St. Luke's - Roosevelt Department of Surgery performs operations employing the newest "minimally-invasive" technology to treat diseases of the entire gastro-intestinal tract. By using the newest techniques and equipment available, our surgeons decrease perioperative morbidity, length of hospital stay and the time required for a full return to all activities.
Robotic procedures that have been pioneered at St. Luke's - Roosevelt include an extended minimally invasive thymectomy, three-hole esophagectomy as well as a modified Heller myotomy for treatment of achalasia and excision of esophageal duplication cysts. By employing the increased dexterity of robotic instruments, the surgeon mobilizes the esophagus using several small incisions, in lieu of the much larger thoracotomy incision used in many instances. This modification offers decreased morbidity, particularly from pulmonary complications, less post-operative pain, a reduced length of hospital stay, and a decrease in time needed for recuperation. : Robotics combines laparoscopic and thoracoscopic techniques to facilitate operations thought too difficult for either modality alone.
Evolving indications for the application of brachytherapy in patients with early stage lung cancer require improved methods of localized resection and tailored delivery of radiation therapy. A technique of robotic brachytherapy seed application was developed at St. Luke's - Roosevelt Hospital experimentally in swine and is now applied to patients as part of an experimental treatment modality with peripheral stage IA non-small cell lung carcinoma. The theory behind the experiment was that the enhanced intracorporeal dexterity of the system allows for increased accuracy in placement of the string of I125 seeds in the wall of the diseased lung. This experiment is one of many that treat surgical robotics as a facilitating technology allowing enhanced applications with other devices as they become available in the market.
STEREOSCOPIC VISUAL ACUITY:
The Da Vinci system uses two camera eyes to produce a stereoscopic, three dimensional visual working field for the robotic surgeon. Experiments in conjunction with the Columbia University Department of Machine Learning have evaluated how reductions in stereoscopic acuity affect the operators' interaction with the visual environment. As the camera scopes become smaller, the distance between the two eyes also decreases which affects how the surgeon is able to perceive depth of field during the operation.
FLIGHT PATH ANALYSIS
In addition to using it clinically to develop procedures involving the resection of medistinal masses, transthoracic esophageal resections, ventricular lead placement and many other cardiothoracic applications we have had the opportunity to study its unique role in resident education.
Research fellows for the last four years have all devoted time to developing techniques for testing resident performance on standardized drill sets. Goals have included developing techniques for testing resident performance on standardized drill sets. This year we hope to continue this work with the goal to ultimately define the role of the robot in surgical training; we will be taking a special look at these skills in the sleep-deprived resident and the new models of surgical education in the world of hours-restriction and advanced simulation models.
Flight Path analysis of the movement of the surgeons hands as well as the Da Vinci arms are recorded via the advanced programming interface (API). Mathematical comparisons are made between novice robot users and expert robot users to try to glean a methodical scoring system for surgical skill. Future experiments employ evaluations with physical modeling programs typically used to evaluate fluid flow dynamics as well as programs used to track ricochet patterns of explosive fragments.
Robotic Port placement is demonstrated for a Heller Myotomy.
Robotic Surgery needs two experienced surgeons to perform a procedure. The table surgeon is shown assisting the robotic device.
A specially designed surgical suture demonstrating the silver capsules impregnated with I-125
A chest radiography demonstrates the exact placement of the seeds spiraled around the resection edge.
A Quad Image splitter is used to capture four views of the operating field in real-time.
A close-up view of the Da Vinci camera demonstrates the two cameras needed for stereoscopic vision
The Advanced Programming Interface allows mathematical analysis of a surgeon's technique
Variations in X, Y, and Z axis are demonstrated. Expert robotic surgeons show variations in efficiency of movement.