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2013
INNOVATION & QUALITY IN
HEALTH CARE
St. Vincent Healthcare expands robotic surgery procedures
LARRY MAYER/Gazette Staff
Surgeons Jeff Rentz, left, and Mike Wilcox talk about their work with the da Vinci robot at St. Vincent Healthcare.
By CARMEN DAYE IRISH For The Gazette Robotic surgery has taken another step forward at St. Vincent Healthcare, expanding its use of the da Vinci surgical system into general abdominal surgical procedures. The da Vinci, a surgical robot, costing St. Vincent upward of $1.7 million, has rolled out as the fastest-growing general surgical specialty in the nation and is the leading alternative to traditional open surgery and conventional laparoscopic. Unlike traditional laparoscopic surgery, where rigid, hand-operated instruments limit surgeons, the da Vinci robotic system provides increased range of motion in tight spaces, said Dr. Jeff Rentz, a St. Vincent Healthcare general surgeon. He is one of two general surgeons performing robot-assisted surgeries at St. Vincent, and one of about 15 in Montana. “We gain seven degrees of motion that extend beyond the limits of the human hand,” Rentz said. “So, the technology is helpful in common procedures, but even more helpful in complicated general surgeries where areas can be difficult to get to and space is tight.” A product of Intuitive Surgical, the da Vinci surgical system is a sophisticated robotic platform first introduced in 2000. The technology is designed to allow surgeons to perform complex procedures through a small, single incision while utilizing high-definition, three-dimensional technology. General abdominal surgeries, such as gallbladder removal and upper gastrointestinal surgical procedures, are now less invasive than ever with the introduction of single-incision robotic surgery. Before the da Vinci technology, the only option for minimally invasive gallbladder surgery involved three to four incisions, each about 2 inches long.
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With the use of a high-definition camera and tiny robotic hands that are interchangeable with more than 200 surgical instruments, specially trained surgeons are able to do traditional operations with the enhanced robotic capabilities to treat broader ranges of conditions using the minimally invasive approach. Rentz and St. Vincent general surgeon Dr. Michael Wilcox began operating with the da Vinci in April. Both were skeptical of robotics at first as they questioned the added value to operative procedures. But, Rentz said, their apprehension soon turned to optimism as the benefits to patients became clear. “Every so often we stop and think, could things be done differently or should we accept the status quo?” Rentz said. “But I think that neither one of us feel like we’re done evolving.” “I personally don’t want to be doing things the old-fashioned way when there are better ways to do things,” said Wilcox, a 17-year general surgeon veteran. “If there is going to be a better way, I want to be involved.” Lana Feldman, the St. Vincent Healthcare robotic surgery coordinator, said at least 300 surgeries — primarily gynecological and urological surgical procedures — have been performed using the da Vinci since the hospital purchased the technology in early 2010. The system uses advanced technology that allows surgeons to see in greater depth and detail as well as operate with more dexterity and precision. Though it is referred to as a robot, the da Vinci cannot act on its own — the surgery is performed entirely by a surgeon. Seated at a separate console several feet away from the operating table, the surgeon views the magnified, three-dimensional image of the surgical field as they control the robot’s camera and surgical tools with hand-
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grips and foot pedals. The surgeon’s fingers grasp the controls below the display, with hands and wrists naturally positioned relative to their eyes. The system seamlessly translates the surgeon’s hand, wrist and finger movements into precise, real-time movements of the robot’s surgical instruments inside the patient’s small incision. Meanwhile, the robotic procedure is also displayed on a large high-definition flat screen near the operating table where a second surgeon and clinical assistants monitor the surgery. Recovery time is often considerably shorter, and with less post-operation pain and discomfort. Other benefits may include reduced trauma to the
body, reduced blood loss, less risk of infection, shorter hospital stays and less scarring, Rentz said. Three gynecologists, two urologists and two general surgeons are trained to perform robot-assisted surgery at St. Vincent, Feldman said. Although not all hospitals have invested in the technology, the surgical procedure is quickly becoming standard practice, Rentz said. “It’s a phenomenal tool,” he said. “I expect that in five to 10 years, a good portion of surgeries will be performed with robotics.” Last year upward of 400,000 surgeries were performed nationwide with da Vinci technology, triple the number just four years earlier.
LARRY MAYER/Gazette Staff
Robotic surgery coordinator Lana Feldman watches a screen showing a macro view of work the da Vinci robot is doing at St. Vincent Healthcare.
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