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Robot-Assisted Laparoscopic Procedures

Definition | Reasons for Procedure | Possible Complications | What to Expect | Call Your Doctor

Definition

For this type of surgery, a doctor uses robotic arms to operate through small keyhole incisions in the abdomen.

The robotic arms are able to do surgical tasks with an increased range of motion. They also can filter out hand tremor. The special tools translate the doctor’s larger hand movements into smaller ones. This allows delicate work in small spaces.

Laparoscopic Cholecystectomy

Close-up view of laparoscopic tools used to remove the gallbladder (green structure).

Reasons for Procedure

Some laparoscopic surgeries that have been successful using robotic techniques include:

Adrenalectomy —removal of adrenal gland
Appendectomy —removal of the appendix
Bariatric surgery —surgery of the stomach to treat obesity
Cholecystectomy —removal of the gallbladder
Colorectal procedures
Hernia repair
Nephrectomy —removal of a kidney
Nissen fundoplication —surgical reinforcement of the valve between the esophagus and stomach
Prostatectomy —removal of the prostate
Hysterectomy —removal of the uterus (results in infertility)
Myomectomy —removal of fibroids (noncancerous tumors in the walls of the uterus)

Compared to more traditional procedures, robotic-assisted laparoscopic surgery may result in:

Less scarring
Reduced recovery times
Less risk of infection
Less blood loss
Reduced trauma to the body
Shorter hospital stay
Faster recovery

Possible Complications

Complications are rare, but no procedure is completely free of risk. If you are planning to have a robot-assisted laparoscopic procedure, your doctor will review a list of possible complications, which may include:

Damage to neighboring organs or structures

Infection

Bleeding

Anesthesia-related problems

The need to switch to traditional surgical methods (eg, traditional laparoscopic or open surgery)

Some factors that may increase the risk of complications include:

Factors that may increase the risk of complications include:

Smoking
Pre-existing heart or lung condition
Obesity
Diabetes
Excessive alcohol intake
Previous abdominal or pelvic surgery
Use of certain medicines

Be sure to discuss these risks with your doctor before the procedure.

What to Expect

Depending on the reason for your surgery, your doctor may do the following:

Physical exam

Blood tests

Urine tests

Electrocardiogram (ECG, EKG) —a test that records the electrical currents passing through the heart muscle
Intravenous pyelogram (IVP) —a type of x-ray that creates images of the kidney, ureters, and bladder by injecting dye into the bloodstream
Kidneys, ureter, bladder (KUB) —an x-ray of the abdomen
Abdominal or pelvic ultrasound —a test that uses sound waves to visualize the inside of the body
CT scan —a type of x-ray that uses a computer to create images of structures inside the abdomen or pelvis

Leading up to the procedure:

Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure, like:
- Anti-inflammatory drugs (eg, aspirin )
- Blood thinners such as clopidogrel (Plavix) or warfarin (Coumadin)
Take antibiotics if instructed.
Take a laxative and/or use an enema to clean out your intestines if instructed.
Follow a special diet if instructed.
Shower the night before using antibacterial soap if instructed.
Arrange for someone to drive you home from the hospital. Also, have someone to help you at home.
Eat a light meal the night before. Do not eat or drink anything after midnight.

Depending on the type of procedure that you have, you may be given:

General anesthesia —blocks pain and keeps you asleep through the surgery
Local anesthesia—just the area that is being operated on is numbed; given as an injection and may also be given with a sedative

Several small incisions will be made. They are called keyhole incisions. Carbon dioxide gas will be passed into the abdomen to expand it. This will make it easier for the doctor to see.

A small camera will be passed through one of the incisions. This tool is called an endoscope. It lights, magnifies, and projects an image of the organs onto a video screen. The endoscope will be attached to one of the robotic arms. The other arms will hold tools that are able to grasp, cut, dissect, and suture. These may include:

Forceps
Scissors
Dissectors
Scalpels

Laparoscopic Tools

The doctor will sit at a console, looking at the images on the screen. Joystick-like hand controls and foot pedals will help to guide the tools. Another doctor will stay by you to adjust the tools as needed. In some cases, organs or tissue might need to be removed. When the procedure is done, the tools will be removed. The doctor will close the incisions with sutures or staples and apply a sterile dressing.

About 1-2 hours (depending on the type of procedure)

You will have pain and discomfort during recovery. Your doctor will give you pain medicine. You may also feel bloated or have pain in your shoulder from the gas used during the procedure. This can last up to three days.

This procedure is done in a hospital setting. The usual length of stay is 1-2 days. Your doctor may choose to keep you longer if you have any problems.

When you return home, do the following to help ensure a smooth recovery:

Wash the incisions with mild soap and water.

Ask your doctor about when it is safe to shower, bathe, or soak in water.

Take antibiotics to help prevent infection if instructed.

Avoid certain medicines.

Resume normal activities (eg, daily walks) soon. This will promote healing. You will have to avoid other activities, like driving, sexual activity, and strenuous exercise.

Gradually progress from a liquid to a solid diet.

To avoid constipation:
- Eat a high-fiber diet.
- Drink plenty of water.
- Use stool softeners.
Be sure to follow your doctor's instructions.

Depending on the procedure, you should make a full recovery within a few weeks.

Call Your Doctor

After you leave the hospital, contact your doctor if any of the following occurs:

Signs of infection, including fever and chills

Redness, swelling, increasing pain, excessive bleeding, or discharge from an incision site

Abdominal swelling or pain

Severe nausea or vomiting

Persistent diarrhea or constipation
Blood in the stool
Pain and/or swelling in your feet, calves, or legs
Cough, shortness of breath, chest pain
Difficulty urinating, such as pain, burning, urgency, frequency, or persistent bleeding
Being unable to eat or drink liquids
Headache, feeling faint or dizzy
Excessive vaginal bleeding (soaking more than one pad per hour) after a gynecologic procedure
Persistent or foul smelling vaginal discharge after a gynecologic procedure
Other worrisome symptoms

In case of an emergency, call for medical help right away.

American College of Surgeons

http://www.facs.org/

National Heart, Lung, and Blood Institute

http://www.nhlbi.nih.gov/

Canadian Cardiovascular Society

http://www.ccs.ca/

Health Canada

http://www.hc-sc.gc.ca/index_e.html/

American College of Obstetrics and Gynecologists website. Available at: http://www.acog.org/.

Computer-assisted surgery: an update. Food and Drug Administration website. Available at: http://www.fda.gov/fdac/features/2005/405_computer.html. Accessed December 9, 2008.

Da Vinci surgery. Da Vinci Surgery website. Available at: http://www.davincisurgery.com.procedures/gynecologic/index.aspx. Accessed December 9, 2008.

General surgical applications. Intuitive Surgical website. Available at: http://www.intuitivesurgical.com/clinical/generalsurgery/index.aspx. Accessed July 17, 2006.

Gynecologic applications. Intuitive Surgical website. Available at: http://www.intuitivesurgical.com/clinical/gynecologicapplications/index.aspx. Accessed July 17, 2006.

Laparoscopic abdominal surgery: bile, duct, and gallbladder. New York University School of Medicine website. Available at: http://www.nyulaparoscopy.org/surgeries/gallbladder.html. Accessed July 18, 2006.

Laparoscopic anti-reflux (GERD) surgery. Society of American Gastrointestinal and Endoscopic Surgeons website. Available at: http://www.sages.org/sagespublication.php?doc=PI01. Accessed July 18, 2006.

Reproductive endocrinology and infertility. Duke University Medical Center website. Available at: http://medschool.duke.edu/. Accessed December 9, 2008.

Ruurda JP, van Vroonhoven ThJMV, Broeders IAMJ. Robot-assisted surgical systems: a new era in laparoscopic surgery. Ann R Coll Surg Engl. 2002;84:223-226.

UNC robotic assisted minimally invasive surgery. University of North Carolina School of Medicine website. Available at: http://www.med.unc.edu/obgyn/gynrobotics/patients.htm. Accessed July 17, 2006.

6/3/2011 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/: Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.e8.

Last reviewed November 2012 by Marcin Chwistek, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.