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"Robotic surgery allows us to virtually place our hands inside the patient without the need for large incisions," Boggess said.

After sleeve placement, the robot, much like a post with three arms, is wheeled over and its center arm docked to a port that holds the camera and the other arms docked to the instrument ports.

However, surgery with the da Vinci does not mean close proximity to the patient. Unlike with laparoscopy, the surgeon is seated across the room from the patient, with arms inserted into the nearby console, fingers on stirrup-like holders and eyes fixed on lenses for sharp magnified images of the surgical site. Focus is adjusted via foot pedals.

While laparoscopy allows manipulation of instruments up, down and side-to-side, surgery with the da Vinci allows more natural wrist movement.

The robot's arms have wrists with eight degrees of freedom that allow the surgeon "to bend around corners and work in ways that are much more natural," said Boggess. This allows full range of motion and the ability to rotate instruments 360 degrees through tiny incisions. Direct and natural hand-eye instrument alignment is similar to open surgery, with "all-around" vision and the ability to zoom in and out.

Another advantage with da Vinci is the elimination of tremor. Surgeons can scale, or ratio, their finger movement to that of the robotic instrument. A movement of inches at the console can be scaled down to centimeters in the patient.

"This can re-introduce precision in an elderly surgeon, who has all those years of experience but has lost some dexterity," Boggess said.

Dr. Daniel von Allmen, chief of surgery at the N.C. Children's Hospital and associate professor of surgery at UNC, has performed several successful pediatric operations with the da Vinci robotic system and said the scalability
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Source:American College of Physicians