Having a surgeon with four arms is one advantage of the latest robotic technology being studied at UT Southwestern Medical Center.

The $1.4 million robot named da Vinci can hold a camera in one hand while manipulating tiny laparoscopic surgical tools in its other hands. And it never tires like its human counterparts.

With a human surgeon at the controls, da Vinci filters out tremor, enhances precision, offers three-dimensional imaging, and eliminates the inverted manipulation of instruments usually required in laparoscopic procedures.

“The catch phrase is ‘more precise than humanly possible.’ That’s the rationale for this technology,” said Daniel Scott, MD, FACS, director of the Southwestern Center for Minimally Invasive Surgery and assistant professor of surgery at UT Southwestern.

Although testing the four-armed robot is ongoing, Dr Scott said, “It seems advantageous from the standpoint of precision for some procedures.”

Da Vinci is most popular in urology for that reason, especially for prostate operations. It’s also proved useful in surgeries on the esophagus and stomach. Researchers are investigating its practicality for cardiac surgery, such as coronary artery bypass grafting and valve replacement.

“It may well prove useful for general surgery procedures that have traditionally required open incisions, like biliary reconstruction or pancreatic surgery,” Dr Scott said.

Laparoscopic surgeries, also called minimally invasive surgeries, are performed via several tiny holes rather than one long incision, reducing post-operative pain and recovery times. The method is increasingly popular.

The first robotic surgery, performed in 1995, relieved the need for an assistant to hold the camera during laparoscopic procedures. Da Vinci represents the next step, offering an instrument that actually performs the surgery based on controls handled by the surgeon.

“It’s not difficult to learn,” Dr Scott said. But it does take longer to set up, mostly to position the robot. “It takes choreography,” Dr Scott explained.

The robot also is expensive and cumbersome, which limits the operative field and can make it impractical for exploratory surgeries or surgeries that require surgeons to go in more than one area.

Surgeons are still discovering its full potential. But to be successful, Dr Scott added, “It needs to supersede laparoscopy in terms of efficiency before the average surgeon is going to use it. But as this technology continues to evolve, no doubt it will be miniaturized. Smaller is going to be better.”

Automation also may be in the future, with a physician pointing to sections of tissue that need suturing and the robot doing it. That potentially could be integrated with computed tomography or magnetic resonance imaging scans, which could offer opportunities for dress rehearsals of procedures.

Another potential for the technology is for telerobotic surgery across distances - physicians in one city using the robot (to perform an operation) in another city. The first test of such a surgery was a successful trans-Atlantic gallbladder procedure, with the surgeon in New York and the patient in France.

“It certainly could have applications for rural surgery or mentoring surgeons in the community on new procedures,” Dr Scott said.

“There are big permutations for the future of surgery, and that’s why we need to be leaders in this field as a medical school and as a center dedicated to minimally invasive surgery,” he said. “We have a strong track record of embracing robotics and research into this new type of technology here, and we look forward to continuing those activities with this new acquisition.”