Three slender metal arms wrapped in protective plastic protrude from Da Vinci 5, a surgical robot, looking for all the world like “Doc Ock” of Spiderman fame. Hip-hop and country music fill the room as nurses and technicians ready the beast for its assignment.
Otolaryngologist Sanjay Athavale is hunkered down over a double lens microscope focusing on the 10X hi-definition image he will use to find and remove two clumps of tonsil tissue from the patient’s throat.
“Everyone has tonsil type tissue in the back of the nose, in the back of the throat and in the back of the tongue,” he said. “All of that is called tonsillar tissue and when you sleep, your body becomes paralyzed. The tonsillar tissue slumps in on itself blocking the air passage, causing sleep apnea. By removing the excess tissue at the back of the throat, including the tonsils, the air passage stays open and the apnea is cured or alleviated.”
Athavale said only three hospitals in Georgia — Cartersville, Atlanta and Macon — use the procedure on a consistent basis.
“Other hospitals have the robotic arms but to make it work correctly, you must have all this,” he said pointing to an entire room filled with flat screen monitors, keyboard controls and what seems to be several miles of cables and wires. “You can’t do this type of work without all this.”
Why use a robot?
“It is physically impossible to get your hands around a corner,” he said. “To get into the mouth, I have to stick my hand into the back of the mouth and turn a corner. The human hand isn’t designed to do that. The beauty of the robot is that you can literally move the robot’s hands 720 degrees. We can’t do that.”
Athavale said the main reason he was attracted to the robot is its possibilities for treating oral cancers.
“Tonsil and throat cancers are remaining the same despite the fact that fewer people smoke and drink,” he said. “We have learned that the human papilloma virus is directly connected to tonsil and throat cancer. The treatment has always been chemo and radiation therapy.”
After removing the patient’s tonsils the old school way, Athavale and Certified Surgical Technologist Kimberly McMicken fire up the robot to continue the surgery. Wide screen televisions suddenly come alive with high definition images of the patients throat.
“There it is,” Athavale said, pointing out what appears to be a huge lump in the patient’s throat. “We have to get rid of that to open the airway.”
Athavale is across the room looking at a screen, his fingers on a controller that guides the robot’s arms. One arm has a claw that holds the tissue while the other arm is equipped with a cutting device and a cauterizer. As his fingers move, the robots arms respond. The claw grabs what seems to be a huge clump of tissue while the other arm makes an incision and cauterizes it. The other piece of tissue is removed the same way. On the screens, the tissue samples look gigantic, but the real remnants are no bigger than a half-dollar.
After 15 minutes, the procedure is complete. The patient will spend one night in the hospital and go home. The surgical team moves to its next assignment.
“It may look like I’m the one doing everything, but that’s not true,” Athavale said. “This is a team; everyone’s job is essential.”