New technology paves the way for robotic 1-incision colon surgery

The surgeon sits at a computer console that looks a bit like a Pixar WALL-E.

After clenching his thumb and forefinger, he makes small movements to cut, cauterize, or suture while watching the console’s screen, which provides a magnified 3D view of the surgical site. He pedals like an organist, switching back and forth between instruments.

Surgeon Garrett Friedman’s movements are teleported to a robot a few feet away, usually an octopus-like machine with four arms. This afternoon, however, the robot in the operating room at Mountain View Hospital has only one robotic arm with four tiny tips, three with pincer tips and a fourth with a tiny camera.

This next-generation robotic surgery system requires a small incision for colon surgery, rather than the multiple incisions of earlier robotic systems, or the groin-to-rib incision of traditional manual surgery.

“It really reduces surgery to the absolute bare minimum that patients need to have minimally invasive colon surgery in 2022,” Friedman said Tuesday when he demonstrated the system.

Freedman and HCA’s Mountain View Hospital have joined an FDA clinical trial to confirm the safety and feasibility of using the da Vinci SP (single-port) robotic system in a variety of colorectal procedures. The trial is enrolling adult patients suitable for minimally invasive surgery for colon cancer, polyps and other conditions.

Friedman is one of the few surgeons in the United States to use the system for colorectal surgery. MountainView is the only facility in Nevada with this system.

Friedman said the system was initially validated by the FDA for use in urology and oral procedures, such as tongue cancer. He has used the system less than 10 times in single incision procedures and 30 to 40 times in other colon procedures. The FDA gives doctors broad freedom to use the device in ways beyond its original approval.

“We have been able to perform these operations safely before, so we have high confidence that it is safe to do so,” he said.

According to the study’s description, the technology’s performance in trials will be assessed by whether it can be done without the need to switch to another method, such as multiport robotics or laparoscopic surgery.

Other participants in the trial include Adventist Health System/Sunbelt in Orlando, Florida, the Mayo Clinic in Rochester, New York, and the Methodist Research Institute in Houston.

Robotic surgery is believed to allow doctors to perform certain complex procedures with greater precision and control. By reducing the number of incisions to one, the single-port system can reduce pain and scarring, Friedman said.

“We all want the least invasive[methods]the least pain, the least complications, and we think this is the way to do that, using this highly specialized technique,” he said. There is a cosmetic benefit, as a single cut can be hidden below the bikini line.

There is no additional or reduced cost for patients to participate in the clinical trial, which requires follow-up examinations at 14 and 42 days after surgery, and more annually for five years, according to the study description.

Friedman, 37, received his medical training at Weill/Cornell/New York-Presbyterian Hospital, Memorial Sloan Kettering Cancer Center, Columbia University Medical Center and Loma Linda University Medical Center.

A US Air Force surgeon, he came to Las Vegas in 2017 to work at Nellis Air Force Base. “I never really planned to live in Las Vegas, but in the end, I fell in love with it,” he said.

“I knew I wanted to stay, I knew I wanted to do more than just hang my shingles and do surgery,” he said. “I want to try to build programs — something we can be proud of here in Las Vegas.”

Contact Mary Hynes at or 702-383-0336.follow @MaryHynes1 on Twitter.

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