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Kemp Kernstine, M.D., Ph.D. Answers Questions On Robotic Surgery

Kemp Kernstine, M.D., Ph.D. Answers Questions On: Robotic Surgery

How did you become interested in minimally invasive robotic surgery and how has it changed since you performed your first?

I have been performing minimally invasive surgery since 1990 and began performing minimally invasive surgery in the chest in 1992 with my first VATS lobectomy in Boston. In 2002, in my prior university-based practice, I was encouraged to learn robotic surgery because a new system had been purchased there. It seemed to offer many great opportunities for patients who were qualified for minimally invasive surgery. There have been improvements since then, but even 10 years ago, it was clearly a very efficient surgical procedure with greater precision that allows patients to experience less discomfort and get back to normal activities sooner. These are still the important points for patients today.

How do you determine when robotic surgery is the best option for your patients?

When conditions of the lungs or esophagus need to be treated with surgery, robotic surgery is often a more appealing option for patients, over traditional surgery, because it is performed through a few tiny incisions between the ribs and patients avoid both a large incision and the possibility of having their ribs spread. It takes a long time to recover from that. However, sometimes an individual’s circumstances (past surgery history, pregnancy, bleeding disorders, or significant cardio-pulmonary conditions) may preclude using minimally invasive techniques such as robotic surgery or may indicate other treatment options.

As our experience increases and technology improves, the issue of past surgeries is becoming less of a factor and we also are making our way into locations that are historically difficult to reach through surgery.

Is an actual robot doing the surgery?

It’s really not a true robot, it’s a computer-assisted surgical system. The system involves large robotic arms that translate the surgeon’s hand movements into smaller, more precise movements to tiny instruments inside the body. The robot arms can move at the very location where they’re doing their work. So what’s outside the patient isn’t moving very much. It’s the inside where all the movement occurs, where you don’t have pain fibers. The surgery is performed entirely by a specially trained doctor using the robot/computer system as a tool.

How precise can you get with robotic surgery?

I had one patient who had a small mass in his esophagus, and it would have required a thoracotomy, which is a big incision in the chest, opening up the chest and pushing the lungs out of the way. With robotic technology, you can precisely go in exactly where that patient has a problem. In this case, I went right into the esophagus, made a small hole in it, removed the mass, sewed it up. The patient went home the next day. This is something for which we used to have to keep the patient in the hospital for a week and a half to two weeks. With robotic surgery, procedures like this may be able to be done on an outpatient basis in the future, maybe even without putting them to sleep. As we get better and better and with more research, things could be very different from what we have now.

What are some of the most promising developments on the horizon for your patients?

Surgically, better minimally invasive robotic equipment is being developed. Because of the successes of the currently approved and available robotic system, there are at least four other robotic companies that are attempting to bring their technology into the market for patient use. As competition increases, the machines will get better and faster. These are exciting times in robotic surgery.

For lung cancer patients specifically, the study of the molecular behavior of cancer cells is being used to determine exactly what treatment will work best for an individual tumor and patient. The day of ‘one treatment fits all’ is over.

How would you describe your patient care philosophy?

We need to perform the highest quality procedures with the least discomfort and physiological side effects for our patients. Part of my team’s patient care philosophy is always thinking out of the box. Don’t just take what’s presented to you. Treating cancer takes teamwork, asking questions, and listening to the patient.