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Robotic surgery taking hold at Macon hospitalsJun 28, 2009 (The Macon Telegraph - McClatchy-Tribune Information Services via COMTEX) -- The morning after surgery, Oliver Ware sat next to the bed in his room at Coliseum Medical Centers, wearing a patient's gown and drainage bag on his hip. The 62-year-old was "feeling fine," but he recalled little about having his cancerous prostate removed. He did, however, remember seeing "the machine" before the anesthesia kicked in. Ware's surgery last month was the third at Coliseum using the da Vinci Surgical System, a robot-assisted procedure that is revolutionizing the way surgeons perform prostatectomies. About 70 percent of all prostate removals in the United States are now done using the robotic system, according to its manufacturer, Intuitive Surgical. The Medical Center of Central Georgia began using the robotic system in 2007. The surgical team of Drs. Joshua Perkel and Frank Casey performed their 100th prostate surgery with the machine Tuesday. They've also used the system in five surgeries to remove tumors in patients with kidney cancer. Surgery with the robotic system is less invasive and more efficient, resulting in a quicker, less painful recovery for patients. "Patients are requesting it. It's a better patient experience," Casey said. Ware recalled that the robotic instrument, which is covered with sterile plastic sheeting during surgery, looked "like a toy." "You've got all these arms sticking out," he said. "What's that new movie, 'Transformers'? It looked like something from that." BETTER SURGERY During surgery with the da Vinci, one surgeon is by the patient's side, assisting with traditional laparoscopic instruments. The other is seated at a console, where he controls the robotic interface. Robotic arms mimic the surgeon's hand movements. A camera attachment on one of the arms gives a three-dimensional, high-definition view from inside the patient's body. The enhanced visualization, along with the flexibility and precision of the surgical instruments, allow for maneuverability not possible with traditional open surgery. "The prostate is tucked under the pubic bone, deep in the pelvis," Perkel said. "When you're in there robotically, ... it allows us to precisely peel away the prostate." The surgery significantly reduces the pain, blood loss and risk of infection for patients, doctors say. It also offers a shorter hospital stay and a quicker return to normal activities. With open surgery, Perkel said, it was generally acceptable for patients to lose a liter of blood. "If you're bleeding, it could sometimes be a very hectic surgery," he said. "We feel comfortable that we're doing a better surgery." With both surgeons getting a magnified view from inside the patient, they are able to dissect the prostate from the urethra and bladder while sparing the bundles of nerves that control sexual function and urinary continence. "It's not just a better view. Now we can see things that we couldn't before -- every tissue, blood vessel, nerve and muscle is easily visible using da Vinci," Dr. James Lewis, robotic urologist at Coliseum, said in a news release. "Men have narrow pelvises and, in an open procedure, it's challenging because there are at least two hands trying to function in that limited space," Lewis said. "With the added visualization and dexterity, we can remove the cancerous prostate gland with minimal damage to the surrounding tissue." The robotic systems don't come cheap. The Medical Center invested $1.8 million in the system two years ago, becoming the first Georgia hospital outside Atlanta to offer the surgery, Perkel said. The robotic arms that attach to the system cost $4,000 each and must be replaced after 10 procedures. None of that cost, Perkel said, is passed on to patients. "It's expensive, but it's what we needed to do." MORE ROBOTIC SURGERIES TO COME Among men, prostate cancer is the second leading cause of cancer deaths and the most common cancer other than skin cancer. Treatment options include radiation, hormone therapy and, for some, doing nothing but watching and waiting. Many men chose to have their prostate removed after diagnosis, and studies show that the prostatectomy option offers better cure rates than other treatments. "It's very curable if found in the early stages," Perkel said. "Patients have been our biggest advocates" for the new surgery. Minnie Goolsby, an operating room nurse at Coliseum Medical Centers, lauded the benefits of the robotic procedure. "You don't have those long incisions down the middle of the abdomen like you do with open surgery," she said. "You have five little poke holes. The patients are on their feet a little faster. "Maybe this will start getting guys to have their testing done early, to get their blood work done, and not put it off like guys do," she said. About 15 percent to 20 percent of hospitals nationwide have a da Vinci system, said local Inuitive Surgeries representative Sonya Larch. Some of them use it in procedures ranging from heart bypasses to weight loss surgery. Lewis said Coliseum plans to use the robot in kidney surgeries. He and Perkel both predict that the system will eventually be used locally in gynecological procedures, especially hysterectomies and complex surgeries. "Gynecology will be the next frontier," Perkel said. "There are so many gynecologists in Macon." Despite the benefits, some patients initially balk at the idea of robotic surgery. "It scares some people. They say, 'I'm not being operated on by a robot.' It's a Big Brother thing," Perkel said. "I'm doing the surgery. It's just an instrument. It's just a tool." To contact writer Rodney Manley, call 744-4623. To see more of The Macon Telegraph, or to subscribe to the newspaper, go to http://www.macon.com Copyright (c) 2009, The Macon Telegraph, Ga. Distributed by McClatchy-Tribune Information Services. For reprints, email [email protected], call 800-374-7985 or 847-635-6550, send a fax to 847-635-6968, or write to The Permissions Group Inc., 1247 Milwaukee Ave., Suite 303, Glenview, IL 60025, USA. |