Less Is More — Minimally Invasive & Robotic Surgery for the 21st Century
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Evolution of Minimally Invasive Surgery

579558_561584637231169_1411236367_nEvolution of Minimally Invasive Surgery

At the turn of the 21st century, robotic surgery made its first debut after the FDA cleared the da Vinci Surgical System for adult and pediatric use in urologic surgical procedures, general Laparoscopic surgical procedures, gynecologic Laparoscopic surgical procedures, cardiovascular and thoracoscopic surgical procedures and thoracoscopically assisted cardiotomy procedures. With the use of the Robot, surgeon can perform minimally invasive surgery with increase visualization of 10 time magnification with the added of 3-D compare to the laparoscopic device.  An analogy to this is like watching a movie that currently in digital and suddenly you can watch that same movie with 10x mag and in 3-D.  Additionally, the wrist articulation is magnificent. The instruments can do much more than my hands alone. The system translates my hand movements into smaller, and more precise movements of tiny instruments inside the body. This is a big step forward in giving surgeons more accuracy and precision in their art.   Recently, the practice of using robotic surgery has moved in the direction of general surgery, for example cholecystectomy, surgeries, colon, stomach and even liver and pancreatic oncology cases.

For a over a decade, the da Vinci Robot has proven to be a useful tool for surgeons to perform minimally invasive surgery in a safe and efficient manner. I’d say robotic surgery is here to stay and without a doubt, contribute to quality of life for patients around the world. In the consumer technology world, smaller is better and faster. The same can be true in surgery. The smaller the incision that’s required, the less pain and recovery time the patients have to grind through.

As we move further along in the field of minimally invasive surgery, we need to do even smaller incisions and fewer incisions. The old four incisions for the removal of the gallbladder now can be done with just one 2 cm incision; yes just one small incision at the belly button.  We call this single-site or single incision surgery.  In 2008, I became the first surgeon to perform this surgery using the laparoscopic devices. Since that time our group have perform well over 1400 cases of abdominal surgeries including stomach, colon, and rectum. I’ve also trained over 500 surgeons. But this procedure (Single Incision Laparoscopic Surgery) demands a highly skilled surgeon; thus only 2% of surgeons nationwide are performing this procedure adequately.  In 2012, FDA approved surgeons to perform single-site surgery using the da Vinci robot. By using the robot, the ease of performing one small 2 cm incision to remove the gallbladder now became much easier for surgeons. Therefore, more surgeons now can offer their patients this procedure.

Because of our vast experience with single-site incision surgery using the laparoscope, we did not have much of a learning curve to begin training for the Single-Site Robotic Laparoscopic Cholecystectomy.  As soon as the FDA approved this procedure;  I again became the pioneer in this field and have trained many surgeons to do the same. As of now, our group is the most experienced group.  I am now the most experienced Single Site Robotic Cholecystectomy (removal of the gallbladder due to stones) globally.

The cost of removing a gallbladder due to gallstones is the same between four incisions and with single-site incision using the robot.  With the experienced surgeon, Single Site Robotic Cholecystectomy is as safe as four incision laparoscopic surgery. The benefits are much improved, too.  With fewer incisions, patients have less pain, recover faster, and the biggest gain is cosmesis.

I have over sixteen years of minimally invasive surgery experience, over five years of performing surgery with a small 2 cm surgery and now over 300 cases of Robotic Single Site Laparoscopic Cholecystectomy where patients come away from my surgery with minimal discomfort, recover from the surgery faster and above all no visible surgical scar.  This is what we offer our patients.  Personally, if I had gallstones, I would seek out surgeons that perform single site robotic surgery and one with the most experience.  Patients come out of surgery with no visible scars.  Imagine having your gallbladder removed without a visible abdominal scar.  That is a powerful image. That is 21st century technology.

  • John Y. Chang

    Thanks for the insight!

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