Friday, October 17, 2008

Robot offers less invasive surgery

For surgeons who perform life-saving procedures daily at CoxHealth, a new, high-tech tool has now been added to their arsenal. The daVinci-S Surgical System was unveiled in mid-August and since early September it has been used in several surgeries.

Doctors say the robotic technology offers a viewpoint superior to an open surgery combined with the minimally invasive incisions of a laproscopic procedure. It’s a combination that means shorter recovery times for patients and unprecedented levels of control for surgeons.

Drs. David Anderson and Howard Follis, urologists at Ferrell-Duncan Clinic, performed the first surgeries with the daVinci robot.

“We’re pleased with the technology and the OR team did a phenomenal job adapting to the new techniques,” Dr. Anderson says.

Dr. Anderson says the first few surgeries with the da Vinci system have been exciting, albeit lengthy. The first and second surgeries – both prostatectomies – lasted seven and five hours, respectively. Dr. Anderson says the first procedures often take longer than normal because of the learning curve and adjustments that are made in the operating room to accommodate robotic surgery.

After those adjustments are made, however, the technology is a major advantage in a delicate surgery such as the prostatectomy.

“The difference between this and an open setting is the level of precision,” Dr. Anderson says. “You’re trying to preserve nerves right along the prostate. The camera offers 10x magnification and you can see the whole neurovascular bundle as you peel it off.

“It’s impressive to see things I’ve never seen before in an operation I’ve done a hundred times.”
Dr. Anderson says that precision is making robotic surgery increasingly popular – with 60 percent of radical prostatectomies in the United States being performed robotically. Prior to the da Vinci’s arrival, many patients in the Ozarks were seeking less invasive robotic treatments in St. Louis and Kansas City.

Now, patients wanting robotic prostate surgeries or hysterectomies have the option of being treated locally, thanks to the efforts of physicians and administrators who made the $1.6 million robot a major 2008 priority.

“We’re excited to be the first in town and I think that it’s very important that Cox is leading the way in bringing this type of technology,” says Dr. John Duff, CoxHealth’s senior vice president.
Inside the operating room, the robot sits adjacent to the operating table with three praying-mantis-like arms poised over the patient. Each arm has a scope that is inserted into the body through the same dime-sized incisions used in laproscopic surgery.

The scopes on each arm include two high-definition cameras set at eye-width apart. The cameras provide two separate images that the surgeon views in a console a few feet from the patient. The two images combine like the images from binoculars to give the surgeon a three-dimensional view – a view that approximates what a surgeon would see if he or she were eye-level with the surgical field.

Dr. Anderson, who had experience with robotic surgery during his residency at the University of Iowa, says the 3-D view is a tremendous advantage.

The daVinci system also offers more articulate surgical tools than a traditional laproscope. While a conventional scope has the ability to open and close and rotate in a single plane, the da Vinci robot features articulated instrument tips that have the same motion capability as the surgeon’s wrists. Inside the console, the surgeon’s fingers operate individual controls that transmit their hand movements directly to the robotic arms.

“The movements of that robotic arm are exactly like the movements of my wrist,” Dr. Anderson says. “The movements I can do sitting at the console are much more precise and accurate than in an open setting.”

Dr. Albert Bonebrake, who began performing hysterectomies robotically in September, says the addition of the da Vinci robot represents an important step forward for surgeons and their patients.

“I see it as a very appropriate evolution for our surgical group,” he says. “Younger people who are finishing training are doing a lot of this. Most fellowships have it and for recruiting the best physicians, it’s something we’ll need.”

Dr. Bonebrake says the months of work that went into bringing the system to Cox are also an example of physicians, staff and administration banding together to do what’s best for patients.

“Everyone had a common goal in making this happen,“ Dr. Bonebrake says. “We were motivated, the administration was motivated; we had the support of Nursing and Surgery. It’s the kind of exemplary cooperation we all strive for.”

Gastric-band surgery now available at Cox

CoxHealth now offers a comprehensive surgical weight loss program using the laparoscopic adjustable gastric band system.

Program coordinator Toni Smith, RN, BSN, HN-BC, says, “The laparoscopic adjustable gastric band surgical technique differs from other weight loss surgeries in that there is no cutting or stapling of the stomach or intestines. This procedure promotes slow, healthy weight loss, and we are excited to be able to provide this valuable and needed service to our community.”

During the procedure, an adjustable silicone ring is inserted through a small incision around the upper part of the stomach, like a belt. An access port, connected to the ring by thin tubing, is placed below the skin. The surgeon is able to adjust the tightness of the silicone ring through the port, decreasing the size of the stomach and allowing a person to feel full while eating less.

Program participants will work closely with the surgical weight loss team, as well as a registered dietitian before and after surgery. They will also consult with a psychologist prior to the procedure; can access the Sleep Disorders Center to diagnose suspected sleep problems; and can access programs with an exercise specialist and registered nurse at The Meyer Center.

Program candidates must meet several requirements. Some include: being at least 18 years old; having a body mass index of greater than or equal to 40 or a BMI of 35-39.9 with severe medical conditions; no drug or alcohol addictions; and being willing and able to make significant eating habit and activity level changes.

The CoxHealth Surgical Weight Loss Program team consists of surgeons Timothy Woods, Daniel Cardwell and Thomas Moffe; physician assistant Meredith Cunningham; coordinator Toni Smith; nurse Lisa Hamilton; and medical assistants Muriel Booyer and Kellie Whitaker.

“For people interested in the program, the initial step is to attend one of our educational seminars,” says Smith.

For additional information on these seminars and other requirements or restrictions, call 875-3593.

Seminar information can also be found at