Dr. Robot: The cutting edge of surgery

UAB surgeons discuss how technology is changing the operating room

The UAB surgery team with their robot assistant. Photo courtesy of the University of Alabama at Birmingham.

Editor’s Note: This is the first in an occasional series about jobs that have been revolutionized by technology.

For centuries, being a surgeon was the quintessential hands-on profession. You cut an opening into a body and put your hands inside to repair the problem. There simply was no other way to do it.

That has changed dramatically over the past 10 to 20 years, thanks to the technology of robotic-assisted surgery. No, this doesn’t mean some C3PO-type machine is working on the patient. Rather, it is a way for physicians to conduct surgical procedures without getting their hands dirty (so to speak).

Instead, the surgeon uses a computer console to direct the smaller, more precise robotic “hands” to do the physical work. This less-invasive technique lowers the risk of complications and speeds the post-operative recovery time for many patients.

Dr. Gregory Kennedy, UAB surgeon.

“It has changed the face of surgery tremendously,” UAB surgeon Dr. Gregory Kennedy says. “We’re basically doing the same operations we’ve always done, just through much smaller incisions. It makes us more efficient, and it’s easier on the patient, so they can recover quicker.”

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Few people are more experienced with this than UAB surgeon Dr. Jamie Cannon, who has performed more than 1,000 robotic-assisted colorectal surgeries since 2011. Cannon was trained in surgery the old-fashioned way in the early 2000s, but began hearing increased chatter about robotic-assisted surgery not long after joining UAB in 2008.

Dr. Jamie Cannon, UAB surgeon.

“People were starting to talk about using it, but it still wasn’t very common at the time,” Cannon says. “I decided to get trained in using it in 2010. I wasn’t sure if it would work for me, but the idea made sense.

“And I figured this was the way things were going to be moving, because the technology was only going to get better, I wanted to make sure as a young person just starting a practice that I didn’t miss the next best thing and get left behind.”

It took approximately a year of training on computer simulators before Cannon conducted her first robotic-assisted surgical procedure. Any trepidation she might have had quickly dissipated once she experienced the benefits of the new technique.

“I was impressed with all that I could do with it,” Cannon says. “Over the next several years, I transitioned to pretty much doing almost all my operations robotically.

“The primary benefit is for the patient. But there are ways that it enhances how well we can do things. You’re working in a very small space, and there are some areas that are just hard to get to and hard to see. Here, we can guide the camera and guide our instruments into a small space, and we’re able to see and work a lot better.”

Research into robotic-assisted surgery dates to the 1970s. Both NASA and the United States Department of Defense experimented with the idea of remote telesurgery as a way to treat astronauts in space or soldiers on the battlefield.

But the first actual robotic-assisted surgery on a living patient did not take place until 1997 in Belgium, and it did not receive FDA approval in the U.S. until 2000. Even then, it took another decade before the procedure began receiving acceptance.

“When I first started my medical training in 1996, it was still being debated whether (robotic-assisted surgery) was even safe,” Kennedy says. “Ten years later, there still weren’t many programs doing this. It was being discussed, but the platform was less than ideal. It was pretty clunky, and a lot of instruments weren’t available to do the things we needed to do robotically.

“It also really requires a certain amount of expertise. Going from open surgery to this minimal-invasive is a huge leap of skills and a huge learning curve. Because you have to learn how to manipulate tissue with these small instruments, versus using your hands where you can grab ahold of something and just lift it up.”

However, both Cannon and Kennedy say that once they became accustomed to the robotic help, the improvements were obvious. Primarily, patients no longer have to be cut wide open in order for the surgical procedure to take place.

Pictures from an operation in progress show the tiny incisions needed for surgery. Photo courtesy of the University of Alabama at Birmingham.

“We make very small incisions, and then the robot itself holds onto the instruments and is able to place them through those incisions,” Cannon says. “So, for me as a surgeon, instead of standing at the bedside and actually having my hands inside the patient, I’m sitting in the corner of the room on a console.

“It’s almost like remote-control surgery. When I move my hands on the console, the robot translates my movements to the instruments that are in the patient. It allows me to do everything I would do if my hands were inside the patient, but through much smaller incisions. Plus, I can control three different instruments at the same time, so it’s almost like you have three hands.”

In addition, Cannon says the small camera that is also robotically inserted into the patient provides sharp visuals that allow for even more precise operating ability.

Pictures from an operation in progress at UAB show the clear view surgeons have. Photo courtesy of the University of Alabama at Birmingham.

“The visualization is amazing,” Cannon says. “The surgeon is able to direct the camera, and you’re always looking at what you want to see with this incredible 3D view. It’s a very stable operating platform. I absolutely love it. There are so many advantages to it.”

Cannon says patients occasionally express some concern when they initially are told that a procedure will be conducted with robotic assistance. But she said the technique is becoming more readily accepted, especially when patients understand the advantages in terms of the quicker and easier recovery process.

“I have to explain to them that it’s not like the robot is operating autonomously,” Cannon says. “I control everything the robot does. I’m still very much the one who is doing the operation.”

Patients probably need to go ahead and accept robotic-assistant surgery, because use of the procedure likely will only expand. According to a study released in 2020 by the University of Michigan Department of Surgery, the number of surgeons who used a robotic system for at least some of their operation rose from 10% in 2012 to more than 30% in 2018. And the next generation of surgeons who were raised on computers likely will embrace the technology.

“Surgeons today are trained very differently than when I was a resident 25 years ago,” Kennedy says. “Most of the procedures I would have been exposed to as a resident would have been done through big open incisions. I really didn’t have any concept of anything else.

“Today, our residents very rarely do open procedures. They’re all done with a robot or laparoscope. It’s really the standard of care for most general surgery now.”

Cary Estes is a freelance contributor to Business Alabama. He is based in Birmingham.

This article appeared in the September 2022 issue of Business Alabama.

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