Dr Nicole Basa

What is Robotic Surgery? Does the Robot do it? No, it’s 100% controlled by the Surgeon.

After seeing this video of the DaVinci it seems like the robot is on autopilot. It is most definitely NOT. When I did open and laparoscopic surgery at first thought I didn’t think I needed the robot to do surgeries.

But, just like everything once you live with the technology day to day you realize that you can’t live without it. Almost like the internet. I didn’t have it as a kid but once it was available I couldn’t imagine going back to those dusty encyclopedias to look up facts.

Robotic Surgery allows the surgeon to do complex operations through tiny incisions with the best view and best ability to move tiny instruments in difficult to go areas in the abdomen even your hands would have a hard time getting to. What this means is the technology allows you to move surgical instruments like you were moving your fingers in the abdomen. The tips of the instruments which are only 2-3 cm in length and work like your fingers. You also have control of the camera and 3 working instruments so you can assist yourself with a third arm.

As a surgeon the more you do robotic surgery the more adept you become at it to where you don’t even think about the different things you do to make the case happen. Now after almost 2000 robotic operations I don’t even think about what I’m doing on the console - it’s become almost second nature. What I’m thinking about is completing the surgery as precisely as possible.

Did you know caffeine boosts cortisol by 30% 60 Minutes after drinking it? It can increase cortisol by 50% if you drink your coffee on an empty stomach. This effect is worsened if you combine stress with caffeine. The stress response of cortisol is almost doubled.

Cortisol peaks at around 6:30-9 AM so definitely drinking your coffee during this time will potentiate this cortisol response.

So why is this important to know? Cortisol impedes weight loss. How does it do this? Cortisol does the following:
1. Increases appetite
2. Increases abdominal visceral fat. Visceral fat is the bad fat inside your abdomen.
3. It suppresses the breakdown of visceral fat.
4. It causes hyperinsulinemia and hepatic and peripheral insulin resistance which can lead to diabetes.
5. It causes muscle breakdown
6. It suppresses Brown Adipose Tissue (BAT) activity redirecting the fat to storage instead of the consumption of energy through thermogenesis.

What if we need our coffee to wake up but we don’t want this cortisol increase?
1. Try to have coffee later in the morning.
2. Have a protein based meal prior to drinking coffee to decrease the spike.
Ultimately how do we drop our cortisol levels?
1. Stress Management
2. Ashwagandha is known in studies to decrease cortisol but it’s not significant for weight loss.
3. Exercise can reduce circulating cortisol

Should I go into surgery as a female? That’s the question I asked 25 years ago and it’s the same question women are asking today. Is it possible to have a family life and be a Surgeon?!?

To this day I hear young women struggling to choose a career in medicine that affords a life work balance.
Oftentimes they’re advised to pick a career in medicine that’s not as rigorous or hard. A field that’s more 9-5 PM than 24/7.

When I was looking into surgical residencies there were certain programs that almost prided themselves on being rigorous with having the highest divorce rates during surgical residency in the country. Seriously!?! Why would this be a positive? Because the resident gets a lot of experience?

Well I’m here to show you that you absolutely can be a female surgeon and have a family. It’s really how you design your work life and family life to do so. So take home point is that yes you can be a Surgeon as a female. I definitely wouldn’t sacrifice your career for the “the what ifs” of having a family. You just don’t know where life will take you. I would however :
1. Make sure to choose your spouse well who’s understanding and can do housework. If not, they may resent you if you’re away from home a lot with being on call etc.
2. Choose or create the type of practice you want which can afford you a work/life balance. If you’re in control of your time it’s possible but as medicine gets more corporatized you may not have too many choices.

Did you know that 25% of female surgeons are single, compared to only 6% of male surgeons? In addition to that only 25% of women choose to have their first child during surgical residency which is half as many as their male colleagues.

I know when I was in surgical training during the ages of 25 to 32 there was no way I wanted to get pregnant during a rigorous surgical training program at USC/LAC. There were a couple of female residents who got pregnant during my training years and even though looking back they were smart to have had kids during these child bearing years others including myself were upset that the rest of us had to work extra shifts for them to go on a “maternity leave.” I didn’t want to “disappoint,” my attendings by not giving 100% to the field of surgery. I didn’t want to be perceived as “weak,” as compared to male surgeons in training. In addition I didn’t want anything to distract me from learning all I could from the demanding field of surgery.

So what about after surgical training? Starting out in private practice with my husband we devoted 110% of ourselves to get our practice started so there was no real time to devote to having a child. With taking 1/3 of the month to overnight emergency surgical call between the two of us having a family was the last thing on our mind. With this mentality there was really no way we could have a child. However, at the age of 37 we had our surprise pregnancy. I hate to admit it but when we found out we were both in such shock that we “weren’t quite ready.” Looking back I can’t believe I thought that way. It was indeed the best thing that happened to us. So can you have a family and be a female surgeon? Yes. When I look back on it we were lucky to have had a child when the field of surgical training taught you to sacrifice everything for your career.

Did you know that 1 in 3 female surgeons can be infertile? By age 40, the chance of conceiving naturally each month is under 10%. I think by knowing this information you can make better informed decisions about when to have kids.

What is Robotic Surgery? Does the Robot do it? No, it’s 100% controlled by the Surgeon.

After seeing this video of the DaVinci it seems like the robot is on autopilot. It is most definitely NOT. First off most surgeons do not only robotic surgery but also laparoscopic and open surgeries. When the first robot platform was purchased by my hospital in 2009 I I didn’t think I needed the robot to do surgeries at all.

But, just like everything as I’ve performed robotic surgeries over the last 17 years weekly I’ve realized it’s hard to imagine live without it. I’ve done some really difficult surgeries with it that doing it laparoscopically wouldn’t have been possible and I would have had to open the abdomen with a large incision. Robotic surgery is almost like the internet when it first became mainstream. I didn’t have it as a kid but once it was available I couldn’t imagine going back to those dusty encyclopedias to look up facts.

Robotic Surgery allows the surgeon to do complex operations through tiny incisions with the best view and best ability to move tiny instruments with your finger tips in difficult to go areas in the abdomen even your hands would have a hard time getting to. What this means is the technology allows you to move surgical instruments like you were moving your fingers in the abdomen. The tips of the instruments which are only 2-3 cm in length and work like your fingers. You also have control of the camera and 3 working instruments so you can assist yourself with a third arm.

As a surgeon the more you do robotic surgery the more adept you become at it to where you don’t even think about the different things you do to make the case happen. Now after almost 2000 robotic operations I don’t even think about what I’m doing on the console - it’s become almost second nature. What I’m thinking about is completing the surgery as precisely as possible.