Expanding the Reach of Robotic Surgery
Saturday, September 17, 2011
Shelby Baptist Medical Center launched its robotic surgery program in 2007 with the purchase of the da Vinci Surgical System. Since then, the technology and the surgeons guiding it have demonstrated considerable success in the urological field for Birmingham patients. Now, building on that first step taken four years ago, Shelby Baptist Medical Center is establishing a multispecialty program for robotic surgery THAT includes a recent upgrade to a four-arm da Vinci S HD.
It was through the technology’s inherent improvements in visualization and instrument articulation that robotic surgery became a viable option in pelvic surgery. At that time, John Wilbanks, M.D., and Jason Burrus, M.D., both board-certified urologists at Shelby Baptist Medical Center, were performing radical prostatectomies — the removal of the prostate gland to treat prostate cancer — with a laparoscopic approach.
While the procedure varies only slightly from a surgical technique point of view, in terms of isolating the bladder, dissecting the prostate gland from the bladder and the urethra, resecting the organ and placing the foley catheter, the da Vinci system’s distinction emerges in its precision. The anatomy of the pelvic region is narrow and even laparoscopic instruments can be clumsy in the tight surgical theater. The articulation of the robotic system’s fine-tuned mechanics and the three-dimensional view are suited for the tiny movements necessary in a radical prostatectomy, such as the reanastomosis of the bladder and urethra.
“The best feature of the robot is that it allows the surgeon to have the instruments, which are our hands, and the camera, which is our eyes, in the body at the same time without compromising the ability to perform the procedure,” says Dr. Wilbanks. “The robotic system gives us the combination of visibility and movement that was almost impossible to have in an open pelvic surgery.”
The Standard of Care
In addition to the surgical advantages, Drs. Wilbanks and Burrus have also noted the benefits the da Vinci system has afforded their patients. Continence and potency rates are improved. The standard recovery period is dramatically reduced from up to six weeks to three weeks, facilitating a much quicker return to full activity. Patients experience less blood loss during surgery due to the shift from the large abdominal incision to the multiple small incisions spread across the abdomen, and the need for pain mediation and risk of infection are minimized.
“While there have not yet been comparative studies between traditional techniques and robotic surgery, the robotic approach has been equivalent if not better in the areas of potency and continence in addition to being much better in terms of patient recovery and post-operative pain,” says Dr. Burrus. “Approximately 80% of the prostatectomies in the United States are projected to be performed robotically over the next year.”
Shelby Baptist Medical Center is exploring how the same improvements apply to the gynecological field. For a robotic hysterectomy, the procedure’s step-by-step breakdown remains similar to a laparoscopic approach until the final stages in which the da Vinci system’s control allows the surgeon to create and close a vaginal cuff through the abdomen rather than the vagina.
Likewise, treating endometriosis has always been a difficult balance of avoiding damaging the perineum lining when cauterizing the endometriotic lesion and removing enough of the endometrial tissue to effect a patient’s condition. The dexterity of the da Vinci system enables the surgeon to tent the perineum layer and adequately resect the lesion without causing trauma or scaring to the tissue or underlying structures.
“The advantage of the da Vinci system is the means to perform small movements in difficult-to-reach areas with much more control and precision,” says James Head, M.D., President of Shelby OB-GYN and gynecologist at Shelby Baptist Medical Center. “The system turns surgery into a more delicate enterprise.”
Greg Thomas, M.D., cardiothoracic surgeon at Shelby Baptist Medical Center, also uses the da Vinci robot to perform procedures, including coronary artery bypass graft surgery, lobectomy, mediastinoscopy, single vessel revascularization, thymectomy and other CVT procedures.
On the Horizon
Shelby Baptist Medical Center continues to investigate the potential for robotic surgery as an answer for patients’ and their physicians’ desires for advanced surgical techniques in minimally invasive settings. As more surgeons become proficient with the da Vinci system, the program will grow to specialties such as ear, nose and throat, and general surgery. Plans are currently forming for the introduction of robotic cardiothoracic valve replacement and partial transitioning to robotic partial nephrectomy.
To learn more about the robotics program at Shelby Baptist Medical Center, please visit www.bhsala.com and select “Shelby Baptist” from the “Baptist Health Locations” menu.
Shelby Baptist Medical Center
MD News September/October 2011, Birmingham