Surgery gets a little more futuristic with single-incision robotic procedures

April 09, 2019
by Lauren Dubinsky, Senior Reporter
In November, Dr. Jeffrey Cadeddu, professor of urology and radiology at University of Texas Southwestern Medical Center, became the first in Texas to use Intuitive Surgical’s new da Vinci SP surgical system. He successfully used it to perform surgery on a ureter, which is the duct that passes urine from the kidney to the bladder.

Laparoscopic surgery historically requires multiple small incisions, which can cause more pain for the patient and increases the risk of hitting a blood vessel. However, the da Vinci SP system can perform the same procedure with a single, one-inch incision.

Cadeddu previously performed single-incision surgery manually when treating patients with kidney problems and prostate cancer. Before the da Vinci SP became available, the only robotic systems on the market required multiple incisions.

“Manual single-incision surgery was always technically challenging because of the ergonomics and the skillset necessary to work through a small hole was quite frustrating,” said Cadeddu. “But now it has been revitalized with this robot for single-port surgery.”

The da Vinci SP consists of three, multi-jointed robotic arms and a small 3D HD video camera. The surgeon sits in a cockpit and inserts all of the instruments through the single incision to reach the target anatomy.

The system scored FDA clearance in April 2014 and Intuitive Surgical began shipments in the third quarter of 2018. UT Southwestern is the first in Texas, but the 12th in the world to use it.

It’s currently only approved for urological procedures including kidney surgeries and prostatectomies. Cadeddu mentioned that ear, nose and throat physicians are already using it for throat surgery and that it will likely also be used for head and neck surgeries in the future.

Cadeddu has used da Vinci SP on 18 patients so far and reported that they appeared to experience less pain and heal quicker. But that cannot solely be credited to the da Vinci SP since he used it in conjunction with a magnet-controlled tool.

Levita Magnetics’ Levita Magnetic Surgical System, which received FDA approval in August 2016, grasps and retracts organs during laparoscopic surgery. Without a tool like this, surgeons have to make additional incisions to move either the bowel or bladder out of the way.

“You have to make a hole and put an instrument in to hold tissue or organs out of the way,” said Cadeddu. “But that hole hurts and there is a chance of hitting a blood vessel in the abdominal wall from which a patient can get a hematoma.”

The magnetic system includes a laparoscopic delivery system, a detachable end grasper and an external magnet. The grasper is inserted through a trocar and its distal tip is used to grasp the anatomy.

The surgeon manipulates the grasper so that it’s within the proximity of the external magnet, which is placed on the patient’s abdominal wall. The anatomy can then be moved as the surgeon moves the magnet.

“Right now other people who use the da Vinci SP robot have to make an extra hole to retract tissue or organs out of the way,” said Cadeddu. “So it’s not actually a single-incision surgery – it’s more like a two- or three-incision surgery. Why make extra holes in a patient if, with magnetics, you don’t have to?”

His long-time interest in magnets inspired him to develop this novel technique. Intuitive Surgical and Levita Magnetics are both interested in this approach and are now encouraging customers to use their systems together.

When it comes to patient outcomes, Cadeddu stated that they are similar to the outcomes from manual single-incision laparoscopy. Over the last 12 years, studies have shown that patients do incrementally better when a laparoscopic procedure is done through a single incision.

“You would think that whether you make one hole with laparoscopic instruments or one hole with a robot, you should end up getting the same benefit,” said Cadeddu.

Single-incision robotic surgery is much easier to perform than the manual alternative, but Cadeddu doesn’t believe that it will become mainstream. Many hospital and health systems likely will not want to part with their existing robotic systems even though they require four incisions.

“The problem with all these robots is that they are so expensive,” said Cadeddu. “I think the single-port robot system will become an alternative way to be even less invasive, but I don’t know if it’s going to ever replace all of the standard multi-port robot surgeries.”

However, he did mention that it could become the standard at big hospitals and health systems that can afford this technology.