The Robot Will See You Now

COLUMBIA, S.C. – Jim Bradford had a close encounter with a robot last year _ and he’s the better for it.

After he was diagnosed with prostate cancer, Bradford’s surgeon removed the diseased organ with a little help from a reliable robot.

Robot-assisted surgery is a step forward in the field of minimally invasive surgery, in which doctors try to lessen the impact of surgery on patients by doing the same procedures through smaller openings in the skin.

Columbia resident Bradford had to go out of state _ he picked Duke University _ for his robotic prostatectomy last year. But now, patients like him have a place near home where they can get that and other kinds of robotic surgery done.

Palmetto Health Richland in Columbia bought a "da Vinci" robot and accessories for almost $2 million from California-based Intuitive Surgical Inc., whose robotic surgical system was the first cleared by the Food and Drug Administration.

The hospital also has recruited a new urologist, Dr. Terrence Chapman, who will get the robotic surgery program going. Chapman came from Buffalo, N.Y., where he did a robotic surgery fellowship at Roswell Park Cancer Institute. He has taken part in more than 100 robotic prostatectomies, and he will do the first one at Palmetto Health at the end of the month.

Three other health systems in South Carolina _ Spartanburg Regional, Carolinas Hospital in Florence and Roper St. Francis in Charleston _ also have robotic surgery programs.

While robot-assisted surgery is used most commonly in urology, Palmetto Health surgeons will be using it in a variety of other areas, including cardiac, pediatric and gynecological surgery.

Although robotic arms do the cutting, the doctor is in full control at all times. The machine cannot operate automatically or be preset.

Along with the robot standing over the patient, at least three people _ the surgeon, a scrub nurse and an assistant _ are involved in each robotic prostatectomy.

The surgeon controls the robot remotely from a console while watching a high-definition, highly magnified 3-D image of the area involved.

Attached to the robot’s four arms are long-handled surgical instruments and a camera with a telescopic lens. The surgeon "drives" the arms using gear shifters and foot pedals, making surgical movements the robot mimics.

The wide range of motion of the robotic arms, and flexible "wrist" joints on surgical instruments, give doctors better access and control in tight spaces than do traditional rigid instruments.

The robot also reduces a surgeon’s normal hand tremors and keeps movements steady regardless of the length of a surgery.

Robotic prostatectomy surgery doesn’t take long _ usually three to five hours, including time for robot setup, depending on factors such as how far cancer has progressed and how much a patient weighs.

Bradford’s took fewer than three hours, and he was out of the hospital in less than 24. With open surgery, he might have stayed in the hospital for three or more days and taken as long as six weeks to get back to normal activities. But he didn’t feel much pain or discomfort afterward and soon was walking and driving himself around.

After three weeks, Bradford _ a medical doctor who works in health administration _ felt well enough to go back to work, although he decided to rest for an extra week.

The development of robotic prostatectomy, led by Dr. Mani Menon of Henry Ford Hospital in Detroit, has made it easier for patients to have advanced surgery by making it easier for doctors around the country to perform it.

"The robot flattened the learning curve," Chapman said.

Robot-assisted surgery is as effective as traditional surgery, preliminary results show, but takes less of a physical toll on patients. For example, patients lose far less blood.

Comparisons between how patients survive after new surgical methods and traditional "gold-standard" ones usually are based on at least 10 years of data on patients. Such "survivability" data is not yet available for da Vinci robotic surgery, however, as it has been just six years since the FDA approved the procedure.

Heart surgeon Dr. Scott Petit, who plans to use the robot for mitral valve surgeries and other procedures, said that while he always looks for new instruments and methods to reduce the impact on patients, the goal remains to do a perfect operation with long-lasting results.

Pediatric surgeon Dr. Juan Camps, who has specialized in minimally invasive surgery for the past five years, says the new equipment will help him with such complex cases as scoliosis and chest and abdomen surgery.

"Everything is smaller" in children, he said.

Surgeons say it might take time for some patients to warm to the idea of robot-assisted surgery. But methods now considered traditional started out new, with acceptance growing over time.

Robotic surgery costs no more than traditional methods and is covered by insurance.

Palmetto Health Richland officials say the robot can attract patients in areas not related to robotics, because it helps people see the hospital as a high-technology center.

They’re counting on it.