Can robotic surgery be used for emergency surgery?

For many in healthcare, there is a belief that while robotic surgery has its place in many specialties, it is not well-suited to the speed and tumult of emergency medicine. According to this view, robotic surgery requires too much setup time, and takes too long, to be widely useful in this context. But in recent years, a growing group of surgeons have realized that emergency surgery is an area that presents enormous possibilities for robotic surgery.

They argue that with proper planning and organization, Intuitive’s da Vinci systems can be the foundation of a successful around-the-clock emergency surgery enterprise, and may help reduce complications, improve patient outcomes compared to open surgery, across a range of common emergency surgical procedures. Pakula and other surgeons say that this trend is important because it means that more surgical patients can be managed with an approach that may be less invasive, potentially contributing to fewer complications and shorter hospital stays, compared to open surgery.

Expert Perspectives on Robotic Acute Care

“This has worked really well for my practice,” says Dr. Andrea Pakula, a general and acute care surgeon at Adventist Health Hospital in Simi Valley. “It’s allowed me to expand minimally invasive surgery to the patients that I see through the emergency room.” She was first introduced to robotic surgery in 2016, and as she began training on the system, she says she saw that it allowed her to perform more complex surgery, often with faster recovery compared to open surgery. “In my experience, many patients can really benefit from this,” she says.

Pakula, who is the medical director of robotic surgery at the hospital, performs a wide range of procedures using the system, including complex hernia surgery, bariatric surgery and other emergency general surgery procedures. Some surgeons are reluctant to use a robotic approach in emergency cases because such patients are often sick or have multiple health issues. However, Pakula notes: “We’re now able to do minimally invasive surgery any time of day or night, with the same level of care.”

Expanding the Scope of Care

Dr. Laila Rashidi, a colorectal surgeon at Multicare Hospital in Tacoma, Washington, was already an accomplished da Vinci surgeon, but she had a vision for how to do more for more patients. She wanted to offer robotic surgery around the clock, seven days a week; she also wanted it to be available to patients in other specialties besides hers. The following list identifies the broad range of procedures that can be integrated into such a program:

• Bariatric: Gastric Bypass, Sleeve Gastrectomy, BPD-DS, and SADI-S.
• Cardiac: Cardiac Generator Replacement & Pacemaker Surgery, and Leadless Pacemaker Implantation.
• Colorectal: Colon Resection and Rectal Resection.
• General Surgery: Gallbladder and Hernia procedures.
• Gynecology: Hysterectomy, Pelvic Organ Prolapse, Myomectomy, Endometriosis Resection, and Early Pregnancy & Emergency Gynecological Surgeries.
• Urology: Kidney Blockage, Kidney Surgery, Prostate Surgery, and Kidney Stone Removal.
• Thoracic: Lung Biopsy and Lung Surgery.

Detailed Procedure and Clinical Benefits

The clinical benefits of these robotic-assisted interventions are detailed below:

• Minimally Invasive Prostatectomy: A procedure that uses advanced techniques to remove the prostate through small incisions, minimizing tissue damage and promoting quicker recovery.
• Kidney Stone Removal Surgeries: These use advanced techniques to break down or extract stones, relieving pain and restoring normal kidney function.
• Bladder Cancer Surgery: Involves the removal of cancerous tissue from the bladder, ranging from minimally invasive tumor excision to partial or complete bladder removal in advanced cases.
• Urinary Tract Surgery: Treats conditions like stones, infections, or tumors in the kidneys, bladder, and urethra, restoring function and relieving symptoms.
• Cardiac Generator Replacement: This procedure replaces the pacemaker’s battery-powered generator, ensuring it continues to regulate heart rhythm effectively and prevent irregular heartbeats.
• Laparoscopic (Key-Hole) Surgery: Minimally invasive gynecological surgery including Ovarian Cystectomy and Fibroid Resection.

Surgeons argue that with the right commitment, we can turn da Vinci into an expected part of acute care surgery, just another option for patients day or night.