Since it was introduced in 2011, robotic surgery has become one of the fastest-growing technologies at University Hospital, growing so quickly that a second robot was added in late 2017 to handle the demand.
Surgeons who embrace the technology cite the pinpoint precision that robotic surgery allows, the three-dimensional views of the surgical field and the greater flexibility of the instruments to work on hard-to-reach places in the body.
For patients, “the biggest appeal is that it’s minimally invasive,” said Dr. Georgia McCann, assistant professor of obstetrics and gynecology at UT Health San Antonio, who chairs the Robotic Surgery Committee at University Hospital.
The number of robotic cases has grown by 30 to 40 percent each year. Ten surgical specialties have been using the devices including general surgery, colorectal, gynecology, gynecology-oncology, urogynecology, surgical oncology, thoracic, transplant, urology and otolaryngology.
Among the less common robotic procedures offered at University Hospital is trans-oral robotic surgery, or TORS. The primary application is to remove malignant cancers, typically at the back of the tongue. These cancers have been on the rise in younger men due to the human papillomavirus, or HPV, that causes cervical cancer in women, said Dr. Jay Ferrell, assistant professor of otolaryngology at UT Health San Antonio.
In years past, reaching these cancers required a large incision on the face or neck and complex surgery that often required splitting the jaw to gain access, which could lead to complications of speaking and swallowing. For the past 20 years or so, radiation and chemotherapy have been the preferred treatment to avoid surgery if possible. But with younger patients, the long-term side effects of chemo and radiation therapy can also cause problems.
Robotic surgery allows the surgeon to access — and see — these hard-to-reach tumors. And by removing them, the amount of chemotherapy and radiation patients receive afterward can be reduced.
Dr. Kent Van Sickle, chief of general and minimally invasive surgery at UT Health, uses robotics for GERD (gastroesophageal reflux disease), hernia repair, gallbladder surgery and other common procedures. Much less common is a robotic combination therapy for gastroparesis, a disabling condition most often seen in diabetic patients in which the stomach doesn’t empty properly. Another less common procedure performed is robotic Roux-en-Y gastric bypass surgery.
Obesity and diabetes are common denominators in many of the conditions the surgeons treat. Dr. McCann said the majority of robotic cases she performs are for endometrial cancer, which is associated with obesity.
“The robot allows us to do these complicated surgeries on very sick people and gets them back on their feet faster,” Dr. McCann said.