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If you need surgery, what tools your surgeon uses is now a crucial factor in your outcome. The type of surgery you have can make a significant difference in how much pain you experience, how long you stay in the hospital (if at all) and your overall recovery experience.

We gathered specialists and surgeons from Inspira Health to talk about the most advanced surgical technique – robotic surgery. It may sound space-agey, but it is here, now. And for patients, these physicians say, that’s a very, very good thing.

Participants:

Christopher Bashian, DO, Medical Director , Bariatric Surgery Inspira Medical Center Mullica Hill

Catherine Mavroudis, MD, General Surgeon, Inspira Health

Elaine Cheng, MD, General Surgeon, Inspira Health

Scott Wagner, MD President, Inspira Medical Group

David Lynch, MD, Division Chief of General Surgery Inspira’s Mullica Hill, Mannington & Woodbury Campuses

Nathan Fairbourn, DO Ob/Gyn, Inspira Health

Why robotic surgery matters…

Minimally invasive robotic surgery is rapidly becoming the standard of care for many different procedures.  We use robotic systems for many different types of surgeries, for general surgery procedures, for gynecological procedures, for orthopedic procedures, and for certain types of lung procedures.
Dr. Scott Wagner

The robot allows us to do the operation with very small incisions, and it allows for a much quicker recovery with less pain. We are able to do the same things we would do in open surgery but through very small incisions. That’s why it has such a wide application among different kinds of procedures. The instruments mimic the exact movements of our hands.
Dr. Christopher Bashian

Sometimes I call robotic surgery the second generation of laparoscopic surgery, and that’s because it’s much easier to perform tasks that are complex inside the human body with the robot. Think of it this way: Let’s say you have to write an essay. Sure, you can type up the essay with a typewriter, but why would you do that these days? That’s basically laparoscopic surgery. When you have the robot available, it’s like having a computer to write your essay. It’s a better set of instruments.
Dr. Elaine Cheng

Robotic surgery is the way of the future. If you look forward 15 to 20 years from now, probably close to 80 – 90 percent of surgeries will be performed this way. The visualization is outstanding. You can see places that are magnified 5 times, compared to what you can see with a laparoscope or with your eyes in open surgery.
Dr. David Lynch

Robotic surgery is better in almost every way. The visualization is just overwhelmingly better.  You can zoom in, you can see things with the camera in 3D that you can’t see with a regular laparoscopic camera.  And we have special filters to help us see blood vessels and other elements. It’s especially beneficial for cancer surgeons who are looking for specific lymph nodes. It really helps us see everything that we need to be able to see.
Dr. Nathan Fairbourn

Misconceptions about robotic surgery…

A big misconception is when people hear robotic surgery, they think it’s an AI thing. They think we press a button and the robot does the surgery by itself. But we are always in full control. The robot doesn’t make any movements without us moving our hands to tell it how to move. It’s still controlled fully by the surgeon.
Dr. Christopher Bashian

I recently had a conversation with a patient where I was discussing their options for a hernia repair and I said I could offer open, laparoscopic or robotic surgery, and for a variety of reasons I’d like to do robotic. The patient and his wife looked at each other very skeptically, and finally it came out that they wanted me to do the surgery, not the robot. Once I explained robotic surgery, they were totally fine proceeding with that. When I saw the patient in post-op, he had zero pain and had taken zero narcotics. He did incredibly well and was very grateful to have had that opportunity. His surgery would have been much more difficult for him from a recovery standpoint if we had done an open surgery.
Dr. Catherine Mavroudis

You have to first learn how to be a surgeon, and then learn how to use the tool. Any new surgery, any new technique, any new tools, you have to be trained on them. You have to master them.
Dr. Nathan Fairbourn

How robotic surgery works…

The robot comes in three parts: a tower with a monitor at the top – that’s the brains of the robot. Then we have the arms of the robot. These arms hold long, skinny instruments that go inside the patient’s body. Then there is the console, where the surgeon sits and looks into this 3D stereotactic vision. The surgeon’s fingers go in metal loops to control how the instruments move. The instruments inside the patient’s body will mimic the motions of the surgeon’s hands.
Dr. Elaine Cheng

At the console, I have full control of the surgical instruments. At that point, it’s the same as if I was standing at the table using the instruments myself. The arms inside the abdominal cavity will make the same movements I make at the console. Once we remove all of the instruments, we only have to put a single stitch, sometimes not even that.
Dr. Nathan Fairbourn

During a bariatric procedure, we end up removing anywhere from 50 to 60 percent of the stomach, and we do that using a stapling device. With the robotic stapler, there is a tissue-sensing capability. So when we clamp it down on the stomach, it will tell us if the tissue is too thick, in which case we need to upsize the stapler. Before this technology, it was a guessing game. It was the experience of the surgeon looking at a stomach and saying yeah, that looks kind of thick to me. The robotic stapler has really changed the game.
Dr. Christopher Bashian

We all use the same robot. In most hospitals, the robot is assigned to an operating room, or there’s one for several operating rooms, so it’s shared and robotic time is allocated among the surgeons and the specialties that use it. The equipment we use is fairly standard across specialties and across surgeons.
Dr. Catherine Mavroudis

Discussing the option of robotic surgery with patients…

As surgeons, we’re obligated to tell patients about all their options. I explain each of the different approaches with the patient and the pros and cons. In some cases I may recommend one approach over the other, but ultimately patients always have a choice. Everyone should be able to make an informed decision.
Dr. Elaine Cheng 

It’s always the judgment of the surgeon to advise on which is the best and safest way to proceed, and the patient has to be educated and know the benefits of the procedure.
Dr. David Lynch

The more patients we have now in the community who’ve had robotic surgery, the more we’re starting to see new patients come into the office and ask for robotic surgery. They’ll say, “Hey, you operated on my friend, and they had such a good recovery. How did you do that with such small incisions? I want to have the same thing.” So we’re starting to see that education in the community, where people actually know what this is and know that it’s better than some of the more traditional approaches. That’s really cool to see.
Dr. Christopher Bashian

We are always going to be about what we can offer to our patients, and being able to offer them less pain, shorter hospital stays, more dexterity and better outcomes is exciting.
Dr. Nathan Fairbourn

Recovery after robotic surgery…

It’s truly remarkable how many patients will say after surgery, “Are you sure you did anything?” because they just have three little cuts on their belly, and those are a little sore, but they get better pretty quickly. They take some Tylenol and feel fine. It’s truly remarkable.
Dr. Catherine Mavroudis

One of the main parts of my practice is weight loss surgery. When operating on people with obesity, especially if you’re doing an open operation or a standard laparoscopic procedure, it’s a lot of stress on the patient. Even with laparoscopic surgery, you have to move the instruments around the belly in such a way that it can create a lot of  pain. The robot eliminates a lot of that because of it’s minimal movement in the abdominal wall. So at Inspira, we have eliminated a lot of the need for narcotic pain medication after surgery. The patient’s recovery is very quick. They don’t experience any side effects from narcotics.
Dr. Christopher Bashian

The biggest advances we’ve seen in gynecologic surgery have been with hysterectomies. An open hysterectomy is a major operation. We have to fully open the abdomen and pull out a big, bulky uterus that can weigh 4-5 pounds. With an open procedure, you have to stay at least overnight in the hospital, but a lot of times you’re there 2 days. With robotic surgery, patients go home the same day. Most often, their pain is very minimal, they’re eating, drinking, and they’re up and walking around that night.
Dr. Nathan Fairbourn

In my practice I tackle some very complex, very large hernias, where traditionally I would make an incision pretty much all the way down the belly. That would result in a lot of pain and typically a 7- to 10-day hospital stay for a patient, because I am reconstructing the muscles and reconstructing the abdominal wall. I have the ability to do that with robotic surgery now, and it dramatically reduces pain and recovery time. Most patients stay only one night in the hospital. Some even go home on the same day. When a robot comes into the more complex procedures, the benefits to the patient are even more magnified.
Dr. Elaine Cheng

Robotic surgery & medical students…

Medical students should know that Inspira is committed to robotic surgery.  We see this not only as the standard of care for many procedures now, but we’re excited about what the future holds for robotic surgery. When medical students are searching out where they’re going to complete their training, whether it be in general surgery, bariatric surgery, gynecology, or even in other areas, like orthopedics or pulmonary medicine, they should look for training programs that provide access to robotic training.
Dr. Scott Wagner

We have many surgeons here at Inspira who are enthusiastic and perform robotic surgery on a routine basis, so there are a lot of opportunities for our residents to practice robotic surgery. I’m proud to say that our residents will graduate with much more experience at robotic surgery than probably most residents in the country.
Dr. Elaine Cheng

There are often two consoles in the room. So for example, a trainee might be sitting at one console, basically shoulder-to-shoulder with the attending surgeon – so the attending surgeon can take over at any time – and the attending may say, “Oh, here, you can have one arm,” and then guide the student through pieces of the operation. That’s how I learned.
Dr. Catherine Mavroudis

Speaking as a physician who graduated from the Inspira residency program, I feel like my robotic training was top notch. I graduated residency with a robotic equivalency certificate, meaning that I was certified to do robotic surgery straight out of residency. I didn’t need any further training. We have so many high-quality robotic surgeons here. You have to have good surgeons to learn how to be a good surgeon. You have to have robotic surgeons to learn how to do robotic surgery, and we have that in spades at Inspira.
Dr. Nathan Fairbourn

One thing you should Know about robotic surgery…

At Inspira, most procedures are able to be done with the robot.  If you’re coming here, you’ve got people who are trained, and people who are really excited about it. You’re in very good hands.
Dr. David Lynch

Patients should ask about robotic surgery when they’re coming in for a procedure. Ask if the procedure can be done robotically, and if so, what are the advantages and potential disadvantages.
Dr. Scott Wagner

The robot is the future. It’s here to stay.
Dr. Elaine Cheng

The robot is a tool. The surgeon is still the one doing the procedure. That’s why it’s important to come to a place that has high-quality surgeons. Many places will have a robot, but it’s still the surgeon who is operating the robot.
Dr. Nathan Fairbourn