Robotic Surgery

The daVinci robot can be used for many different operations. 

The daVinci robot is made by an American company Intuitive Surgical. 

The "robot" is really a form of telesurgical surgery; that is, the robot does not function autonomously or "know" how to do any operation or any maneuvers. 

The surgeon controls the robotic instruments from a console. The console is usually in the same room as the patient, though in theory the console could be in any location connected with an electronic signal. 

An assistant attends to the patient at the bedside, while the surgeon is at the console. 

With thoracic operations, several small incisions are made between the ribs. The robotic camera and robotic instruments are inserted. The surgeon then manipulates the controls at the console, which allow the camera and instruments to move and accomplish the operation. 

A robotic approach can be difficult to learn. The hand controls take a while to get used to, for one thing. 

One of the main things to learn is related to the fact that the robot has no haptic feedback. This means that the robot instruments and controls do not provide any feedback to the surgeon about how soft or hard tissues may be. There is no indication about the consistency of tissue, other than visual feedback. 

This is much different than how a surgeon usually operates. Usually, a surgeon can feel the tissues with his (or her) hands. The feedback from his hands combines with what he can see to guide his maneuvers. 

Without haptic feedback, it is easy to pull tissues to the point of breaking. Or to crush a delicate tissue with an instrument. With the robot, the surgeon must learn to manipulate tissues based solely on what he can see. This is a major change for most surgeons. 

However, once the robotic technique is learned, the daVinci robot provides an excellent way to perform many operations. 

There are many different instruments which have been developed for the robot. Scissors, graspers, retractors (which hold tissues out of the way), staplers, and other instruments have been designed. 

Generally, the smaller incisions used with the robot involve less pain than more traditional open operations. This can lead to less pain, quicker recovery, and quicker return to work. 

In some cases, a robotic operation has been shown to be safer than open operation, meaning less risk. Dr. Pool would be happy to discuss the feasibility and risks of robotic surgery for you.  

Dr. Pool has performed hundreds of robotic operations. 

Dr. Pool is among the busiest surgeons who perform robotic thoracic operations. In 2018, he was among the top 1% of surgeons in the USA, in terms of how many thoracic robotic operations he performed. 

Dr. Pool is a proctor for the daVinci robot and teaches other thoracic surgeons how to use it. 

Dr. Pool is one of the only surgeons the Dallas area who performs robotic bypass surgery (CABG). 

Dr. Pool uses a method involving 3 incisions in the left chest between the ribs. The breastbone is not cut. 

A robotic CABG usually takes 2-3 hours to perform. 

The Left Internal Mammary Artery (LIMA) is prepared using the daVinci robot. 

The LIMA is connected to the LAD thru one of the small incisions. 

Dr. Pool has done a number of robotic CABG operations. 

Patients are usually in the hospital 4-5 days after a robotic CABG. 

Dr. Pool does not perform robotic CABG for more than one target; that is, he does not perform double or triple or quadruple bypass using the robot. 

For patients who have blockages in more than one coronary artery but who desire robotic CABG, a hybrid approach can be considered. A hybrid approach involves a robotic CABG followed by stents being placed for blockages in other arteries. 

Insertion of Robotic Ports
 

God bless & heal you! 

J. Mark Pool, MD

ABTS Board-certified

214-692-6135

Member of Society of Thoracic Surgeons