The Cutting Edge of Robotic Surgery

Robots are no longer a futuristic notion. In fact, they’re becoming more and more common in nearby operating rooms. Robotic surgery is an advanced form of minimally invasive surgery that makes use of computer-controlled robots to do what humans can’t—and also to do what surgeons can, only better.

Think about how bulky human hands are when compared to a robot’s. “The robotic instruments are articulated at the end of the instrument where the working end is, so the working end can move like a hand would, as if it had a wrist,” explained Dr. Anne Rodriguez, a gynecologic oncologist and breast surgeon who heads up the Cottage Health Robotic Surgery team.

“That gives you the ability to maneuver much more than you would with a straight instrument. And that ability can get you into small spaces, can get you into difficult spaces, and can allow you to do a lot finer technique, so to speak.”

In 2019, the Cottage Robotic Surgery Center performed 574 robotic surgery procedures with the da Vinci XI manufactured by Intuitive. The most common surgery was hysterectomy, with 117 of them performed last year, said Maria Zate, the hospital’s public relations manager, followed by prostatectomy and hernia.

Dr. William Gallivan of the Orthopedic Institute of Santa Barbara is a big proponent of the technology. “In 2005, I started using computer navigation,” said Gallivan. “It was new technology back then, and I haven’t gone back.” He’s performed robotic surgeries on knees since 2014, tallying 350 surgeries as of August 2020, using the NAVIO Surgical System and recently the MAKO Robotic-Arm System.

The precision advantages of robotics for knee surgeries are critical. “When we use robotics, we can actually do a better preservation of bone,” he said. “For young people who want to be active, they will be able to have a very high level of activity. We’ve got this technology that allows better preservation and maintenance of bone and other soft tissues and is very effective.”

Rodriguez also pointed out the advantages of the robots for surgeons themselves. “You’re basically sitting at a console to control the instrument rather than controlling the instrument at the bedside,” she said. “So ergonomically, it’s easier on the surgeon and that gives advantages both short-term and long-term in terms of your ability to continue to do surgery.”

Other advantages include shorter hospital stays and faster recoveries, in part because there is less need for narcotic pain medicine.

“About 95 percent of my patients are wide awake with a spinal anesthetic,” said Gallivan. “It’s the safest way to do it, and the patients have more fun being awake.” Patients can listen to music (“unless it’s something bad,” he laughed) and watch 3D models and cartoon versions of the operation.

Virtually scar-less, single-site surgeries can also be handled by robots, such as single-incision hysterectomies. Rather than making several incisions, the robotic process makes just one incision through the belly button, which decreases blood loss and shortens recovery time.

“Robots have obviously been used for a long time by the aviation, automotive, and military [sectors], and then health care,” said Gallivan. “But the robotic technology has never diminished or exited from an industry that’s adopted it. It’s not going anywhere. I’m a firm believer that this technology we’re using is here to stay.”


UCSB graduate Dr. Yulun Wang is considered one of the fathers of modern surgical robotics. The founder of both InTouch Health and Computer Motion, Wang developed AESOP, the first FDA-approved surgical robot (1990), and the ZEUS Robotic Surgical System. ZEUS was used in the world’s first tele-surgery procedure, known as the Lindbergh Operation, in 2001. The da Vinci surgical system now used by Cottage Health was developed by Intuitive Surgical following its merger with Computer Motion in 2003.

Tech Talk Special Issue for Santa Barbara Independent, published October 1, 2020.

Tech Talk Special Issue for Santa Barbara Independent, published October 1, 2020.


Tech Talk Special Issue for the Santa Barbara Independent, originally published on October 1, 2020.

To read the issue as it appeared in print, please click here, Tech Talk 768_10_01_20


The Shift to Telemedicine

The Shift to Telemedicine, from Santa Barbara Independent, Active Aging Special Section, July 30, 2020.

The Shift to Telemedicine, from Santa Barbara Independent, Active Aging Special Section, July 30, 2020.


All it took was a pandemic and a government-mandated shutdown, but it looks like telemedicine — the modern version of the house call — is here to stay.

Dr. William Gallivan and his team at Orthopedic Institute of Santa Barbara were using telemedicine on a limited basis for years before COVID-19, primarily for out-of-town patients who wanted to discuss possible surgical procedures and for short, post-surgical follow-up appointments. So when the pandemic mandated physicians to digitize their health-care process in March — while lifting some privacy restrictions to allow virtual exams — his office was better prepared than most. Even with restrictions now eased, the Orthopedic Institute is managing more than one-third of patient visits via telehealth.

In order to train seniors and other non-digital natives in the process, Gallivan is a “heavy utilizer of scribes,” enlisting tech-savvy, pre-med students to work with patients in advance of their appointments to set up remote communication. There’s a learning curve. “Sometimes it’s three or four calls to connect,” said Gallivan. “And with the outliers, it takes me two days of calling them to actually get a connection to do the telehealth. But most of them, more than 90 percent now, are set up and engaged with the telemedicine portal.”

How does this work for orthopedic exams, say, for a bad knee? “If it’s not a post-op, the patient actually can do a self-examination as we instruct them how to do it,” he said. “If we can see their range of motion, assess the swelling a little bit, and they can point out where it’s tender, we have a reasonable way to assess the problem and make recommendations.”

He plans to continue with telehealth as a bigger part of the practice even when the pandemic is over. Of course, he can’t replace the first post-op visit, when sutures are removed — “at least it would be a bit more of a challenge,” he said — but telemedicine works well for the six-week checkups.

“We can really be quite effective,” he said. “The communication has been excellent. Actually, some of it may even be better than the in-person stuff, because you are looking at the screen, instead of staring at a knee most of the time, you’ve got the patient’s face right there. The nonverbal communication is important, and I think we get that with telemedicine pretty well.”

He’s been happily surprised with how well it works, leaving visits confident that he provided a good service and not a second-rate one just because it is remote.

“It’s certainly not perfect, and I’m a big fan of in-person communication,” he said. “But the efficiency of not having sick people that have to travel for a meeting, and being able to get stuff done and having direct communication, is enhanced.”

Orthopedic Institute of Santa Barbara:

Active Aging 2020: Our Annual Guide to Senior Life, Seen Through a Pandemic Lens; Santa Barbara Independent, Active Aging Special Section, July 30, 2020.


Originally published in the Santa Barbara Independent on July 30, 2020. To view the Active Aging Guide to Senior Life, Seen Through a Pandemic Lens, click here.