Robot gives surgeons cutting edge

It has been five years since New Zealand's first robotic surgery took place at Tauranga's Grace Hospital. "DaVinci" has since been used in 250 operations on people from across the country. As part of the robot's anniversary, Bay of Plenty Times reporter Kiri Gillespie and chief photographer John Borren were invited to see it in action.

The first thing you notice inside the operating room is that the surgeon is not with his patient when he begins to operate.

Instead, Peter Gilling is seated at a console up to five metres away, where he can view the surgical field of his patient through a special visor in magnified 3D clarity.

He slips his thumbs and forefingers into soft plastic loops instead of metal surgical tools. The loops correspond to those tools already inside the patient, attached to four robotic arms.

Dr Gilling's feet sit in striped socks, on top of foot pedals that help him manoeuvre the camera inside the patient and he speaks instructions to his first assistant through a microphone transmitting to an earpiece.

His hand movements are translated to the robot's arms in real-time and scaled down in size to precise, fine motions, thus enabling greater control and less risk of tremor.

Robotic surgery offers many more degrees of freedom, far beyond that of open or laparoscopic (keyhole) surgery, Dr Gilling says.

He demonstrates this by rolling his wrists and the movement is replicated by the robotic arms holding medical tools.

The operation he is performing today is the removal of a prostate.

It is delicate and intricate, at times requiring a slipknot stitch that calls for all the dexterity the robotic arms and Dr Gilling's skill can provide. Traditionally prostate surgery can sometimes leave men with incontinence and impotence but this is eliminated by robotic surgery.

At the patient's bedside, surgical first assistant Jo van Zyl controls the robot's two other arms, operating from a screen on the other side of the patient.

The $2.7 million robot operates through four small incisions in the patient's abdomen.

As he works, the Johnny Cash playing in the background changes to a soulful Amy Winehouse and assistants at the patient's bedside swap and change the surgical instruments at the end of the robotic arms during the operation.

The operation takes a bit more than an hour to complete. If it had been an open surgery, it could taken up to four or five hours and even longer recovery time for the patient, Dr Gilling says.

In the event of a power outage, the surgeon and robot have five minutes of power from a generator to remove and seal whatever is necessary before they lose power completely.

Robotic surgery during the past five years has been a huge asset to Tauranga and New Zealand, as people often travelled from out of town for the surgery, he says.

As a surgeon, he finds robotic surgery far superior to open or laparoscopic surgery.

"You can see so much more, the visibility by comparison is amazing, and the control you have ... the dexterity is far more advanced.

"I've been doing that operation for the past 20 years, I've learned a lot about that. Basically you can see so much better. There's just so many modifications to the surgery that have come about and the era of robotic surgery that has changed the way the surgery is done," Dr Gilling says.

This is for the better, he says.

The robot, named DaVinci, has been used in 250 operations since its arrival.

Despite Auckland and Christchurch now having robots of their own, New Zealand still lags behind the rest of the world, Dr Gilling says.

Much of this has to do with cost and how the health system is set up compared to other countries such as the US.

When key instruments cost $8000 each and can only be used 10 times, it is easy to see how the costs add up. The computer mechanics of the robot means it will not accept a tool already used 10 times. It also means the machinery is dated, and not adaptable with upcoming technology.

As impressive as the robot is, Dr Gilling says it is coming to the end of its life and he hopes to get a second-hand model for between $3 million and $4 million to replace the DaVinci when its day eventually came.

Dr Gilling is not sure when this will be but says the company that makes the tools no longer makes them to fit with the model of robot Tauranga has.

When the robot first arrived in Tauranga, patients expressed an uncertainty about being operated on by a machine. Five years later, "the patients are pretty savvy".

"They get on the computer and have a look around, do their own research," the surgeon says.

The 70-year-old Bay of Plenty man at the centre of the operation we sit in on confesses he had pre-surgery nerves.

"But I know a couple of others who have had it done and they seem to think it's a good thing"

"I guess people are pretty satisfied with that ... It's been well tried and proven over five years."