While it sounds like something out of a sci-fi movie, the reality is that if you’ve been into surgery within the past few years, robotic technologies of some sort have probably played a part in your procedure.

Murdoch’s da Vinci robot being prepared for training

Robotic technologies are operated at the hands of skilled surgeons or technicians and generally play a part to assist your surgeon, rather than taking the place of a human. The benefits can include higher degrees of accuracy, faster procedure duration and minimally invasive entry meaning less tissue damage and therefore a speedier recovery than open procedures.

Murdoch Hospital has invested in many robotic technologies over the years and now has a leading suite of equipment to support a range of specialities. While these robots differ in the intricacies of how they operate, they all help surgeons plan their surgery and make precision incisions to reduce the impact on muscles and tissue surrounding the affected joints.

Here are a few of the technologies in our theatre robotics program:

da Vinci Xi:

The da Vinci Xi Surgical System has been in use at Murdoch since late 2019. The multi-million dollar system supports minimally invasive surgery across a range of specialties, including gastro intestinal, urology, gynaecology, colorectal, thoracic and trans-oral.

By enabling efficient access throughout the abdomen or chest, the da Vinci Xi System expands upon core da Vinci System features, including wristed instruments, 3D-HD visualization, intuitive motion, and an ergonomic design. The Xi System’s immersive 3D-HD vision system provides surgeons a highly magnified view, virtually extending their eyes and hands into the patient.

Fun fact! Murdoch is the only WA hospital utilising this technology for upper and lower GI and gynaecological procedures and has the broadest range of specialities using the system.

MAKO:

Murdoch has completed hundreds of joint replacement procedures under the MAKOplasty® Robotic Assisted Joint Replacement system with excellent patient outcomes.

Procedures performed under the MAKO include patient specific pre-operative planning where the system creates a 3D model of the individual joint. This model is then used to plan the surgery and to be accurately templated with the new prosthetic joint.

During surgery, implants are moved around “virtually” before any surgery is performed, allowing for the ideal positioning of the prosthesis based on the patients’ individual bone and tissue.

The robotic arm creates boundaries that allow for only the removal of diseased bone and cartilage and prevent removal of tissue outside of these boundaries. The robot uses haptics to indicate to the surgeon when the boundary is being approached and does not allow damage to tissue or bone outside the boundary.

Navio:

The Navio can be used for partial or total knee replacements and Murdoch surgeons have been using the device since 2019.

Computer assistance is used to collect the unique shape and motion of your kneed to virtually plan the procedure, then robotic assistance is used in theatre for accuracy and precision. Trackers are used to secure the femur and tibia with four small surgical pins. The trackers are the constant reference point for the surgeon throughout the procedure.

A three-dimensional model of your knee is used and determines proper implant size and position. The handheld robotic assisted tool is used to accurate position of bone removal cut guides, making a precise space for the implant.

So what does the future look like in the robotic theatre?

Our surgeons are undertaking research into the ongoing benefits of these technologies, including looking at reductions in pain, improvements in range of movement and reduction in hospital length of stay.

As this research is released, we will start to understand more about the potential benefits of these technologies and be able to invest in the best outcomes for patients.

Investments in things you can’t see are just as important. Other improvements less visible to patients includes surgical equipment, new and renovated theatres, improvements to our sterilising departments and digital monitors to track progress through theatres so surgeons know exactly what is happening.

Murdoch leading Robotic Surgery in WA

L-R Keith Sargent, Professor Martin Oehler, Mini Nelson, Dr Nikki Damen, Mr Raj Mohan, Susan Paul, Rainee Restrepo, Sony Abraham, Dr Joel Butler

St John of God Murdoch surgeons Mr Abe Jacobs and Dr Raj Mohan are pioneering robotic surgery in WA, both performing state first surgeries in 2021 on the new da Vinci XI system.

With a large focus on Women’s Health, Dr Raj Mohan is the only surgeon in Western Australia performing Gynaecological Oncology robotic surgery.

“We are now looking at its [da Vinci robot] use in women’s health and the advancement it can make in difficult complex gynaecological surgery.” 

Uterine cancer is the most diagnosed gynaecological cancer in Australia, with risk of diagnoses by age 85 being 1 in 40, making these technological advancements crucial.

“Using the da Vinci robot is all about progress in our field and to constantly be looking forward towards new and more precise solutions,”

Patients with uterine cancer are currently the main individuals operated on using the da Vinci robotic technology. 

Mr Abe Jacobs performed a state-first robotic colorectal surgery and now performs regular bowel resections and rectal prolapse procedures in cancer and non-cancer patients. 

Jacobs said the jump from keyhole to robotic surgery is huge and is thrilled to be leading the way in WA.

“It is new technology which has been around for at least a decade in the colorectal space in the eastern states. It is about time it is offered in WA,”

The da Vinci Robotic System has the ability to undergo safer and more complex surgeries.

“It is a tool, so the main focus is for people to have safe and effective surgery. The robot has proven many advantages, including some benefits over laparoscopic surgeries,”

“Being the first colorectal robotic surgeon in WA is a huge milestone and hopefully it will soon be introduced into other hospitals.”

The da Vinci Robotic Surgical System, which arrived at Murdoch in late 2019, was first used for gastrointestinal and bariatric surgery cases.

Jacobs and Mohan are currently joining forces to work on a collaborative case, potentially focusing on gynae malignancies which involves the bowel and cannot be performed via keyhole surgery.

“We are working together and looking at the possibility of a combination robotic case, combining a colorectal and gynae surgeon, as well as a urologist, in serious cases. It is a unique combined surgical opportunity that will deliver some exciting medical advances.”

Both Jacobs and Mohan will continue performing robotic surgery at St John of God Murdoch Hospital throughout the year, working up to more complex and frequent cases.

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