Smooth Operator
A thousand-pound surgical assistant named da Vinci is lending
a steady hand to IU surgeons and improving outcomes for their patients.
Carl Methner is sleeping and his vitals are good as the scrub nurses
arrange instruments and adjust monitors and overhead lighting. The
assistant surgeon steps up to the table, makes dime-wide cuts in
the lower abdomen and an incision in the navel. The higher incision
will be used to inflate the patient’s abdomen with carbon
dioxide so it can accommodate the surgical tools needed to make
the sinuous journey to the cancerous prostate.
”Okay, it all looks good. Let’s get started everybody,”
says lead surgeon Chandru Sundaram, MD, associate professor and
director of the urology department’s minimally invasive surgery
program. After speaking with the anesthesiologist and other members
of the operating team, Dr. Sundaram sits down at a special unit
several feet from his patient and begins to operate.
Another member of the team is at the foot of the table. Though
he can’t walk or talk, he’ll play a major hands-on role
in this operation to remove the cancerous gland. Shake one of the
several hands of the da Vinci® Surgical System, a unique extension
of IUSM’s surgical staff. The robotic system has been in place
at Indiana University Hospital and its Clarian Health partner Methodist
Hospital since 2003 and has been used in a variety of laparoscopic
procedures for adults and for a small number of patients at Riley
Hospital for Children.
According to Intuitive Surgical, the company that developed the
da Vinci system, Clarian surgeons have developed one of the top
three robotic surgical programs in the United States. They have
used it to perform more than 150 procedures, including surgeries
to repair mitral valves, esophageal conditions, chronic heartburn
and urological and gynecological problems, as well as for thymus
gland removal, gastric bypass, and placing pacemaker leads.
“We’re committed to deliver patient care that is second
to none, and purchasing this robotic system is another way we demonstrate
that commitment,” says Paul Caulkins, MD, Clarian’s
medical director of operating room services. “The da Vinci
system is the latest and best in minimally invasive care, and one
we felt we should master to treat our patients.”
Armed For Precision
The da Vinci system was developed more than a decade ago at the
urging of the Department of Defense. Military surgeons were looking
for ways they could perform procedures from remote locations, far
from battlefields. While that ultimate goal has yet to be realized,
the computerized robotic system has been welcomed by surgeons in
public and private hospitals.
The million-dollar-plus system has two main components: a hulking
half-ton computer unit with up to four maneuverable arms, and miniature
elbows and wrists that manipulate detachable surgical tools. The
human surgical team members assist at the patient’s side,
to drape, snip, clamp, suture, and monitor the procedure.
Stationed about eight feet away from the patient, da Vinci’s
complex computer console instructs the robotic arms and wrists and
signals to other instrumentation. The lead surgeon sits at the console,
peering into an binocular-like eyepiece. He sees highly magnified
three-dimensional images illuminated by a fiber optic endoscopic
light and transmitted from an endoscopic camera, all operated by
foot controls beneath the console.
The surgeon grasps two master controls resembling joysticks, directing
the hands and tools they wield.
“The arms of the robot can pivot 360 degrees and allow me
to manipulate instruments more fluidly,” says Dr. Sundaram
as his hands direct the da Vinci’s to the cancerous prostate
seated at the base of the patient’s bladder. “The system
does only what I want it to do and increases mobility, flexibility
and precision.”
One thing, however, is lost in the translation—and for good
reason. As the surgeon’s hands guide the robot, the system’s
computer eliminates the tremors that normally accompany all human
movement, even that of the most skilled surgeon.
Results: Rapid Recovery
While the technology makes surgery more precise and often faster
for the medical team, the patient is the true beneficiary. General
surgeon David Canal, MD, associate professor, has used the da Vinci
in several procedures at Indiana University Hospital.
“Patients do better with minimally invasive surgery compared
to open procedures,” says Dr. Canal. “For example, there
is less blood loss, much smaller incisions resulting in less scarring,
decreasedpost-operative pain and earlier return to normal physical
activity.”
Hospital stays are reduced too. Patients undergoing open radical
prostatectomies typically are discharged three to seven days after
the procedure. Those having the robotic procedure can be at home
resting in twenty-four hours. Carl Methner’s progress was
even better.
His surgery was over at 2 p.m. on a Tuesday, and several hours
later he was “wandering the hall looking for a cup of coffee.”
By 5 p.m. Wednesday he was on his way home to Avon, Indiana.
He returned to his job as a sales manager, a position that often
puts him on the road, a few weeks after his procedure. Mr. Methner
says he is fortunate to have the advantage of being treated with
the robotic procedure.
“A couple of friends of mine had invasive prostate cancer
surgery and they all had to have a big slit in their belly and suffered
a lot of pain for about a month,” he says. “My experience
was so much better.”
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