Surgeons Get a New Tool: Robotic Device Has Precision Benefits.

By Abraham Mahshie, Columbia Daily Tribune, Mo.

Jun. 12–Columbia Regional Hospital has added a $1.6 million robotic surgical device that doctors can use to perform minimally invasive surgeries for prostate cancer, hysterectomy and gastrointestinal surgery.

At a news conference yesterday, surgeons said the da Vinci Surgical System — approved for purchase last week by University of Missouri Board of Curators — would result in smaller incisions, shorter hospital stays, less pain, a faster recovery, less blood loss and a quicker return to normal functions or a quicker start to cancer treatment for cancer patients.

“The da Vinci robot combines robotic and surgical technology into the cutting edge of minimally invasive surgery,” said Scott Troxel, a urologist and medical director of robotic surgery for MU Health Care. Troxel would perform the first surgery with the device, a prostatectomy, on Monday.

Troxel conducted a demonstration of the robot while seated at a console a few feet from the four-armed docking station. Leaning into a three-dimensional viewing screen, he clamped controls with the thumb and forefinger of each of his hands. As Troxel squeezed the clamps with his fingers and turned his wrists, the robotic arms replicated his actions with tiny clamps at the docking station.

Using foot pedals, Troxel operated a camera that creates a magnified 3-D image of the work area. As the surgeon pulled his head back from the viewing screen, the machine’s arms locked in place, awaiting Troxel’s next command.

“There is a perception from some people that robotics implies that the machine is independently doing the procedure,” he said later. “But we are in complete control of everything that happens, every movement. So, it’s really an extension of pure laparoscopy. … The machine just allows us to have movements and dissections that are just not possible with standard laparoscopy.”

Jonathan Thomas, director of minimally invasive gynecologic surgery at MU Health, is training to use the da Vinci system to treat conditions such as uterine and vaginal vault prolapse. Rather than making a large abdominal incision as long as 10 to 15 centimeters for those procedures, the da Vinci system would allow Thomas to make five dime-size incisions.

“I think it really allows us a fine precision of being able to provide our patients with a better dissection,” Thomas said. “We are able to manipulate instruments in the abdomen as if our fingers were in there touching the instrument, and all of these instruments are less than the size of our fingernail.”

Mark Plunkett, area sales manager for Intuitive Surgical, called the da Vinci system the No. 1 treatment option for prostate cancer. Plunkett said the device was approved for use by the Food and Drug Administration in 2001 and has since expanded to more than 500 hospitals, a group that includes more than 80 percent of all teaching hospitals.

“This is driving toward the standard of care, so there’s been many, many procedures performed,” he said. “It may be a longer procedure, because he’ll go slower — real methodical and meticulous, but as” surgeons “get more comfortable, the procedures will decrease in time.”

“They’re highly skilled laparoscopic surgeons, and this is a laparoscopic tool, so they’re used to the procedure,” Plunkett said. “We’re not teaching them procedure. We’re giving them a better tool to do the procedure.”

Troxel has already had several hours of training with the device and will have an experienced da Vinci surgeon at his side during his first two robotic surgeries.

Troxel and Thomas said patients will have the option to rely on traditional surgical methods if they prefer.

“What you will find is most patients are seeking it out,” Troxel said. “They are actually calling and asking if we have a robot, and they are going places that have it. I think the problem is going to be more that we’re going to get inundated with people that want robotic surgery.”

Hospital officials said the da Vinci will initially be used for urological and gynecological procedures but in the future might also be used in cardiac, pediatric and general surgery.

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