With New Surgical Robot, Urology Team Can Better Serve Patients

Dr. Carmen Tong and the Children’s of Alabama urology team are preparing to start using the new Da Vinci surgical robot.

When Stacy Tanaka, M.D., arrived at Children’s of Alabama as the chief of pediatric urology, she resolved to bring in more technology. “I don’t want families of patients who need our services to go elsewhere because they think we can’t provide it,” she said at the time. That was in January 2022. By the end of her first year, one big piece of the puzzle was in place.

The da Vinci surgical robot arrived in December 2022, and according to Carmen Tong, D.O., director of pediatric robotic surgery, staff should be ready to use it within the next several months. “I’m so excited to offer this service for our children,” she said.

The surgical robot provides an alternative to laparoscopic surgery, in which instruments are inserted through two or three small incisions. Laparoscopic surgery is minimally invasive, but the technique is not ideal. “The instruments don’t articulate at the wrist, so they don’t mimic actual hands in the body,” Tong said. This makes certain maneuvers, such as internal suturing, quite challenging. “It’s as though you’re using chopsticks,” she said. There is also a steep learning curve.

The robot, however, “completely changed the landscape of minimally invasive surgery,” according to Tong. It provides a three-dimensional view with improved depth perception. In addition, the instruments enable much more refined movements—mimicking hands and fingers—and are gentler, which is particularly important when operating on babies, who have very delicate tissue. Overall, robotic surgery is less invasive, less disfiguring and results in quicker recovery than the traditional open technique. One small study also found it resulted in shorter surgeries and less suturing than using a laparoscopic approach for the same procedure.[i]

One major advantage is the three-dimensional, magnified view of the surgical field through the console, which isn’t available with the tiny cameras used in laparoscopic procedures. “It’s fabulous,” Tong said. “You’re able to see exactly what you’re picking up and what you’re cutting and stopping the bleeding on. From a safety standpoint, it’s a superior product.” One study found that robotic-assisted surgery could complement the motor skills of the surgeon’s nondominant hand, eliminating the innate difference in dexterity between hands and conveying ambidexterity.[ii]

Having the da Vinci robot also means Children’s no longer has to rely on access to the surgical robot at the University of Alabama at Birmingham (UAB), which is an adult hospital.

[i] Silay MS, Danacioglu O, Ozel K, Karaman MI, Caskurlu T. Laparoscopy versus robotic-assisted pyeloplasty in children: preliminary results of a pilot prospective randomized controlled trial. World J Urol. 2020;38(8):1841-1848. doi:10.1007/s00345-019-02910-8

[ii] Choussein S, Srouji SS, Farland LV, et al. Robotic Assistance Confers Ambidexterity to Laparoscopic Surgeons. J Minim Invasive Gynecol. 2018;25(1):76-83. doi:10.1016/j.jmig.2017.07.010

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