Teresa deBeche-Adams, MD, FACS, FASCRS, Colorectal Surgeon at AdventHealth Orlando talks about the Senhance robot and how it helps with surgeries.
Interview conducted by Ivanhoe Broadcast News in February 2019.
I want to start by asking you about the Senhance robot. We’ve heard a lot about robotics but this is a newer system so can you tell me a little bit about it?
DEBECHE-ADAMS: Robotics is basically just an extension of laparoscopy. And this new device mimics laparoscopy more than the ones before. It’s basically doing the same surgeries that we were doing before but with a little bit more precision and care and it also gives us a lot of feedback during the surgery with the camera being in 3D. And then it actually moves a little bit. If we’re putting too much tension on the tissues or pushing too hard the robot tells us that that’s happening. It’s in the way we can kind of adjust as we go.
I want to ask you a little bit more about that. It almost has haptics. You get a feeling, a sensation back in your fingers. Can you describe that?
DEBECHE-ADAMS: Exactly. It almost pushes on you a little bit which is a weird sensation at first but it does tell you that you’re putting too much tension there. So then you can back off because a lot of times, especially with robotics we don’t have that feedback and you have to train your eyes to know when you’re putting too much stress on the tissues and so it can be a little bit difficult to get around that way. But this makes it a lot easier.
And you mentioned the 3D camera. Can you tell me about how that’s deployed into the patient and how having that extra level of vision can help you with surgery?
DEBECHE-ADAMS: It looks like a regular laparoscope. There’s no difference in it. But you do wear 3D glasses so everybody sees us in pictures with the robot and it looks like we have sunglasses on, but it gives you a better depth perception. As you’re operating you can tell exactly where the tissues are and exactly where your blood vessels are and then your relationship to your instruments so that you can be a little bit more precise.
What is the benefit to be getting that feedback and not pushing too hard and having that extra precision?
DEBECHE-ADAMS: One of our surgical principles is gentle handling tissue and so it just helps us be more cognizant of what we’re doing during the surgery so that we can be more precise. And with the 3-D image is just how much depth perception it improves so that you can manage the tissue a little bit better and then be more precise in your dissection.
Tell me about the surgeries for which this robotic system is especially beneficial.
DEBECHE-ADAMS: We’ve used it more for cancers to date, but really it can be used in any surgery that laparoscopy is generally used. So that’s the benefit of it is that it just replaces laparoscopy so we can use it for cancers. We can use it for things like diverticulitis or for other benign issues like Crohn’s disease or ulcerative colitis. It can expand beyond just one type of surgery.
You had mentioned cancers. What’s the benefit to having this kind of precision?
DEBECHE-ADAMS: We like to be more precise in order to get an adequate sample for the pathologist to look at. We’re looking at our lymph nodes and other things around the tumor. And then also that we get adequate margins around the tumor. By being more precise we can make sure that we get an adequate lymph node number for them to sample and then make sure that the margins end up negative.
Benefit for the patient?
DEBECHE-ADAMS: The nice thing about it is the small incisions. These are only five millimeter instruments and they do have some smaller ones that are about to come out which is going to be maybe even a little bit fancier in the future, but they’re only 5 millimeters, so less than a centimeter incision. So, very little damage to the abdominal wall. Patients have quicker recovery that means out of the hospital faster but then back to normal life faster too.
Can you describe for me what the surgery looks? Are you driving a computer or driving a robot with a computer with your hands, with a joystick.
DEBECHE-ADAMS: We start out at the bedside just like basic laparoscopy, placing our ports and getting the robot set up. And then you sit at a little cockpit and you’re in a nice chair, sitting upright which is great because it reduces a lot of fatigue for the surgeon. You’re just sitting upright and then it’s got the handles and then a screen that you’re looking at with several instrument controllers, a little keyboard and we can type in our settings what we want and then we just start working like we would in a normal case. The graspers feel very much like the laparoscopic handles and so we just can get to do the same surgery just sitting down which is great.
Are you able to tell me a little bit about the patient, Miss Flores?
DEBECHE-ADAMS: She’s really wonderful. I had originally thought about doing her case on the robot and then because of some scheduling we said maybe not. And then we brought back the thought of doing it. She was game for it. It was going to be great for her because she had a nice polyp that we had to remove surgically that wasn’t able to be removed with a colonoscopy and so we wanted to give her a very nice surgery that would be equivalent to a cancer surgery just in case we found something there. And it really worked out to her benefit to have that done that way. And like I said in a very minimally invasive way she was out of the hospital in just a few days and back to normal life very quickly.
At what point does it become surgical?
DEBECHE-ADAMS: That depends because it not only has to do with the size of the polyp and whether or not we’re suspicious that there might be some cancer there, but also sometimes the location. If it’s behind a fold or around a corner, sometimes it’s just impossible to get with a colonoscopy. And we have to do surgery.
Did her polyp did turn out to be cancer?
DEBECHE-ADAMS: It did turn out to be cancer yes.
What is the benefit of having this procedure? How does that benefit her health?
DEBECHE-ADAMS: She’s basically finished with treatment so her cancer was very early and we did a perfect cancer operation for her. All of the margins were negative. None of the lymph nodes had any spread to it. Basically she’s pretty much done. Now, from here on out we just would follow her and observe her with lab work and colonoscopies again. Just the basic follow up.
How quick was her recovery as compared to what it would have been? Would that have been considered major surgery to get the polyp out?
DEBECHE-ADAMS: It is major surgery. Most of our patients even before the era of laparoscopy would have spent probably close to a week in the hospital recovering. She was gone in three days. So it’s really amazing. And then like I said once she gets home because there’s not a lot of pain involved and people can get back to their daily lives much quicker which is great for them.
How long have you operated here at Florida hospital? It’s been a little more than a year that I’ve known about it.
DEBECHE-ADAMS: Yeah. We actually didn’t get everything done and set up for the credentialing and everything. That wasn’t until April 30, I think was our first case on it. So even though we had it for several months, we weren’t able to operate with it yet. And since then we’ve done a number of cases, both colorectal related and also some of our general surgery colleagues have done several cases on it as well which just shows it’s usability in several different areas.
And am I correct in saying that Florida hospital is the first in the country to utilize the robot?
DEBECHE-ADAMS: Yes you are.
END OF INTERVIEW
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