New technology paves the way for robotic 1-incision colon surgery
The surgeon sits in front of a computer console that looks a bit like Pixar’s WALL-E.
After placing his thumbs and index fingers in handles, he makes small movements to cut, cauterize or sew, while looking at the console screen offering a magnified three-dimensional view of the surgery site. He presses pedals with his feet, like an organist, to switch from one instrument to another.
Surgeon Garrett Friedman’s movements are transmitted to a robot a few feet away, which would typically be an octopus-like machine with four arms. This afternoon, however, the robot in MountainView Hospital’s operating room has a single mechanical arm with four small pins, three with pincer-like tips and a fourth with a miniature camera.
This next-generation robotic surgical system requires a small incision for colon operations rather than the multiple incisions of earlier robotic systems, or the groin-to-rib cut of traditional manual surgery.
“That really boils down the absolute bare minimum surgery that a patient needs to have in 2022 to have a minimally invasive colon surgery,” Friedman said Tuesday when demonstrating the system.
Friedman and HCA’s MountainView Hospital have joined a Food and Drug Administration clinical trial to confirm the safety and feasibility of using the da Vinci SP (single port) robotic system in a variety of colorectal surgeries. The trial is recruiting adult patients who are candidates for minimally invasive surgery for colon cancer, polyps and other conditions.
Friedman is one of the few American surgeons to perform colorectal surgeries using the system. MountainView is the only Nevada facility with the system.
The system was initially cleared by the FDA for use in urology and for mouth surgeries, such as tongue cancer, Friedman said. He has used the system less than 10 times for single incision surgeries and 30-40 times for other colon operations. The FDA gives doctors wide latitude to use the devices in ways that go beyond their original approvals.
“We’ve been able to perform these operations safely before, so we have a high degree of confidence that it can be done safely,” he said.
The performance of the technology in the trial will be assessed based on whether a procedure can be performed without the need to convert it to another approach, such as multiport or laparoscopic robotic surgery, according to a description of the study.
Other trial participants include Adventist Health System/Sunbelt in Orlando, Florida, Mayo Clinic in Rochester, New York, and Houston Methodist Research Institute.
Robotic surgery is credited with allowing doctors to perform certain complex procedures with greater precision and control. The one-port system, by reducing the number of incisions to one, can reduce pain and scarring, Friedman said.
“We all want the least invasive (approach), the least pain, the least complications, and we think this is a route to that, using this highly specialized technology,” he said. There is a cosmetic advantage, in that the single incision can be hidden below the bikini line.
There is no additional – or reduced – cost for patients to participate in the clinical trial, which according to the study description requires follow-up examinations at 14 and 42 days after operations, and more follow-ups every year for five years.
Friedman, 37, received his medical training at Weill/Cornell/New York Presbyterian Hospital, Memorial Sloan Kettering Cancer Center, Columbia University Medical Center and Loma Linda University Medical Center.
As a surgeon in the US Air Force, he came to Las Vegas in 2017 to work at Nellis Air Force Base. “I never really planned to live in Las Vegas, but eventually I fell in love with it,” he said.
“I knew I wanted to stay, and I knew I wanted to do more than just hang my shingle and do surgery,” he said. “I wanted to try to create programs – something we can be proud of here in Las Vegas.”