For many in healthcare, there is a belief that while robotic surgery has its place in many specialties, it is not well-suited to the speed and tumult of emergency medicine. According to this view, robotic surgery requires too much setup time, and takes too long, to be widely useful in this context.
But in recent years, a growing group of surgeons have realized that emergency surgery is an area that presents enormous possibilities for robotic surgery. They argue that with proper planning and organization, Intuitive’s da Vinci systems can be the foundation of a successful around-the-clock emergency surgery enterprise, and may help reduce complications, improve patient outcomes compared to open surgery, across a range of common emergency surgical procedures.
“This has worked really well for my practice,” says Dr. Andrea Pakula, a general and acute care surgeon at Adventist Health Hospital in Simi Valley, just outside Los Angeles. “It’s allowed me to expand minimally invasive surgery to the patients that I see through the emergency room.”
Pakula and other surgeons say that this trend is important because it means that more surgical patients can be managed with an approach that may be less invasive, potentially contributing to fewer complications and shorter hospital stays, compared to open surgery.
She was first introduced to robotic surgery in 2016, when the hospital where she then worked purchased a da Vinci system. Until then, she had worked as an open and laparoscopic surgeon. As she began training on the system, she says she saw that it allowed her to perform more complex surgery, often with faster recovery compared to open surgery. Three years ago, she went to Simi Valley in large part because she was excited by their commitment to using a robotic approach in emergency surgery.
“We want to turn da Vinci into an expected part of acute care surgery, just another option.”
Robotic surgeries, any time, day or night
Pakula, who is the medical director of robotic surgery at the hospital, performs a wide range of procedures using the system, including complex hernia surgery, bariatric surgery and other emergency general surgery procedures. “We’re now able to do minimally invasive surgery any time of day or night, with the same level of care.”
Some surgeons are reluctant to use a robotic approach in emergency cases because such patients are often sick or have multiple health issues. Pakula says robotic surgery with da Vinci may in some cases help reduce complications and recovery time with these patients, compared to open surgery. “In my experience, many patients can really benefit from this,” she says.
Pakula is not the only surgeon taking this approach to emergency surgery. Dr. Laila Rashidi, a colorectal surgeon at Multicare Hospital in Tacoma, Washington, was already an accomplished da Vinci surgeon. But she had a vision for how to do more for more patients.
She wanted to offer robotic surgery around the clock, seven days a week; she also wanted it to be available to patients in other specialties besides hers. “At the time,” she says, “we had two da Vinci systems, and they were only available from 7:30 a.m. to 3 p.m. So that left a lot of patients out.”
In 2020, she started to do a few of her emergency cases robotically, during normal hours. These cases generated interest among her colleagues. “I had nurses, surgical techs, even surgeons coming into the operating room and watching because they heard that we were doing emergency cases with da Vinci,” she says.