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the robot lets me access areas that were simply out of reach before. In addition
to controlling the 2 surgical arms of the robot, the surgeon can also control a
third arm that holds or moves items, so he doesn't have to rely on an assistant.
Another advantage you might find surprising is that the robot reduces some of
the burden with obese patients. That's something I didn't appreciate at first. In
fact, I knew of one surgeon who wouldn't use the robot on patients with BMIs
above a certain level. But when you're trying to do conventional minimally inva-
sive surgery in that population, the weight of the abdominal wall can be very dif-
ficult to deal with. With the robot, once you're in, it handles all the heavy lifting
and eliminates the physical strain of surgery.
In fact, it's much more comfortable for surgeons to operate with the robot.
With all the bending over in odd positions at the table, complex laparoscopic
procedures can cause aches and pains. But with the robot, surgeons sit at a
console that they can arrange in whatever way feels most comfortable for
them.
Gaining access to the abdominal cavity can also be easier. When surgeons try
to torque ports with conventional laparoscopic instruments, the thicker the wall
is, the more they have to twist. The robot is stronger and handles that tension,
so surgeons aren't struggling with their wrists or arms to manipulate instru-
ments. That makes the operation much more comfortable, so they're not worn
out at the end from having to fight against the abdominal wall the entire time.
• Improved access. I've trained a lot of surgeons on the robot and the learn-
ing curve isn't as steep as you might think. If they've already done a fair amount
of laparoscopic surgery, it's probably going to take about 5 to 10 cases for them
feel comfortable at the controls of the robot. Most general surgeons seem to be
able to get a handle on it within 15 or 20 cases. After that, it's just a matter of
getting faster and more efficient.
The more surgeons use the robot, the better they'll get. In a typical week, I
do about 10 robotic hernia cases with sutures and sewing, just as I would dur-
ing open procedures. I haven't used a tack — the way you would in lap surgery
