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Services: Robotically Assisted Surgery

More advanced than the original da Vinci® surgical system, the da Vinci S increases the types of surgical procedures that can be performed by skilled UF surgeons. The da Vinci S utilizes four robotic arms that insert surgical instruments into tiny incisions less than the size of a dime.

The surgeon is in complete control of the da Vinici S and guides the surgical instruments by watching the area on a high definition monitor. With instruments that provide better dexterity and range of motion than the human hand, the surgeon gains greater control and precision than found in traditional open operations and some laparoscopic procedures.

Patients benefit by having more options for minimally invasive procedures - many not performed elsewhere in Northeast Florida and Southeast Georgia. University of Florida surgeons at UF Health Jacksonville can perform the following operations using the da Vinci S:

Your physician can refer you to a surgeon at UF Health Jacksonville to see if robotically assisted surgery is right for you.


Adrenalectomy

Part of the body's endocrine system, the adrenal glands are located on top of each kidney. The adrenals secrete powerful hormones directly into the bloodstream that regulate sodium and potassium levels, raise the level of sugar in the blood, control some sexual functions and secrete the "flight or fight" hormone adrenaline.

Tumors or enlargement of these glands may secrete an abnormal amount of the hormones and can affect the patient's metabolism. These are usually benign growths, but occasionally may be cancerous. Tumors left untreated can secret abnormal levels of hormones causing a severe imbalance. After removal of one of the adrenal glands (adrenalectomy), the body produces a normal amount of adrenal hormones. When both glands are removed, patients must take supplemental adrenal hormone replacement medication.


Anti-reflux Fundoplication

Because the esophagus does not have a mucus lining like the stomach, it can become irritated by acid that abnormally flows back (refluxes) from the stomach. Anti-reflux fundoplication is a procedure for treating gastroesophageal reflux disease (GERD).

GERD results when acid refluxes from the stomach back up into the esophagus. GERD is normally prevented by a functional muscular valve at the junction of the esophagus and stomach, the lower esophageal sphincter (LES). Most of the time, this sphincter is contracted to close off the esophagus from the stomach, acting as a barrier. In patients with GERD, the sphincter is either weak, relaxes inappropriately, or is forced open by a hiatal hernia. GERD causes inflammation, heartburn and other serious complications, such as scarring and narrowing of the esophagus. During an anti-reflux fundoplication procedure, the part of the stomach closest to the esophagus is sewn around the lower end of the esophagus. This procedure increases the pressure at the lower end of the esophagus to strengthen the valve function and reduce acid reflux.

  • Ziad T. Awad, M.D., F.A.C.S.
    Associate Professor
    Associate Chair, Quality; Chief, Division of General Surgery; Medical Director, Minimally Invasive Surgery Program; Program Director, Advanced GI Minimally Invasive Surgery Fellowship
    Specializes in Minimally Invasive Surgery; Surgery

Cholecystectomy

The gallbladder's main function is to store and concentrate bile, which is produced by the liver, and to release it for digestion. While the gallbladder performs an important function, it is not an essential organ.

It may be necessary to remove the gallbladder in patients with gallstones or those in which the gallbladder is not functioning normally (biliary dyskinesia). Gallstones (small, solid formations composed of cholesterol, pigment, and bile salts) are the most common disorder and can cause problems in the gallbladder and the rest of the biliary system, including the pancreas. Surgical removal, known as a cholecystectomy, is the most common therapy for gallbladder disorders.


Cystoprostatectomy

Cystoprostatectomy is surgical removal of the urinary bladder and prostate gland to eliminate muscle-invasive bladder cancer. Because the prostate gland and bladder are closely located within the body, removal of the prostate is usually done at the same time as the bladder in males. Removal of the bladder and prostate together reduces the risk of tumor spillage and reduces the risk of leaving bladder cancer cells on the prostate gland if it were allowed to remain. Removal of the bladder using the da Vinci robot typically allows for less blood loss and quicker recovery.


Esophageal (Heller) Myotomy for Achalasia

Achalasia is the second most common swallowing disorder after GERD and affects the esophagus in which the lower esophageal sphincter (a ring of muscle between the lower esophagus and the stomach) is unable to open and let food pass into the stomach. As a result, patients with achalasia have difficulty swallowing food. Left untreated, achalasia may cause the esophagus to become enlarged and eventually stop functioning. Causes of achalasia are not well understood; however, it is seen primarily in young women and middle-aged men and women. Patients with untreated achalasia are at a greater risk of developing esophageal cancer.

A Heller myotomy is a procedure for the treatment of achalasia during which the surgeon cuts the muscles of the lower esophageal sphincter to allow food to pass more easily into the stomach. Robotic assistance allows a more precise and accurate cutting of the affected sphincter muscle.

  • Ziad T. Awad, M.D., F.A.C.S.
    Associate Professor
    Associate Chair, Quality; Chief, Division of General Surgery; Medical Director, Minimally Invasive Surgery Program; Program Director, Advanced GI Minimally Invasive Surgery Fellowship
    Specializes in Minimally Invasive Surgery; Surgery

Gastrectomy

This procedure involves removal of all or part of the stomach. The body's digestive system uses the stomach to receive and break down food into nutrients that can be absorbed by the small intestine. If the stomach is completely removed, the esophagus is connected directly to the small intestine, which requires some dietary changes.

Stomach-related operations performed with robotic assistance include removal of cancerous or benign tumors, ulcer repair, insertion of gastric pacemakers and gastric bypass to relieve obstructions of the stomach and upper intestine.


Gastric Bypass

A surgical treatment for severe obesity, gastric bypass involves isolating a small section of the stomach to form a pouch to hold food as it passes from the esophagus. A part of the small intestine is disconnected from the upper intestinal tract and connected directly into this pouch. Because the pouch is small - and initially holds only one or two ounces of food - the patient is able to eat only small meals and over time can lose significant amounts of weight. Robotically assisted gastric bypass gives the surgeon greater precision and ability to operate on patients considered too heavy for open or laparoscopic procedures.


Gastric Sleeve

Severely obese patients may be recommended to have gastric sleeve surgery. The surgeon removes approximately 60 percent of the stomach, leaving a sleeve-shaped portion to receive and digest food. Reduction in stomach size forces patients to lose weight. A significant advantage to the gastric sleeve procedure is that it requires no re-routing of the digestive system. Surgeons performing gastric sleeve using the da Vinci S can complete the procedure in about 90 minutes, and with the greater dexterity provided by robotics can ensure that sutures are tied tightly to close the stomach walls.

Severely obese patients may be recommended to have a duodenal switch operation. This is performed in conjunction with a gastric sleeve, and like gastric bypass, a significant portion of the upper small intestine is bypassed in order to decrease the absorption of the food that is eaten.


Hysterectomy

A woman's uterus (or womb) is part of her reproductive system and is home to a developing fetus during pregnancy. A healthy uterus rarely needs to be removed, but a number of factors can precipitate removal as treatment. Conditions such as excessive fibroids, endometriosis (where uterine tissue grows outside the uterus covering ovaries and fallopian tubes), uterine prolapse (when the uterus falls into the vagina or persistent vaginal bleeding, may call for a hysterectomy. The most common form of hysterectomy is the complete or total hysterectomy that removes the uterus and cervix. A partial hysterectomy removes the uterus and leaves the cervix in place. Radical hysterectomies remove the uterus, cervix and the upper part of the vagina. Although not always necessary, ovaries and fallopian tubes may be removed during a hysterectomy.

Most hysterectomies are performed abdominally with a "bikini" incision in the pelvic region or vaginally, which removes the uterus through the vagina. Robotically assisted hysterectomies increase the number of women eligible for minimally invasive options by using tiny incisions to extract the uterus and other associated organs or tissues. Abdominal hysterectomies can require up to four weeks recovery time and may involve excessive surgical blood loss. With robotically assisted hysterectomies, most women can return to normal activities within one to two weeks and have minimal scaring for a better cosmetic outcome.


Myomectomy

Myomectomy is the removal of fibroid tissue in the uterus. Fibroids are non-cancerous tissue masses that occur in a large number of women of childbearing age. Most women with fibroidal tissue never show symptoms. When symptoms such as severe, painful cramping, heavy menstrual bleeding, bleeding between periods, unusual constipation and urinary incontinence or frequency do not respond to other therapies, removal may be the best option. Often done as open surgery, robotically assisted myomectomies reduce recovery time and have proven advantageous when a women wishes to preserve fertility and keep her uterus intact.


Nephrectomy and Living-Related-Donor Nephrectomy for Transplantation

The body has two kidneys located just below and behind the liver on the right and below the spleen on the left. The kidneys play a major role in overall health and are responsible for filtering fluid wastes from the bloodstream (urine) and storing the liquid wastes in the bladder until expelled. A kidney damaged by injury, cancer or excessive cysts may need to be removed. If the remaining kidney is healthy, over time it compensates for the missing kidney and resumes its blood filtering function with little to no difficulty.

A nephrectomy is also performed when a living donor, usually biologically related, has one kidney removed for transplantation. Success rates for transplanting a kidney from a living-related donor are much higher than when using kidneys from deceased, unrelated donors. Recovery time for the living-related donor is usually swift and complete.

When small tumors suspicious for cancer are present in the kidney, they can sometimes be removed and the remainder of the kidney left behind. This is known as a partial nephrectomy. This is desirable whenever possible because a health partial kidney may have enough function to keep a person off dialysis if it were the only kidney left.


Pancreatectomy

The pancreas is part of the body's endocrine system and lies across and behind the stomach. It produces digestive enzymes and hormones and insulin to regulate blood sugar. Removal of all or part of the pancreas may be necessary to treat cancer, eliminate cysts or other benign tumors, or to treat pancreatitis.

With a distal pancreatectomy, only a part, typically the end, of the pancreas is removed and the pancreas continues to function in a normal fashion.

A total pancreatectomy removes the entire pancreas and parts or all of digestive organs associated with it. Patients having total pancreatectomies have to take digestive enzyme supplements and insulin for the rest of their lives.

  • Ziad T. Awad, M.D., F.A.C.S.
    Associate Professor
    Associate Chair, Quality; Chief, Division of General Surgery; Medical Director, Minimally Invasive Surgery Program; Program Director, Advanced GI Minimally Invasive Surgery Fellowship
    Specializes in Minimally Invasive Surgery; Surgery

Prostatectomy

The prostate is a walnut-shaped gland found in the pelvic region of men, just under the bladder and in front of the rectum. It surrounds the urethra, the tube that drains urine from the bladder and out the penis, and when enlarged can create urination difficulties. The prostate's prime function is to produce seminal fluids necessary for sperm transportation. While studies are inconclusive as to the cause of prostate cancer, the disease is the most common form of cancer in men.

A prostatectomy is the removal of all or part of the prostate and surrounding tissue to eliminate cancer and abnormal cell growth. With early detection and removal, survival rates are high. Post-prostatectomy treatment for possible bladder incontinence and sexual dysfunction may be necessary. Robotic assistance during this procedure gives the surgeon greater dexterity and ability to probe deeper with better visualization than other surgical options.


Pulmonary Lobectomy

A pulmonary lobectomy is an operation to remove a lobe of the lung. A lobectomy is performed to treat lung conditions such as lung cancer, congenital defects, cysts, tuberculosis and emphysema. While a traditional lobectomy involves making a large incision and spreading the ribs to remove the lung lobe affected by the tumor, surgeons using the da Vinci S are able to make several small incisions between the ribs to remove the lobe. Patients who undergo robotically assisted lobectomy typically experience less pain and fewer complications.


Small Intestine, Colon and Rectum Resection

A number of causes can contribute to perforation, bleeding, inflammation or obstruction of the small intestine, colon and rectum, inhibiting the normal passage of feces, including injury, cancer, diverticulitis, rectal prolapse, ulcerative colitis or Crohn's disease (an inflammatory bowel disease). An intestinal resection is the removal and repair of the diseased section of small or large intestine. When small sections are required to be removed, the ends are connected to each other. Most patients reach full recovery and return to normal intestinal function, although rectal cancer patients sometimes require a colostomy and may undergo additional treatment such as radiation and chemotherapy.


Splenectomy

The function of the spleen is to remove bacteria as well as dead and dying blood cells from the body, creates and stores new red blood cells, and assists in fighting certain types of infections. The spleen may need to be removed due to injury or a number of diseases, including acute and chronic leukemia, thrombocytopenia, cysts, splenic tumors, splenic artery aneurysms, or a variety of anemias.