The past two decades have witnessed a revolutionary transition in surgical technique and technology. Traditionally, surgeries had been performed in the open manner. This often came with the risk of major blood loss and a large incision was required for the surgeon to plainly observe and manipulate the surgical field. These incisions inevitably created significant patient trauma—substantial pain and suffering, major scarring, extended recovery time, prolonged pain management and elevated costs.
Approximately 20 years ago, surgeons began practicing a new approach to performing surgery, an approach that came to be known as minimally invasive surgery, or MIS. During this era, tiny cameras in instruments called endoscopes or laparoscopes were introduced. These visual and surgical aids could be inserted in the patient's body through small ports.
Although revolutionary in its positive effect on patient trauma and recovery times, MIS encountered significant technical drawbacks. The surgeon operated using a standard 2D monitor instead of looking at his or her hands. The resulting image flattened the natural depth of field, and the fixed-wrist instruments limited his/her dexterity. The lack of 3D visualization of the operative field, the poor ergonomic design and reduced control were major roadblocks to further progress. As a result, this type of MIS turned out to be suitable for a narrow range of surgical procedures.
In the late 1990s, another evolutionary stage in the development of surgical technique was achieved with the application of robotics to surgical technology. At the forefront of this new era, Intuitive Surgical introduced the da Vinci® Surgical System. The da Vinci System features wristed instruments that enhance dexterity, precision, and control. It also has a three-dimensional view that offers greater visualization and a console that provides ergonomic comfort for the surgeon. Patients who undergo this surgery experience:
- Quicker recovery and return to normal activities
- Significantly less pain
- Less risk of infection
- Shorter hospital stay
- Small incisions for minimal scarring
On October 11, 2004, Southern Illinois University entered the robotic age with the region’s first robotic assisted surgery. The Urology division at SIU is spearheading the St. John’s Hospital robotic surgery program by performing four different urologic procedures by surgeon. Dr. Brad Schwartz, Associate Professor and Director of Laparoscopy, Robotics and Endourology has performed more than 250 robotic procedures since the hospital acquired the DaVinci robotic platform by Intuitive Surgical. In July of 2009, St. Johns Hospital upgraded its system to the most recent technology the da Vinci Si with a dual surgeon console. This aquisition displays SIU Urology and St. John's Hospital continued commitment to education in addition to its mission in excellence in clinical care. SIU Urology aims to be a university at the forefront of robotic education for residents. In August 2010, Dr. Alex Gorbonos joined the SIU Urology team as the director of robotics after completing his fellowship in urological oncology and advanced laparoscopy/robotics at City of Hope Cancer Center, which pioneered the use of robotics in urological oncology.
Dr. Schwartz’s expertise with the robot lies in kidney reconstruction and female pelvic surgery. The four procedures best designed for the robot in his practice are:
Robotic Pyeloplasty for ureteropelvic junction obstruction
Robotic Sacrocolpopexy for pelvic organ prolapse
Robotic Partial Nephrectomy for kidney cancer
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Dr. Gorbonos performs virtually all urologic procedures in a minimally invasive fashion with the help of the robotic platform. He pioneered the use of robotics for bladder cancer at SIU and has the largest series of robotic cystectomies in Central and Southern Illinois.
URINARY TRACT RECONSTRUCTION
Ureteropelvic Junction (UPJ) Obstruction
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