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In Lowell General's $1.6M Video Game

Posted on: Saturday, 14 June 2008, 12:00 CDT

Frank Jusczak of Pelham likes things fast. He repairs cars in his spare time, and he's no stranger to New England Speedway.

And he didn't want the prostate cancer doctors found a couple months ago to slow him down.

So when a surgeon approached him about a prostatectomy that would get him up and running faster, he was all for it.

Even when they mentioned robots.

"I just said, do this as fast as you can," says Jusczak, 58, a Lowell native. "And robots? You know, you think about it, technology just gets better and better, and I guess this is like getting the bugs out of the car. I wasn't scared of the robots."

On June 6 at Lowell General Hospital, urologist Miguel Antelo removed Jusczak's prostate in the Merrimack Valley's first robotic-assisted surgery.

Antelo was assisted by Matthew Cohen and the da Vinci Surgical System.

It was the hospital's second use of the da Vinci system, following a June 2 hysterectomy performed by Dr. Purnima Sangal. Sangal and Antelo are co-chairs of LGH's robotics program, and they pretty much light up when talking about the new technology at their fingertips.

"We're doing things now we never thought we could do," says Antelo.

"When I do this surgery," says Sangal, "it is like I am sitting inside the pelvis, working."

Jusczak was home Sunday morning, and was tinkering with cars in his garage a couple days later.

He can't wait to tell his buddy.

Thursday afternoon, Cohen is the

lead surgeon in operating room 6. With assistance from Antelo and verbal guidance from da Vinci veteran Michael Stifelman of New York University Medical Center, he performs a pyeloplasty, removing a blockage from the ureter.

He is at least six feet away from the patient, hunched over what looks like an arcade video-game console. His feet work pedals beneath him, controlling cameras. His hands grasp handles under the console, the thumb and forefinger of each hand slipped into little slings.

Video monitors above show the operation in high-definition, in tradition two-dimensions.

But the monitor Cohen peers into offers a three-dimensional view melded from two cameras, and shows him ... well, it's like nothing he's seen before in the OR. He can see around corners. To the sides. It can magnify images 10 times.

Sometimes, such delicate operations meant large incisions so surgeons could better see and operate precisely, sparing nerves and surrounding tissue. But less invasive surgery is possible thanks to the view the da Vinci offers.

In addition to the surgeon's console, a robotic platform rests alongside the patient. The surgeon's movements are relayed to the three robotic arms that work the long, thin tools that toil inside the body. The robotics translate Cohen's movement and steady any movements or tremors that come from being human.

Though robotics are an aid, it is very much still a human procedure, say doctors.

And awe-inducing fun.

"It is," Cohen says, "like I'm flying around inside there."

The da Vinci system, a $1.6 million addition to LGH's arsenal, offers surgeons what The Jetsons, Star Wars and video games foretold.

"It's like a game," says Nonnie Estella, who will perform her first da Vinci surgeries (two hysterectomies) June 24. "A very sophisticated video game."

But patients are the real beneficiaries from the da Vinci, which takes traditional laparoscopic surgery into new territory. Recoveries are faster, with fewer complications, side effects, less blood loss and pain, thanks to the precision it offers surgeons. Incisions are the size of keyholes. It spares precious nerves and lessens scarring.

"For traditional kidney surgery, it would be like this," says Antelo, holding his fingers at least six inches apart on his side. "And that's a painful place to heal from an incision."

Now, everything is performed through five dime-sized holes.

Hospitals in Boston, Winchester, and Lahey Clinic in Burlington also have the da Vinci.

Surgeons say studies have shown the generation that grew up playing video games can be more proficient at wielding the controls. But Sangal, a women's health specialist who has been at Lowell General for 17 years, said she has "never played a video game in my life."

She says that when she stepped into the operating room June 2, "I had been waiting two years for that day. I always want to do things that are good for the patient, and this is so good for them. And I wanted to be the first to do this here.

"It is the ultimate. I am so excited about this. It's like you're sitting in the pelvis, which is a pretty small area. I can see the tiniest parts of the blood vessels. I can see out on both sides of where I am working, and since you are seeing things in 3-D, there's that depth. We call it going global."

She trained over the past 18 months in Boston, New York, New Jersey, "anywhere and any time I could."

"But I did this 100 times in my mind before I ever touched the patient."

She cites the patients benefits and adds, "it's only going to get better over time as we give the company feedback and they improve it further."

If a surgeon can work on a patient several feet away, why not a state or a continent away?

"There will come a time," says Sangal. "Right now, we're practically doing it in the next room, and I guess it depends how long the cord is. But psychologically, I still depend on being there with the patient. And that's a good thing, I guess."

"The way to think of it is as a means to an end," says Estella. "It allows you to do what you have to do, better."

"Minimally invasive surgery has been around for a number of years, nut this is different," says Antelo. "Traditional laparoscopic instruments have limitations." The clip-like pincers used to do the work are "straight, rigid." Like chopsticks. The fingernail-sized ones attached to the da Vinci can be rotated 360 degrees.

"The view we get with the magnification and the 3-D is a whole new thing. "Before, we were seeing what we thought we were seeing. And with the prostate, we're dealing with erectile function. With the magnification, we're able to identify tissue and nerves in a way that was previously impossible."

The machine arrived at the hospital on his birthday, April 29. Antelo says he's never received such an expensive birthday gift.

Jusczak says he experienced less pain than "having a tooth out."

"You know, my buddy had the same thing done a couple months ago the old-fashioned way," says Jusczak, who is headed on his traditional Fathers Day fishing trip tomorrow. "It took him four to six weeks just to get up and around the house. He was in the hospital seven days. He had a lot of pain. They gave me two prescriptions I never even had filled. I can't wait to catch up to him and tell him about mine."

Source: The Sun (Lowell, Massachusetts)

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