What do I mean by “robot”? Basically, I mean an instrument about 8 millimeters in diameter that enters through a small incision and has the same range of motion as the human hand. There are also cutting instruments, tools to cauterize tissue, tools to put needles through to sew with and retractor tools. There’s also a robotically controlled camera. I can zoom in. I can zoom out. I can look around. I’m controlling it all from the robotic console.
The way I explain it to patients is, it’s just like being up in an airplane. When you fly a modern jet aircraft and you pull back on the yoke, you’re not pulling pulleys. What you’re doing is sending electrical signals to motors that are moving wings. So you’re not actually moving a wing; you’re telling a device to move a wing. Robotic surgery is like that.
I was not always a believer in robotics. But during a special assignment while on active duty in early 2000 at the VA (U.S. Department of Veterans Affairs) in San Francisco, one of the urologists brought in a robot. I said, “I’m going to give this a second look.” I later attended a conference with three guys from small, private hospitals who were doing endoscopic surgery, which is where minimally invasive stuff had been the most powerful. These guys were doing very innovative surgeries. I went and watched a case and said, “Wow, I think this has value.” I ended up doing military-sponsored research at SRI International in Menlo Park, California, where we built a robot arm that fires the suture, tensions it, welds it together and then cuts it.
From an early age, I learned to value and respect the men and women who serve in the U.S. military. My father served as a combat medic with the Navy during the Vietnam War, and my grandfather was a chaplain in the local hospital. Since I was a kid, I knew I wanted to focus on healing the sick and the injured.
As an officer in the Army, I served three tours as a trauma surgeon — twice in Afghanistan as chief of clinical services with the 249th General Hospital detachment at Forward Operating Base Salerno.
My last role was as chief of surgery for the 47th Combat Support Hospital in Mosul in northern Iraq. Through it all, I faced a diverse set of clinical challenges: shrapnel wounds, head injuries, strokes, heart attacks and viral meningitis, among others. The spectrum of diseases that I dealt with was so broad that it gave me an old-school experience of learning medicine from the ground up. Because of this, I can practice medicine now outside of the box.
Robotics falls under that umbrella. Patients really value smaller incisions and less pain. I discharged a patient who had mitral valve repair after just two days. We’ve had many patients discharged on day three, which is extremely quick.
In terms of the skills to do robotics, small-team leadership is the most important. For an operation that requires exquisite team cooperation, shared responsibility and shared tasks, you must have that level of teamwork.
Dr. T. Sloane Guy, director of Robotic Cardiac Surgery, leads the first-ever robotic cardiac surgery program at NewYork-Presbyterian/Weill Cornell Medical Center and Weill Cornell Medicine, heading a clinical team that performs innovative and minimally invasive procedures for cardiac patients. His robotics team is equipped to perform a wide range of totally endoscopic cardiac surgical procedures — methods that use small, dexterous robotic instruments and require only tiny incisions.