After five-plus years at Trinitas, the da Vinci Robotic System continues to surprise and impress
By Erik Slagle
If there’s a certain level of art that goes along with the science of surgery, the wave of advances taking place in robotics-assisted procedures could be considered its Minimalist movement. Less cutting. Less blood loss. Less pain. Less recovery time.
Less is usually more when it comes to surgery, and the procedures made possible by innovations such as the Single-Site da Vinci System are bringing surgeons and their patients to the cutting edge—which in many cases means a lot less cutting than in years past. Nowhere around New Jersey is that more evident than at Trinitas, where robotic equipment has transformed the concept of surgery in fields such as gynecology, colon and rectal, and gallbladder removal. The surgeons carrying out these operations often turn to robotics for maneuverability and visibility—consistently leading to more positive outcomes and faster recoveries for their patients.
“The ability to carry out robotic surgeries at Trinitas enables us to be more aggressive in how we treat, while giving us almost unlimited access within the surgical field,” says
Dr. Labib Riachi, Chairman of Trinitas’ OB/GYN Department and Director of Robotics. Dr. Riachi has carried out more than 700 procedures since 2009 on the da Vinci System. While at a console, a surgeon can manipulate the “arms” that maneuver a camera and carry out cutting, holding and coagulating all through a single or multi-port precise abdominal incision. Dr. Riachi has used the system to perform corrective surgeries for conditions such as prolapse, fibroids, bleeding, lysis of adhesions and endometriosis, and now trains other surgeons to do the same.
The benefits are easy to see—literally. “This technique provides us with ten times the magnification that we’d have with conventional open and laparoscopic surgeries,” Dr. Riachi says. “When treating endometriosis, for example, we have unparalleled precision in identifying, lifting and excising the lesions. At the consoles, we can manipulate surgical equipment with 360-degree rotation—superior even to laparoscopy. We can hold, dissect, and clean at better angles, and bring in a second surgeon if necessary without having to scrub out—that doctor can sit down at the adjacent console and see exactly what we’re seeing.”
A recent patient of Dr. Riachi’s, only in her 30s, had consulted with nearly a dozen doctors over a 15-year period to treat endometriosis that threatened to claim her ovaries. Still hoping for the opportunity to one day become pregnant, the young woman was desperate to avoid losing her reproductive organs, but appeared to be running out of options. Through the da Vinci method, however, Dr. Riachi was able to clean and correct all of her adhesions and excise all the endometriotic lesions in a single surgery, saving her entire reproductive system in the process.
“For 15 years, this patient had lived with chronic pelvic pain,” Dr. Riachi says. “But thanks to robotics, in cases like hers we no longer have to take out an ovary. We can clean and clear the reproductive system instead. At a follow-up appointment, she said she hadn’t felt this good in years.”
Preserving organs and saving body functions are primary goals of systems such as the da Vinci. Even in cases where Single-Site isn’t an option, surgeons are finding that introducing other types of robotics into the process can yield great results.
For Dr. Andrea Zimmern, colon and rectal surgeries can be carried out using a combination of laparoscopy or open surgery along with a robotic “helping hand” to gain the most favorable outcomes. In Dr. Zimmern’s field, robotic precision can help surgeons carry out procedures that might otherwise prove impossible.
“The visualization [using robotic equipment] is far beyond anything we’ve had previously,” Dr. Zimmern says. “With robotics, we can perform surgeries that used to be impossible even via laparoscopy. We recently treated a patient who came to us with an abdominal tumor that took up his entire pelvis. The patient was also suffering from obesity, which made his case especially complicated. Even with laparoscopy, we wouldn’t have been able to remove the cancer without giving the patient a permanent colostomy. But the precision of our robotic equipment allowed us to do just that. So we’re learning there are particular instances and cases where the ability to carry out robotics-assisted surgery isn’t just advantageous—it’s really the ideal.”
The use of robotics in surgery is quickly becoming common across a range of fields including cardiology, endocrinology, and general surgery. Robots are now key players in helping surgeons tackle aggressive cancers of the bladder, uterus, prostate, throat and more. With skilled, talented, trained surgeons at the controls, the robots at work in the operating theaters at Trinitas are driving modern medicine into a future that used to exist only in the realm of science fiction. Like its namesake, the da Vinci System is redefining an art form: the art of complex, life-changing and life-savings surgeries.
Pioneering surgeon Rodolfo Colaco, MD, underwent specialized training and performed the region’s first robotic single site procedure at Trinitas in 2013. The patient’s gallbladder was removed through one tiny incision in the belly button, making the procedure virtually scarless.