The newest generation of the da Vinci surgical robot has rolled into Birmingham. The only one in the city, the 3-D high-definition (HD) version at Princeton Baptist Medical Center solves a few of the older system’s limitations and ups the visuals to high definition. “The new version is lot more versatile as far as cardiac surgery,” said Gregory A. Thomas, MD, a cardiologist with Thoracic, Cardiac & Vascular Surgery of Alabama. “The improved optics allow you to see the tissue planes, and the higher definition allows you to be much more precise with your suture placement.” Though the 10,000x magnification and 3-D remain the same as on the older version, the HD screen on the new version allows greater acuity. “Instead of seeing four or five vessels being framed together, you’ll see them individually more clearly,” said Josh Boyd with Intuitive Surgical, makers of the da Vinci. On bedside the monitor showing the camera’s internal view, the new da Vinci offers telestration. The old version’s monitor was static with no interplay, but the new version allows those at bedside to draw on the monitor, just like football announcers on TV do. The marks show up on the surgeon’s console. “It allows for better communication between the bedside and the surgeon without the need for the surgeon to look away,” said Boyd. The monitor and the surgeon’s console now also allow three images to appear simultaneously. The top two-thirds of the screen always show the surgical camera’s viewpoint. But the bottom third can split into two frames. In those two smaller frames, the surgeon can view X-rays, the patient’s vitals, ultrasounds or other camera views. “If there’s a camera in the OR, the surgeon could monitor what’s going on in the room without taking his head out of the console,” said Boyd. Thomas is impressed with the greater flexibility of the new system. “The arms have more rotation, which gives you a lot more dexterity in doing procedures,” he said. The greater articulation with four times the range of motion, and the instruments being two inches longer, allows for multi-quadrant access. “You can work in the periaortic level, and all the way down into the pelvis,” Boyd said. Port placement, a frustration for many surgeons, plays a lesser role because of these two advancements. Some surgeons who tried the old system had problems with port placement, because they had to be so exact to reach the surgical site with enough instrument flexibility. But with the greater movement and extension of the instruments, port placement on the HD system is not as crucial. “You have a greater margin of error,” Boyd said. Thomas performs about sixty robotic operations a year and has used the new system for several types of surgeries, including a thymectomy and a bypass. “For bypasses, with the old system, we used the robot to harvest the left internal mammary artery from the chest wall to bypass the LAD. But you still had to make a small incision between the ribs to sew the artery onto the heart,” he said. “With the new system, we’ve been able to do the whole process endoscopically with the same port access.” He said the improved optics and the fourth arm allow the use of a special stabilizer developed by the company for the heart while it’s being worked on. The greater reach and flexibility available in the new da Vinci S HD will broaden the use of robotic surgery. Gynecological surgeries will be easier with the multi-quadrant access, including accessing the periaortic lymph nodes. The pelvic area becomes far more accessible as well, such as for pelvic prolapses and colo-rectal applications. “This new flexibility facilitates getting further down in the pelvis with better ease,” said Boyd. Michael Bivens, MD, a urologist with Urology Centers of Alabama, will be making use of the improved optics to save more kidneys. “Now we can save as much kidney as possible. Kidneys are one of the bloodiest organs in the body, but with the robotic system, we’re able to see tumors better, dissect out better and get the margins better,” Bivens said. Despite the marked improvements to the da Vinci, the surgeon console remains almost the same, keeping the learning curve minimal. “Nothing has changed in the surgeon console as far as the controls on the left and right pod, just a few minor changes to adapt for some new options. It will all feel real familiar,” said Boyd. August 2008