|
|||
   |
|||
News Article
Suggested Links:
Robot Revolutionizes Surgery
Concord Transcript
A New Era in Operations: High-tech device trims patients' recovery times, keeps Mt. Diablo surgeons on cutting edge.
By Theresa Harrington
Staff Writer
Walnut Creek Journal and Concord Transcript
CONCORD - Surgery at Mt. Diablo Medical Center is entering a new era.
Instead of a surgeon leaning over a gaping incision and handling scalpels and other tools, a robot now often guides pencil-thin equipment inside small cuts to perform the surgery.
And where is the surgeon?
He's over in the corner of the operating room, manipulating robotic controls with his hands and feet while looking at a three-dimensional magnified viewing screen that can make him feel as though he's inside the patient's body.
"The da Vinci robot is the next major advance in laparoscopic surgery," said Dr. Stephen Taylor, a urologist who uses the robot for prostate cancer surgeries.
Taylor and other laparoscopic surgeons say the $1 million da Vinci robot, created by Intuitive Surgical, represents a huge technological leap because it has "intuitive" controls that mimic hand movements, uses tiny surgical tools, and has a three-dimensional screen with images magnified up to 16 times.
"Instead of being limited to just taking something out, we can do very fine delicate reconstruction techniques," Taylor said. "I think in years, (robotic surgery) will replace the way people do prostate cancer surgery."
Surgeons have used the robot to perform about 37 surgeries since it arrived at the hospital at the end of June. Besides operations for prostate cancer, it can be used to remove tumors and kidneys, and to do other detailed work.
Mt. Diablo Medical Center is the fourth hospital in Northern California to be equipped with a da Vinci robot. There are about 125 such robots around the world, including 75 in the United States.
Although the technology is new, there are plenty of patients willing to go under the robotically operated knife at Mt. Diablo Medical Center. Advantages to patients include smaller incisions, less pain and blood loss, and shorter recovery times than with conventional, or open, surgeries.
Gail Varner, who had a tumor robotically removed from her esophagus in October, went home two days after her surgery and said she felt no pain. Her five tiny scars are each about a half-inch long and have almost disappeared, she added.
"I had no problems," she said. "It was really nothing."
She and other patients who have undergone surgery at the medical center said the expertise of local surgeons made them feel comfortable with the technology.
"We're developing the techniques," said Dr. Horacio Asbun, director of advanced laparoscopic surgery at Mt. Diablo Medical Center. "We're pioneering the procedures. Some people have done it, but there are no books to go and read about it."
Asbun is spreading the word about the robot's capabilities by speaking at medical conferences and allowing other surgeons to watch his operations. Five doctors from Japan recently observed an operation in which Asbun used the robot to clear an obstructed pathway in patient Walter Ghio's esophagus. No hospital in Japan has a da Vinci robot, and the surgeons were keenly interested in its abilities.
"It's amazing and it's impressive," said Dr. Kiyokazu Nakajima. "I'm not only impressed by the robot, but with the quality of the surgical team."
He noticed that the nurses and anesthesiologist at Mt. Diablo Medical Center adapted their usual practices to accommodate the robot. The anesthesiologist sat farther away from the patient than he would in open surgery, to make room for the large robotic arms that were positioned over the patient.
"Sometimes there is resistance," Nakajima said, explaining that surgical teams had to adjust when laparoscopic surgery was introduced 10 years ago. But nurse Sharon Krhoun said the Mt. Diablo Medical Center staff is excited about the robot.
"It's real cutting edge," she said. "It's been a real boost to this hospital."
As Asbun manipulated the robotic controls during Ghio's surgery, he moved his fingers and wrists in the exact way he wanted the robotic instruments to move. Fingers on one robotic hand grabbed a muscle while the other hand delicately burned through the tissue with a small cautery attachment. With a 3-to-1 scale of motion, the robot translated Asbun's large movements to small and precise manipulations of the surgical tools.
"This works beautifully," Asbun said, as he performed the delicate surgery without getting blood on his hands.
Dr. Fernando Otero assisted with the surgery by changing the instruments attached to the robotic arms and by controlling laparoscopic forceps inserted through two small incisions. A tiny camera inserted through another incision gave the surgical team an insider's view of the action.
When Asbun achieved a clear opening into the stomach, he was ready to stitch up his work.
"I'm waiting for you. Where are you?" Asbun joked, as he twiddled the robot's fingers.
Otero inserted a suture using laparoscopic forceps, and the robotic fingers grabbed it and began sewing with a tiny needle. Next, the robotic fingers tied several knots and pulled the sutures tight.
"You can't sew with that precision laparoscopically," Asbun said, explaining that the da Vinci's three-dimensional camera gives the surgeon a sense of depth.
Laparoscopic surgeons manipulate surgical tools through small incisions with their hands while watching video monitors, but the tools are not as tiny as the robot's, the movements are not as precise, and the images are two-dimensional.
After Asbun finished suturing, the surgical staff removed the robotic arms and pushed the robot out of the way. The surgical tools were pulled out of the incisions, leaving six small holes just big enough to poke an index finger inside. Asbun stitched up the openings by hand, and Ghio was on his way to recovery.
Three days later, Ghio was home. And in less than two weeks, he was enjoying Thanksgiving dinner.
"I never felt any pain," he said. "It's amazing the way I feel. I can eat and I can drink, no problem."
Asbun is enthusiastic about the robot's capabilities, but he said doctors must weigh all options when considering surgery.
"I use the robot when I think it's beneficial," Asbun said, "not just because it's a fun toy."
Taylor agreed.
"We're not doing things robotically on everybody," he said. "If we have someone with very extensive disease, I think we need to do an open surgery. Maybe in a year, when we get more experience, we could do it robotically. This is life and death."
For more about minimally invasive procedures at Mt. Diablo Medical Center, including robotic and laparoscopic surgeries, call 800-593-0093. For more on the da Vinci surgical system, visit www.intuitivesurgical.com.
------------------------------------------------------------------------Theresa Harrington covers the Concord area. She can be reached at 925-682-6440, ext. 29, or by e-mail at tharrington@cctimes.com.
(Posted December 5, 2002)