Recovery can be quicker with a robot on the case

When gynecologic oncologist Bradley Monk, MD, operates these days, he often does so while sitting several feet away from his patient.

Instead of standing over the patient, Dr. Monk sits in a comfortable chair in front of the da Vinci Surgical System console. Instead of peering through a surgical microscope, he views a magnified 3D image of the surgical site displayed on a high-resolution screen. And instead of wielding a scalpel or rigid laparoscopy tools, he uses hand controls and foot pedals to perform the operation with the da Vinci’s robotic arms and tiny, highly maneuverable surgical instruments.

The da Vinci Surgical System is a type of robotic-assisted laparoscopy; St. Joseph’s Hospital and Medical Center has two of the systems. The second was funded through a gift from Mary Lou and Ira Fulton to St. Joseph’s Foundation.

For Dr. Monk and many other St. Joseph’s physicians, what was once a medical novelty is standard medical practice today.

“Surgery is very rough on patients,” Dr. Monk says. “With robotic-assisted laparoscopy, we can be very precise and exact. We can make smaller incisions, and we can reduce blood loss, scarring and pain.”

Experiencing the benefits firsthand

Laura Tarrant learned of these benefits firsthand when she underwent surgery three months ago. Tarrant, a registered nurse who works in the Division of Surgery and Pelvic Pain at St. Joseph’s, was diagnosed with endometriosis 23 years ago. Medical Director Michael Hibner, MD, hired her in part because of her experience with endometriosis, a condition many of his patients have.

Endometriosis is a female health disorder that can cause pain, irregular bleeding and infertility. Over the years, Tarrant underwent one open surgery and six laparoscopic procedures for her condition.

In July, she underwent a final operation to remove a remaining ovary. Nita Desai, MD, a colleague of Dr. Hibner, performed the procedure using the da Vinci system.

“We knew her surgery would be challenging because she’s had several complex operations. She’s had procedures that require a long recovery period and, frankly, a lot of pain,” says Dr. Desai. “We wanted to do a surgery that would cause minimal bleeding and minimal pain and that would give her a better recovery than she’s had in the past.”

The operation required five small incisions—compared to the three larger incisions in a standard laparoscopic procedure. Dr. Desai was able to remove the ovary despite a “very scarred abdomen” and even resect a recurrence of endometriosis in a small place that would not have been accessible using other surgical methods.

Tarrant was amazed when she woke up after the operation. “I felt around on my belly, and I had barely any pain. And when I saw the incisions, I thought, ‘Wow, that’s really small.’” She was up walking eight hours later.

The surgeons’ choice—for some conditions

The da Vinci Surgical System has become the go- to technology for many urological and gynecological surgeries, including hysterectomies, ovary removal, appendectomies, bowel resections, prostate removals and fibroid tumor removals. Dr. Hibner, who in 2009 performed more surgeries using the da Vinci system than any other physician in the country, estimates that he uses the system in 60 to 70 percent of his cases.

Other specialties are also exploring the system’s possibilities. St. Joseph’s thoracic surgeons, for example, now use the da Vinci system for 15-20 percent of their cases. The team completed Arizona’s first robotic-assisted lobectomy for early-stage cancer.

Thoracic surgeon Elbert Kuo, MD, says that although the system is impressive, it is not right for every patient. “Patients come in asking for robotic surgery,” he says. “They need to have a heart-to-heart with their doctor about whether it’s the best approach for their particular case. It offers another tool in our arsenal, but it’s definitely not the best tool in the box for every patient.”

The da Vinci system does have its downsides. Research shows that procedures utilizing the system are more costly than standard laparoscopic procedures. Other disadvantages include longer procedure times and a lack of tactile sensation for the surgeon.

The future of surgery

But for the appropriate case, robotic-assisted laparoscopy offers several distinct advantages over other surgery techniques, these surgeons say. These include enhanced visualization, thanks to 3D images of the surgical field; wristed instruments that have more range of motion than the human hand; a computer system that scales and fine tunes the surgeon’s hand movements, eliminating tremor; and a more comfortable working environment for the surgeon.

Robotic-assisted laparoscopy is pushing surgical technology in the right direction, says Dr. Desai. “For patients, it can get them back to their lives quicker, and that’s what’s important to us—doing the best for our patients.”