News Column

Robotics transform way surgery is performed

August 10, 2014

By Michael Iorfino, The Times-Tribune, Scranton, Pa.



Aug. 10--Four robotic arms hovered above the operating bed.

Seated about 10 feet away, Barbara Plucknett, M.D., pressed her face against a viewfinder and grabbed the two joystick-like controls beneath. An hour earlier, during a hysterectomy, she saw a 3-D view of the inside of the patient's pelvis, as she moved her hands to manipulate small surgical instruments and remove the uterus.

"It's amazing, just amazing," said Dr. Plucknett, a staff surgeon at Regional Hospital of Scranton. "With this technology, most patients can go home after six hours."

Regional Hospital of Scranton's recent addition of the da Vinci Si, a dual component robotic system, reflects the skyrocketing rate of robot-assisted surgery in hospitals nationwide.

From 2000 to 2012, the number of robotic surgical procedures worldwide jumped from 1,000 to 450,000, according to a 2013 article published by the Wall Street Journal. Geisinger Wyoming Valley Medical Center in Wilkes-Barre offers a da Vinci surgical system, but Regional marks the first Scranton hospital to dive into robotic-assisted surgery.

Launched in April 2009, the da Vinci Si is a four-armed robot. Tiny instruments, such as scissors or forceps, are mounted on three separate arms, while the fourth arm is outfitted with a 3-D camera and a light that guides the surgeon.

After the surgical team puts the instruments in small incisions, the surgeon moves to a console about 10 feet away. While examining the high definition video feedback sent from the 3-D camera, the surgeon simultaneously makes finger, wrist or hand movements -- such as cutting or stitching -- that are replicated in real-time by the instruments.

Foot pedals allow surgeons to adjust the camera view and switch instruments.

"The nice thing is, the machine takes out any tremor in your arm, or any fatigue and so it's a nice smooth motion," said Robert Ramey, M.D., director of minimally invasive and robotic surgery at Regional Hospital of Scranton.

Experts tout robotic surgery as a way to perform more complicated minimally invasive procedures, because the instruments bend and rotate far greater than a human's wrist. Compared with open surgery, the less invasive technique normally leads to shorter hospital stays and less pain and blood loss.

At Regional, the robotic system is used to perform gynecologic, urologic and general surgery. Among the list of new procedures it allows surgeons to perform is a single-site gallbladder surgery and minimally invasive colorectal surgery, Dr. Ramey said.

"It allows us to expand the complicated procedures that we can perform locally," he said. "Previously, people would have to travel to Philadelphia or New York or beyond to have something done robotically."

Despite the rise in the use, some question the cost-effectiveness of robotic surgical systems, which can cost more than $2 million.

Critics argue that most of the benefits stem from the fact that it's a minimally invasive procedure, not that it's robotic. They point to laparoscopic surgery, in which surgeons guide specialized tools and a video camera by hand through small incisions, as a cheaper, viable alternative.

Others say doctors use it as an advertising tool more than a surgical tool, said Jason G. Newman, M.D., director of head and neck surgery at Pennsylvania Hospital in Philadelphia.

"I'm sure under some circumstances the answer to that is yes, but I can tell you for sure that it's definitely much more than (an advertising tool)," said Dr. Newman, who is also associate professor of otorhinolaryngology at the Hospital of the University of Pennsylvania and the Pennsylvania Hospital. "I think it's going to be the future of surgery.

"The presence of the robot has literally changed our approach to the management of throat cancers. It hasn't just turned a surgery into a sexier surgery, it has put surgery onto the list of options for cancer."

Contact the writer:

miorfino@timesshamrock.com, @miorfinoTT on Twitter

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(c)2014 The Times-Tribune (Scranton, Pa.)

Visit The Times-Tribune (Scranton, Pa.) at thetimes-tribune.com

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Source: Times-Tribune (Scranton, PA)


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