Section: Highlights

Transforming Surgery: Using Minimally-Invasive Robotic Surgery to Create More Precision, Fewer Complications and Exceptional Outcomes

Transforming Surgery: Using Minimally-Invasive Robotic Surgery to Create More Precision, Fewer Complications and Exceptional Outcomes

At the vast majority of hospitals, lung cancer surgeries are performed using an open thoracotomy. A procedure first performed in 1912, it remains the technique used today in the United States — resulting in a large incision and a hospital stay of seven to 14 days.

St. Jude is one of a small number of hospitals with the expertise and technology to create a very different scenario, where lung cancer is removed through tiny incisions, creating better outcomes, fewer complications, less pain and a much shorter hospital stay.

Using the da Vinci Surgical Robotic System, our surgeons are creating the next generation of minimally-invasive surgeries in areas from gynecology and urology to the treatment of lung and colon cancers.


“Long-term survival rates after lung cancer surgery have not improved in decades,” explains Daniel Oh, MD, Harvard-trained thoracic surgeon, and one of the first in the state — and nation — to routinely perform robotic lung cancer removal. “Robotic surgery is allowing us to finally change that, by giving us the tools to more completely and aggressively remove the cancer.”

Inside the hospital’s state-of-the-art surgery suites, the da Vinci’s robotic and computer technologies scale, filter and seamlessly translate a surgeon’s hand movements into smaller, more precise movements. Inserted through very small incisions, the robotic “wrists” hold miniaturized instruments and a high-definition 3D camera offering magnified views of the surgical field.

“The ability of the robotic wrists to bend and rotate far exceeds that of a human hand, allowing us to perform complex and highly controlled motions that would otherwise be impossible,” says Dr. Oh, medical director of the St. Jude Center for Thoracic and Esophageal Diseases and assistant professor of surgery at Keck School of Medicine of USC. “The outcome is more significant than simply making surgeries less invasive: we are creating a more precise and successful cancer treatment.”


Pelvic-organ prolapse — in which the ligaments supporting the uterus and bladder weaken — affects almost 50 percent of women. Once only correctable through a large abdominal incision, Melanie Santos, MD, a fellowship-trained, board-certified urogynecologist at St. Jude, now almost exclusively uses a robotic procedure to secure a thin mesh in place. The procedure is performed through a few small incisions, allowing patients to often go home the very next day.

“Telling women this is fixable — and we can do it in a way that allows you to recover quickly, heal faster, and experience less pain — that is encouraging more and more women to not simply live with it anymore,” explains the Stanford-trained surgeon.

“Robotic surgery allows a precision that isn’t possible through other techniques — which means a less invasive procedure, better recovery and higher quality of life for patients,” explains Thomas Hughes, MD, a UCLA-trained, board-certified gynecologist who uses a robotic approach for hysterectomies as well as the treatment of uterine fibroids. “Because there is significantly less blood loss and trauma to the tissue, surgeries that might normally require three to four days in the hospital, are now becoming same-day procedures.”


In addition to all the usual benefits of robotic-assisted surgery, Theodoros Daskalakis, MD, a board-certified general surgeon who specializes in robotic surgeries, is adding one more. He routinely performs gallbladder surgery through a single incision across the belly button, offering patients an almost scarless procedure. “Robotic surgery is dramatically reducing the emotional and physical impact of surgery for patients,” he explains, adding that the number of procedures performed with a robot will continue to increase. “This is the future.”

Dr. Daskalakis is also using the da Vinci robot to perform hernia repair and remove diseased sections of the colon through dime-sized incisions. The robot’s Firefly Fluorescence Imaging capabilities — in which a dye is injected allowing the surgeon to clearly visualize anatomy and blood flow through a fluorescent camera — is proving valuable in minimizing the risk of complications. “Firefly allows me to identify potential issues before completing the surgery,” he says, “an advantage not possible with traditional surgery.”


Six years ago, Michael Gazzaniga, MD, a board-certified urologist, performed the first robotic procedure at St. Jude — a robotic prostatectomy — a surgery which has since become the gold standard for the treatment of prostate cancer.

“Robotic prostatectomy demonstrates that, through a few small incisions, we can maximize cancer removal while creating substantially less pain, shorter recovery, and fewer risks of long-term side effects such as incontinence,” explains Dr. Gazzaniga.

The robotic approach offers better visualization and access, allowing surgeons to more successfully avoid the nerves, blood vessels and muscles that control function. Research suggests that robotic-assisted prostate surgery is also less likely to leave cancer cells at the edges of the tumor sites, reducing the need for additional cancer treatments, such as radiation.

“Robot-assisted surgery has significantly changed what we can offer patients in terms of safety and outcomes,” Dr. Gazzaniga says. “And this is just the beginning.”


The price tag for the technology used in robotic surgery is not small. When surgeons at St. Jude first began pursuing a robotics program, generous donors within the community came forward to purchase the $2 million da Vinci Surgical Robotic System.

Since then, the program has grown into one of superior expertise and success. “What is uncommon about this hospital is the commitment found here,” Dr. Oh explains, who proctors and trains surgeons from around the world on performing robotic lung cancer removal. “Anyone can purchase the technology — using it to meaningfully advance patient care is a much higher standard.”

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