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Bringing the future into the present, surgeons at Columbia University Medical Center at NewYork-Presbyterian Hospital have pioneered the use of robotic surgery for gallbladder removal. This marriage of minimally invasive surgery and traditional open surgery by way of robot technology permits optimal viewing of the surgical field through small incisions and results in less pain and faster recovery time for patients.

This new technology allows us to offer patients the best of both surgical worlds-traditional and minimally invasive-which translates into many patient benefits, explains Emina Hui-na Huang, M.D., assistant attending surgeon at Columbia University Medical Center and assistant professor of surgery at Columbia University College of Physicians & Surgeons. The increased flexibility, safety, precision, and ease that we experience with robotic surgery results in reduced trauma to the body, and thus, a faster recovery time, less postoperative pain and discomfort, and a shorter hospital stay, as well as less anesthesia, less scarring.

It very closely mimics the surgical movements that we would use in traditional 'open' procedures, but allows us to do them through the very small incisions that are associated with minimally invasive, or laparoscopic, surgery, adds Beth A. Schrope, M.D., assistant attending surgeon at Columbia University Medical Center and assistant professor of surgery at Columbia University College of Physicians & Surgeons.

The surgical robot used by Drs. Huang and Schrope, Intuitive Surgical®'s da Vinci™ Surgical Systems, has been approved by the Food and Drug Administration for a number of clinical trials in which Columbia University Medical Center's surgeons participate as lead investigators. Like a puppet-master, the surgeon manipulates the robot's movements from a viewing console located several feet away from the patient. The robot, bent over the operating table, performs all of the delicate surgical procedures.

Part of the robot's uniqueness lies in the fact that, unlike most surgical instruments, it can enhance human capability. The robotic appendages-pencil-sized arms with pincer-like digits attached by wrists-are designed to mimic the dexterity of a surgeon's forearm and wrist. In fact, the robotic wrist surpasses the human range of motion and is less susceptible to tremors, allowing surgeons a finer degree of precision than was before possible. By the same token, the endoscope, acting essentially as the eyes during surgery, provides an improved view of the surgical site, with 360-degree range of vision, the ability to zoom in and out, plus high-definition, full-color, magnified, 3-D images.

Using the robotic technology for gallbladder removal takes about the same amount of time as doing the surgery via laparoscopy, but the 3-D imaging makes a huge difference. For many types of procedures, laparoscopy represents a major advance over traditional open surgery. And now, robot-assisted surgery seems to represent a major advance over laparoscopy in many cases, points out Dr. Huang.

Because of the advantages afforded by this new technology, robotics will not only be able to help improve existing minimally invasive techniques, but may be able to aid in the development of new minimally invasive procedures as well. We're currently using robot-assisted surgery for gallbladder removal, but because of our success, we plan to begin using it in more complex gastrointestinal surgical procedures, concludes Dr. Huang.