As technology continues to expand and improve, surgical patients are among those reaping some of the greatest benefits.

For the past couple of decades, robotic-assisted surgery has become more and more precise, resulting in smaller incisions, shorter hospital stays, and a decreased risk of complications for many common and lifesaving procedures.

According to Dr. Matthew Meissner, a urologist at Geisinger Medical Center, in Danville, Pennsylvania, the robotic technology also makes it easier on the surgeon’s body, since it allows him to sit down to operate. In addition, technology has made surgical procedures easier to teach.

Meissner has seen this especially in prostatectomy procedures (removal of the prostate gland).

“There can be two different consoles, one for the surgeon and one for the trainee,” he said. “With literally the touch of a button, the surgeon can give the controls to the trainee…and can immediately, with the touch of a button, take the controls back.”

In 2018, UPMC Susquehanna implemented new neurosurgery technology called BrainLab, which includes a 3D image that displays treatment planning capabilities and has assisted neurosurgeons in the performance of brain surgery, making the procedures safer, more precise, and improving outcomes. The hospital is currently the only one of its size with this technology that includes the Zeiss microscope, which illumines and magnifies simultaneously, reducing thousands of steps a neurosurgeon would have formerly had to take.

Georgios Klironomos, MD, a neurosurgeon at UPMC Susquehanna in central Pennsylvania, said the technology includes a scanner that allows for precise, real-time responses during the surgery.

“We can get an update of the progress of the surgery inside the operating room,” he said. “We can get a CT scan of the head or spine at the time of the surgery and can check on the progress of the procedure, such as how much of the tumor is out and how close to a structure we are.”

Eliminating error

Two years ago, Tom Graboski, 59, of Coal Township, Pennsylvania, was told he would have to have a knee replacement. Having torn his ACL in the 1980s, it wasn’t surprising news. Yet it was still daunting.

“I’ve never even had a stitch in my life,” Graboski said. “It was all new to me.”

But his pain continued to increase, restricting him from the things he loved, such as archery hunting.

“I knew it was getting worse and worse,” he said. He put it off for a year, but when it got to be too much, he met with his doctor, who educated him about the procedure.

“When the doctor told me it was robotic, I asked him if that meant he would be sitting in the back having a coffee,” he joked. But he soon learned that the surgeon, assisted by the robotic technology, would be able to make a much more precise cut, eliminating the chance for error. That, Graboski said, made him feel much more confident. His surgery took place on Jan. 4 at Geisinger Shamokin Area Community Hospital.

Meissner said the term “robotic” often conjures up a picture of a robot that is going to be operating on them autonomously. But in reality, the robot, he said, “is controlled by the surgeon from a console right next to the bed.” While the robotic arms contain the instruments, the surgeons control each movement. And there are always assistants at the bedside, scrubbed, sterile, and ready to jump in if an issue ever arises.

Precision

However, robotic technology has proven trustworthy, with a precision that has made many life-threatening procedures, such as neurosurgery, safer.

According to Klironomos, before this technology - in the case of the removal of a brain tumor, for example — surgeons had to base their approach on “anatomic knowledge”. But because anatomy varies among individuals, and because tumors also change a person’s brain pathways, it was not very precise.

“Having this technology now,” he said, “we have more information at the time to do the operation.”

The system includes a navigation machine — a screen that allows surgeons to see at any time during the procedure exactly what location in the brain they are. Klironomos said the screen shows where the fibers inside the brain are that connected to the critical areas such as speech, motor and vision, decreasing the risk for brain injury.

They can make smaller incisions and create smaller and better-oriented corridors in the brain, he said, decreasing damage to the structure. The technology is also used for procedures in response to vascular lesions, aneurysms, and epilepsy, as well as spinal procedures such as fusions. These minimally invasive approaches, he said, “can result in a shorter hospital stay for the patient, and at the same time decrease the risk of complications.”

Improvements

According to Meissner, a “very primitive robot” was used around 2000 at Geisinger to perform a prostatectomy — a procedure that he said requires “a lot of sewing and delicate movements”. Over the years, the technology has been improved, and now he performs nearly 100 percent of such surgeries robotically. The technology, which Meissner said has “tiny robotic arms that have reticulating natural hand and finger movements,” makes incisions smaller and the cutting and sewing more precise, allowing him to successfully complete, among other examples, the removal of a tumor from a kidney, or the removing of a bladder and the creation of a urine diversion.

“There are a lot of procedures that we had never really been able to do on the scale or precision we do with pure laparoscopic surgery that we can do with the robot,” he said.

The precision has meant less blood loss and less pain in post-operative recovery.

Other common robotic procedures at Geisinger include gastric bypasses and hernia repairs.

Graboski’s post-operative recovery has been successful so far. He pushed through physical therapy and looks forward to the day when, as the doctor told him, “you won’t even know you had it done.”

He plans to put it to the test in October when hunting season begins again. But until then, he’s getting stronger day by day.

“The way I feel right now,” he said, “it feels really good.”