LapaRobotic Surgery™ (LapaRobotics™)
LapaRobotic Surgery™ (LapaRobotics™) is the melding of two separate but related surgical techniques – laparoscopic surgery and robotic surgery. Scott D. Miller, MD coined the term LapaRobotics and LapaRobotic Surgery because of the special and unique ways in which the two techniques have come together in his treatment of urological conditions, as well as his dedicated and sole focus on these techniques.
Rather than using a large incision, laparoscopy uses several small incisions along with tiny instruments and video camera inserted into the body to perform a surgical procedure. Robotic surgery is a laparoscopic procedure, only with an added layer of technology. Rather than the surgeon’s hands directly moving the instruments, the robotic device is wheeled up to the patient and the robotic arms are attached to the telescope and the instruments. All movements of the camera and robotic instruments are precisely performed in real time by the surgeon using ergonomic finger controls.
Most urologic robotic surgeons have very little, if any, experience with advanced laparoscopic surgery. In fact, less than 1% of all urologists have performed even one laparoscopic prostate removal without robotic assistance. Dr. Scott Miller’s patients benefit from the fact that he has done more than 3,000 advanced laparoscopic procedures and robotic surgeries. Although he now performs all prostate removals with the robotic method, Dr. Scott Miller still uses the laparoscopic technique in some other types of surgery where the advantage of being at the patient’s side outweighs the benefits of robotic surgery.
What are the advantages of laparobotics – combined skills and knowledge from both procedures – to patient and surgeon alike?
- Better attention to detail – One of the benefits of robotic surgery is that it is easier to learn than laparoscopy. As a result, less experience is required to perform the same surgery with robotic assistance. However, there is no substitute for experience when it comes to interpreting and acting on subtle anatomic details. In fact, laparoscopic surgeons pay particular attention to anatomic detail in order to overcome the obstacles that are eliminated by robotic technology. A laparoscopic surgeon performing robotic surgery is like a carpenter using a power tool when he can complete the job with a hand tool – that additional skill lends itself to a better attention to detail.
- Improved safety – Robotic surgery is laparoscopic surgery. Anything that can go wrong with laparoscopy can happen with robotics. Dr. Scott Miller’s extensive experience with various advanced laparoscopic surgeries allows him to prevent and readily detect problems during robotic procedures.
- The ultimate contingency plan – Although very rare, should mechanical/technical difficulty prevent completion of a robotic procedure, Dr. Scott Miller would complete the procedure laparoscopically through the same small incisions yielding the same outcome. Most robotic surgeons would be forced to resort to open-incision surgery.
- Surgeon’s choice – In some patients, portions of a robotic procedure are better performed with a laparoscopic technique. Some examples would include unpredictable anatomy from prior surgery, need for access to the entire abdomen, and desired direct hands-on control.
Robotic technology is merely a tool that enhances the surgeon’s skills. The value of extensive laparoscopic experience is proven by the first robotic prostatectomy performed in Georgia by Dr. Scott Miller (2003) – with a fantastic outcome: favorable pathology and early return of urinary and sexual function. This demonstrates the natural transition from laparoscopy to robotics – the essence of LapaRoboticSurgery™.