Rutgers Docs Develop Best Practices for Next-Gen Surgical Robot

Today’s popular surgical robots have three separate arms that — under human control — enter patients through three separate cuts and triangulate on the target tissue. 

Next-generation robots pack those three arms and a camera into a single cylinder or port that enters the body through a single 2-inch incision. The camera and arms then fan out around the surgical site to do their work.

Robotic-assisted surgeries typically cut less tissue than traditional, open-incision surgeries— their robotic arms access tissue through tiny holes — but the new robots cut even less than the old ones.

And two of the four such robots in New Jersey are in the hands of Rutgers doctors.

“Robotic surgery has several advantages over open surgery. Patients benefit from less blood loss, spend fewer nights in the hospital and minimize or even avoid narcotic pain medication after they go home,” said Evan Kovac, an associate professor of urology at Rutgers New Jersey Medical School, who is one of the first at his institution to begin using the new device.

“The single-port robot is the next technological step, even better than its multi-port predecessors because it is even less invasive,” he continued. “Many cancer operations that have always required overnight hospital stays can be done as outpatient procedures.”

Outcomes should improve as early adopters devise and publish best practices for various procedures. 

Kovac, for example, uses the new device to access the prostate without first cutting through the abdominal cavity, which reduces pain and the risk of bowel injury. Having all three robotic arms enter the body through a single site allows access into small spaces that can be inaccessible with the multi-port robot.

Sammy Elsamra, an associate professor of urology at Robert Wood Johnson Medical School, has utilized the limited footprint of the single-port robot to access the space behind the peritoneum for various surgeries. Such unique procedures are being presented at the American Urologic Association annual meeting this year.

“The single-port robot may not replace the three-port robot for all surgeries, though early adopters, like those at Rutgers, are working towards developing and improving upon new techniques for this new system,” Elsamra said. “We’re also tracking outcomes to publish comparisons with outcomes from the three-arm robots.”

Additionally, urology and ear-nose-and-throat residents at both medical schools benefit from early access to these innovative robots in their training. 

The robots also provide standard clinical care to patients at University and Robert Wood Johnson hospitals. The most common procedures so far are urological, including partial and complete removal of the prostate or kidneys and urinary reconstructive surgery.  The single-port robot is also utilized by ENT (Ear, Nose and Throat) for trans-oral robotic surgery for otherwise inaccessible surgical tasks deep in the throat.  

“A single entry point also has cosmetic advantages,” Elsamra said. “We can hide the incision scar for many surgeries in the belly button or under their waistline, thus improving overall body self-image in addition to superior clinical outcomes."