Lacks News

Hands-off Method is Surgical Success

05/21/2007

Monday, May 21, 2007

By Pat Shellenbarger

The Grand Rapids Press

GRAND RAPIDS -- Janice Roberts was surprised when her doctor said a robot would assist with her surgery.

"I was like, 'a robot?'" the Howard City woman recalled. "I had no idea what it was, to be honest."

But if Roberts was worried about an android messing with her innards, that was more than offset by her fear of being cut open. Dr. Kevin Brader, medical director of gynecologic oncology at Saint Mary's Health Care, assured her the robot would require only five small incisions, and the operation would be far less invasive than conventional surgery.

"I told him, 'Heck, yeah,'" said Roberts, 45. Thus, in late April she became the first person in West Michigan to undergo a gynecologic cancer surgery performed with a da Vinci robot. The first robotic hysterectomy was performed at Hackley Hospital in Muskegon.

One year after the first of two da Vinci robots arrived in Grand Rapids, doctors at Saint Mary's and Spectrum Health are branching out, finding new uses for the $1.5 million machines. Doctors at Spectrum Health's Butterworth campus have performed 147 urological surgeries with the da Vinci in the past year, mostly to remove prostate glands, as well as seven thoracic surgeries on lungs and to place pacemaker leads. In the next month or so, Spectrum doctors plan to begin performing hysterectomies and possibly open-heart surgery with the robot.

"It's a race," said Dr. David Dull, perioperative medical director at Spectrum. "My guess is we'll probably go with gynecologic next, but cardiac is right up there."

But he emphasized, "We decided we're going to bring up one specialty at a time, get to a level of expertise on that, then bring up another specialty. ... It's a great piece of technology in the right hands."

Roberts never saw the da Vinci, because she was under anesthetic, but she's a big fan. The day after her hysterectomy, she went home.

"Oh, I feel great," she said a couple of days later. "I'm walking around just fine."

Less than three weeks after her surgery, she was looking forward to riding her horse again.

Brader has performed six more hysterectomies with the da Vinci. From now on he intends to use it with all hysterectomies, he said, except in rare cases when the patient is unusually overweight.

"It's completely changed my way of working," Brader said. "I think it's a huge step forward, because people will not need large incisions."

A decade ago, the idea of performing surgery by remote control bordered on science fiction. The first robotic surgery was performed in 2000. Since then, tens of thousands of da Vinci procedures have been performed around the world.

Intuitive Surgical, the California-based company that builds the robots, has installed more than 300 worldwide. Spectrum got its robot last May, and Saint Mary's in December. Both were purchased with grants from jewelry store owner Tom Fox, sparking a bragging rights competition between the two hospitals to be the first to perform various types of surgery.

So far, the most common surgery performed with the robot is prostatectomy, removal of the prostate gland, the procedure Randy Neuman underwent one recent morning at Spectrum's Butterworth campus.

As Newman lay sedated under five robotic arms, Dr. Anthony Avallone sat at a console several feet away, peering into two eyepieces. With his feet, he operated pedals, and in each hand he grasped handles, allowing him to manipulate surgical instruments inserted through small incisions. A tiny camera gave him a three-dimensional view inside Neuman's abdomen.

Avallone flies radio-controlled model helicopters as a hobby.

"It's way harder than this," he said.

Younger doctors who play video games pick up robotic surgery quicker than those who haven't, advocates say.

With a pair of tiny scissors, Avallone snipped away flesh, then cauterized it with another instrument to stop bleeding. He has performed similar surgery with large, open incisions and laparsopically, directly manipulating instruments through small incisions. Laparopscopy gave him only a two-dimensional image and was less maneuverable than the robot arms, he said. The robotic surgery results in less blood loss, is less traumatic for the patient and, in some cases, has a quicker recovery time.

A disadvantage is the surgeon has no sense of touch and must rely on what he sees as he cuts away flesh and ties sutures.

"These are very powerful arms," Avallone said. "You could drive them right through the patient."

After a couple of hours, he picked up the cancerous prostate gland with an instrument, dropped it in a tiny plastic bag, cinched it shut and removed it from Neuman's abdomen.

By the following week, Neuman was walking a half-mile a day and relieved to be cancer free.

Sometime this summer, Spectrum may become only the second hospital in Michigan to repair defective heart valves robotically. That will please Tom Mejeur, even though it's too late for him. He already had a defective mitral valve repaired in December with the da Vinci robot at Saint Joseph's Healthcare in Macomb County, the only Michigan hospital performing the heart operation.

Driving 2 1/2 hours across the state was preferable to having his chest cracked open for conventional surgery, he said. He lifted his shirt, revealing five small scars on his right side.

"It was less painful than I thought it would be," he said. "I am now FDA certified with a permanent fix. I'm free to do anything I want.

More News