannot tolerate special positioning or length of the procedure. Severe obesity and intra-abdominal scar tissue may also be a factor that would prevent the patient from having robotic surgery.
What are the risks?
Robotic surgery has the same kinds of risks that traditional open surgery has, including injury to the intra-abdominal organs. Because robotic surgery uses small incisions, however, there is a minimized risk for wound infections and blood clots. Talk to you doctor to find out more about the risks.
What is the recovery like?
Many gynecologic robotic procedures can be performed on an outpatient basis and some will require an overnight stay at the hospital. Recovery times vary on the procedure, but are typically one to four weeks.
What is a sacrocolpopexy?
This is a procedure used to correct uterine or vaginal prolapse. The surgery involves suturing a synthetic mesh to a ligament at the front of the sacrum and connecting it to the vagina to provide vaginal support.
Removing the prostate with small incisions and robotic assistance
How is a robotic prostatectomy performed?
1. While the patient is under general anesthesia, the surgeon makes six small incisions, each less than an inch wide in the abdomen.
2. To remove the prostate, and sometimes surrounding lymph nodes, the surgeon moves two of the robotic arms while a third "arm" keeps other structures out of the way.
3. Very small movements of the surgeon's fingers control tiny instruments for precise movements. The camera's magnified, 3-D vision allows the surgeon to better identify tissues around the prostate and aids in preservation of the nerves controlling erections and the sphincter muscles that help maintain urinary control.
4. The prostate is removed through an incision near the belly button.
What are the benefits for a robotic prostatectomy?
Robotic prostate removal is precise, with reduced blood loss, and potential need for blood transfusion. This surgical approach often results in fewer complications and a shorter recovery than open surgery. Whenever possible and appropriate, physicians spare the nerves next to the prostate to preserve the ability to have an erection.
How long will it take to recover?
Most patients are able to leave the hospital the day after their surgery. Patients are often able to return to their normal personal and work activities within 2-6 weeks
Laparoscopic / Robotic Partial Nephrectomy
For some tumors of the kidney, it is possible and preferable to preserve as much of the normal kidney as possible. Surgeons will remove the tumor and a small amount of surrounding normal tissues to maintain as much function as possible while still minimizing the risk of regrowth of the cancer.
How is a robotic partial nephrectomy performed?
When a disease requires that part of the kidney be removed, our specially-trained urologists can remove the tumor with robot assistance under general anesthesia, using three to five small incisions for the instruments and a one-to-two-inch incision to remove the tumor. This replaces open or traditional surgery where the incision is typically 10 inches long and often goes through the muscle of the abdominal and/or chest wall.
To safely cut into the kidney, the blood supply to the kidney is temporarily clamped off to minimize bleeding and help with precise visualization. The remaining kidney is repaired and the blood supply is returned to the kidney.
What are the benefits of a robotic partial nephrectomy?
This approach helps minimize pain, recovery time, and scarring.
How long will it take to recover?
Most patients are able to leave the hospital in 1-4 days and resume normal activities in 2-6 weeks.
What is a robotic pyeloplasty?
Robotic pyeloplasty is a procedure that may be performed on either children or adults to fix an abnormal connection between the kidney and the ureter; the tube that connects the kidney to the bladder. Some people are born with this condition, or, it may be caused by scar tissue. This condition may cause flank pain and/or nausea and can eventually lead to kidney failure.
With state-of-the-art robotics, the surgeon has a 3-D magnified view. Using the delicate movements of the robotic arms, the surgeon is able to remove the abnormal area and precisely reconnect the ureter to the kidney.
How is a robotic pyeloplasty performed?
1. This procedure is performed under general anesthesia.
2. Using four to five tiny incisions, instead of one large one, the abnormal connection is removed and a healthy section of the ureter is attached to a healthy part of the kidney pelvis.
3. A temporary stent is placed to help with drainage of the kidney during healing.
What are the benefits of a robotic pyeloplasty?
The benefits of our physicians using the robot to perform this procedure include:
How long will it take to recover?
- Better precision
- Improved outcomes
- Faster recovery
- Less post-operative pain
- No disfiguring incision
Most patients are able to leave the hospital in 1-2 days and return to normal function in 2-3 weeks. The temporary stent is removed in 3-6 weeks
Precise bladder removal
How is a robotic cystectomy performed?
1. The procedure is performed using general anesthesia.
2. Your bladder (and prostate, for a man) can be removed using a robot-assisted approach. As in prostate surgery, this allows for precise visualization and manipulation of the tissues. Five to six small incisions are made for the robotic instruments and camera, and the entire bladder and a large number of lymph nodes are removed through a 3-4 inch incision.
3. After the bladder is removed, the surgeon creates a new drainage system for the urine. In most cases, this means using a small piece of intestine to drain into a stoma bag. In some cases a larger piece of intestine can be used to create a reservoir (neobladder) for the urine.
What are the benefits of a robotic cystectomy?
The benefits of a robotic cystectomy include:
How long will it take to recover?
- Minimized blood loss
- Faster recovery
- Earlier return to normal function
Most patients will be discharged from the hospital in 3-7 days and will be able to return to normal function in 4-6 weeks. Recovery depends on the type of urinary diversion created.
1. What is TORS (Transoral Robotic Surgery)?
TORS is minimally-invasive robotic surgery technique that enables head and neck surgeons to remove benign and malignant tumors of the mouth and throat. Small robotic arms and a high definition three-dimensional camera are inserted through the patient's mouth and the surgeon removes the tumor. The robot does not do the surgery. Your surgeon performs the surgery from a console at the side of the patient.
2. Benefits of TORS can include:
No routine use of tracheostomy during surgery Quick return to normal activity Shorter hospitalization Earlier return to oral intake as compared to traditional open surgery Better functional and swallowing outcomes than traditional open surgery Fewer complications compared to traditional open surgery No cutting of lip or lower jaw as compared to traditional open surgery Lower risk of infection Less need for blood transfusion
3.What to expect
A. Before TORS
Knowing what to expect before and after robotic resection helps patients best prepare for this procedure and provides greater peace of mind.
Your TORS surgeon will explain the diagnosis, options, procedure, recovery, the recommendation of the GBMC Head and Neck Multidisciplinary Tumor Board and treatment plan. Patients are encouraged to ask questions and how TORS fits into their treatment plan. The recovery and recuperation after robotic resection is different for every patient. However, the following are guidelines that are useful for patients.
B. What is a Direct / Staging Endoscopy?
Direct / Staging endoscopy is done in the operating room with the patient asleep. We then take a small piece of the lesion (a biopsy) to send to the pathology department so they can examine it and make a diagnosis. At the same time we evaluate the extent of the lesion. We also determine the feasibility of special oral retractors to expose the lesion and whether the patient is a candidate for TORS.
C. Transoral Robotic Surgery for Benign Lesions - General Guidelines
D. Transoral Robotic Surgery for Malignant Lesions - General Guidelines
- Depending upon your TORS surgeon assessment, patients may need a Direct and Staging endoscopy to determine if the tumor is malignant or benign and to evaluate the extent of the tumor.
- If biopsy results are available from another institution, then your TORS surgeon will ask the GBMC pathology team to review the biopsy results. The extent of your tumor is determined by head and neck examination, endoscopy and imaging. For some patients, an office examination will be sufficient to determine if he/she is a candidate for robotic surgery and if a direct/staging endoscopy will be necessary. Most benign lesions do not need a staging endoscopy.
- The hospital stay following TORS depends upon the location of tumor, extent of surgery and postoperative function. For benign tumors, the hospital stay ranges from three to five days or even less.
- Most patients go home swallowing their food and medications by mouth.
- Some patients may go home with a tube from their nose to their stomach (nasogastric tube) to allow supplemental nutrition during the initial healing phase. The tube can also be removed before discharge or during the first postoperative day visit depending on the patient's ability to swallow.
- The Milton Dance Center Speech and Language Pathology professionals and other team members who evaluate patients before and after surgery, will help you in your recovery period especially in regard to nutrition, swallowing and social aspects of your recovery.
- Depending upon your TORS surgeon's assessment, patients may need a direct and staging endoscopy to histologically confirm if the tumor is malignant or benign and to evaluate the extent of the tumor.
- If biopsy results are available from another institution, then your TORS surgeon will ask the GBMC pathology team to review the biopsy results. The extent of your tumor is determined by head and neck examination, imaging and endoscopy. For some patients, an office examination will be sufficient to determine if he/she is a candidate for robotic surgery and if a direct/staging endoscopy will be necessary.
- The hospital stay following TORS depends upon the location of tumor, extent of surgery and postoperative function. For tonsillar and base of tongue cancer, the hospital stay ranges from three to five days.
- Most patients go home being able to swallow their food and medications by mouth. Some patients may go home with a tube from their nose to their stomach (nasogastric tube) or stomach tube to allow supplemental nutrition during the healing phase. Some patient may require stomach tube placement for nutrition in preparation for their postoperative radiation with or without chemotherapy.
- The Milton Dance Center Speech and Language Pathology professionals and other team members who evaluates patients before and after surgery, will help you in your recovery period especially with regards to nutrition, swallowing and social aspects of your recovery.
- Patients with cancer diagnosis who will undergo TORS may also undergo a concomitant neck dissection or a staged neck dissection in one to three weeks after TORS depending upon the extent of disease.
- Depending upon the cancer stage and risk factors, many patients may require postoperative radiation therapy after TORS. Patients with histologic high-risk features may need the addition of chemotherapy in addition to radiation in their postoperative treatment.
- If a patient already completed radiation or chemoradiation and there is persistent or recurrent disease, robotic surgery may be used to resect or remove the tumor if patient is a candidate for TORS.
E. What is a Neck Dissection and Why Might the Patient Need This?
Lymph nodes are small ball-shaped tissues that serve as our body filters. They are distributed throughout our body.
A neck dissection is a surgical procedure that removes neck lymph nodes which harbor cancer cells that have migrated to neck nodes (neck metastasis) and or potential sites of neck metastasis. The procedure removes of mainly fat and lymph nodes with preservation of other important neck structures. The incision is closed in a very cosmetic fashion.
Even if a patient were to choose chemoradiation for oropharyngeal cancers, patients with metastasis to a single lymph node of more than 3 centimeter (cm) or multiple lymph nodes would still require neck dissection.
F. How is it determined if the Patient Needs a Neck Dissection?
Neck dissection is not necessary for benign disease.
A patient who has a cancer of the oropharyngeal region might either have neck lymph nodes involved by the cancer, positive nodes on scans or at high risk for getting lymph nodes involved by the cancer will require a neck dissection.
G. After TORS
After surgery the patient should plan on:
Depending on the postoperative course, TORS patients may spend three to five nights in the hospital.
Patient Guidelines After Transoral Robotic Surgery (TORS)
- No heavy lifting for at least four weeks.
- Return for post-operative appointment about one week after surgery.
- Follow the advice your physician, nutritionist, speech language pathologist as to what foods and drink may be taken by mouth.
- If the feeding tube is placed, follow instructions on care and use the feeding tube.
- Avoid stress.
- Patient and family members are encouraged to ask questions.