Thursday, Nov 20, 2014
Health

Robot-assisted surgeries becoming more common


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Just 10 years ago, the idea of robotic-assisted surgery was still far removed from the typical patient's ability to comprehend. But with the introduction of the da Vinci Surgical System to hospitals across the country, the idea of robotic assistance in the operating room is no longer a figment of a futuristic imagination.

It is now a common procedure in many of the nation's top operating rooms.

The benefits to the patient, from less invasive procedures to shorter recovery times, are the main reason Oak Hill Hospital purchased their system in late February as part of their massive expansion.

"We have 10 surgeons out of Oak Hill that are specially trained on the da Vinci," said Richard Linkul, Oak Hill's marketing director.

In fact, Intuitive, the manufacturer of the da Vinci Surgical System, acknowledged that Oak Hill Hospital is the "fastest hospital in the nation as it relates to the launching of the da Vinci," according to Linkul.

"It looks at the number of physicians, the number of specialties, the number of surgeries performed and the quality of the surgical team," he added.

The da Vinci Surgical System is comprised of a robot with arms the surgeon controls from a console. A high-definition monitor displays the entire procedure on a screen. From the console, the surgeon sees three-dimensional images and controls the robot's arms. It is important to note that the surgeon is still in complete control of the procedure and a highly trained surgical team is present to prep the patient and assist the surgery.

The surgical team is an important element, Linkul said. In fact, the same team works each da Vinci procedure.

"The da Vinci stays in that one room in a designated suite with designated surgeons and a designated surgical team," he added.

Using a computer program called the Navigator, surgeons and surgical team members learn through simulated situations.

"And they are tested for dexterity and speed," Linkul said. "It's very sophisticated."

The da Vinci also has thousands of safety checks built in. For instance, the surgeon's head must be touching the monitor at all times.

"As soon as they move their head, the whole system stops," Linkul said. Learning the robotic method for laparoscopic procedures requires several steps until the surgeon is comfortable with the procedure.

"The surgeries aren't necessarily quicker, but the safety and technology is much enhanced," he said. "And it is high-definition, three-dimensional clarity. It's so far evolved from open (surgery), which then evolved to laparoscopic."

More top surgeons are learning the da Vinci system, including experienced surgeons like David Buethe, a urologist by training with a subspecialty fellowship training in urologic oncology.

Buethe performs both urologic cases such as sacrocolpopexi and urologic oncology cases targeting cancers of the urinary tract.

"To my knowledge there is no other surgeon who is doing this within the local vicinity," Linkul said.

Buethe's resume is impressive, including an extensive two-year fellowship at Moffitt Cancer Center, accredited by the Society of Urologic Oncology. His expertise in areas of urology and oncology with da Vinci training is a huge benefit to Oak Hill's surgical team.

As a urologic oncologist, Buethe deals with issues involving the urinary tract, including the kidneys, ureter, bladder and prostate and cancers identified within those organs.

"I spent two years at Moffitt specifically treating urologic cancers," Buethe said. "I consider myself a urologic oncologist and am probably the only one in the Hernando/Pasco county region."

The da Vinci is geared toward urologists and gynecologists," he said, "as they often perform procedures deep with the pelvis where the working space is limited and visualization often obscured at time of open surgery."

During his residency, Buethe performed all of his prostatectomies and cystectomies using an open surgical approach.

"It is a difficult space to work," he said. "The amount of bleeding, especially during a prostatectomy is significantly more than we see with robot-assisted laparoscopic procedures. Further, the recovery times were significantly longer. With robotic-assisted surgeries, there is less bleeding and therefore less recovery time."

Patients go home sooner, thereby decreasing the overall cost of surgically managing a specific illness.

Traditional laparoscopic surgeries use two instruments that move with limited articulation and range of motion. But robot-assisted surgery allows the surgeon to have a range of motion comparable to the human wrist, Buethe explained.

During surgery, Buethe sits at a console and uses his fingers to gently pinch and release the controller, and the robotic arms mimic the movement within the patient. The ability to see three-dimensional clarity from the console viewing apparatus allows for complete vision in and around the surgical site.

Monitors display the images in real time as the surgeon works, allowing the surgical team complete access to the procedure at all times.

Carla Hamilton, a surgical technician who worked with Bluethe on his first da Vinci-assisted surgery, admitted she was a bit apprehensive at first. But after learning the techniques, she is very comfortable with the system.

She and her colleague, Linda McMahon, an OR registered nurse, are part of the surgical team that is present for nearly all da Vinci-assisted procedures.

The technology has added considerable benefits to the patients of Oak Hill as well as the staff.

"It is becoming the standard in surgeries," Linkul said.

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