Dr. Ninh T. Nguyen, UCI‘s chief of gastrointestinal surgery, utilized a robotics system called the da Vinci Surgical System to perform the laparoscopic – or minimally invasive – surgeries. The robotics system enhances surgeons’ precision and capabilities in laparoscopic procedures, performed through tiny incisions with pencil-thin instruments and cameras.

The first surgery performed with the assistance of the da Vinci system was a Nissen fundoplication, a treatment for gastroesophageal reflux disease. Surgery began about 11 a.m. and concluded about 1:30 p.m. The second involved removal of a benign tumor from the stomach muscle wall. 

In future weeks and months, the da Vinci system is expected to be used at UCI Medical Center in a wide range of surgeries, particularly in the field of urology.

The da Vinci Surgical System provides the surgeon with 3-D imaging of the operating field and intuitive hand movement – two major improvements over standard laparoscopic surgery. Traditional laparoscopic surgery has 2-D imaging, and the movement of instruments is "counter-intuitive," similar to doing surgery while looking into a mirror.

The da Vinci is the first robotic surgical system to provide the surgeon with nearly all of the natural movements of the human wrist. It also eliminates natural hand tremor and improves dexterity to enable surgeons to do ever-finer surgery in a more controlled manner.

"It gives the surgeon back his hands and his eyes," says Dr. Ralph Clayman, chair of UCI’s Department of Urology. "Specifically, the robot allows the surgeon to see in 3-D instead of 2-D and greatly increases his ability to guide minimally invasive surgical instruments." Clayman, who has pioneered laparoscopic procedures in urology, is establishing a multidisciplinary, minimally invasive surgery center at UCI Medical Center, along with Nguyen. The robotics system will be a centerpiece of the minimally invasive center.

The da Vinci system can be used for many minimally invasive procedures, including Nissen fundoplication for treatment of gastroesophageal reflux disease, radical prostatectomy, hysterectomy, donor nephrectomy for kidney transplant and reconstruction of the kidney and ureter.

Patients benefit from minimally invasive surgery through smaller incisions, less injury to surrounding tissues, lower risk for wound infection, shorter hospitalizations and quicker recoveries.

The da Vinci system comprises three components: the surgical cart, a computerized vision system and a surgeon’s console. The surgical cart, stationed adjacent to the operating table, has three arms—one for the right hand, one for the left hand and a middle arm to hold the laparoscope that the surgeon uses to "see" inside the body. The robot effectively becomes the mechanical hands and eyes of the surgeon.

The computerized vision system transforms the images from the camera inside the patient into a 3-D, real-time image viewed by the surgeon sitting at the surgical console. Seated a few feet away from the patient, the surgeon looks through the console’s binocular viewer to see the operating field in 3-D and places his or her right and left fingers onto separate special grippers that control the right and left surgical instruments. The surgeon’s exact finger, hand and wrist motions then are translated into precise movements by the robotic arms inside the patient. The robot scales the large movements of the surgeon into minute movements of the surgical instruments.

Robotic controls allow surgeons to make natural hand movements—instead of the counter-intuitive movements characteristic of nonrobotic, standard laparoscopic surgery—so that procedures feel more like open surgery. The robotic arms are guided by cables, much like the wrist is maneuvered by tendons. "It’s as instinctive and as comfortable as driving a car," says Clayman.

The surgeon’s view of the operating field is enhanced by zoom-in and zoom-out capabilities, which when coupled with the motion scaling feature of the robotic system, allow the surgeon to perform very fine reconstructive and dissection procedures.

"It’s truly impressive," says Nguyen. "The robotic surgical system greatly enhances what I can do laparoscopically. The robotic instrumentation provides me with better surgical precision and dexterity to perform more advanced laparoscopic operations than conventional laparoscopic instrumentation. As such, the da Vinci is ideal for many different types of reconstructive general surgical cases."

Having a robotics-assisted surgical system "further establishes UCI Medical Center as a leader in minimally invasive surgery," says Clayman. "We already have surgeons at UCI who are internationally renown leaders in developing minimally invasive techniques in their specialties. Now we also have the very latest in technology. The combination of the two – skilled surgeons and the most modern instrumentation – truly places UCI at the forefront of minimally invasive surgical procedures."

To consult a UCI surgeon about eligibility for robotic-assisted, laparoscopic surgery, call toll free 1-877-UCI-DOCS or visit www.ucihealth.com.