Archive for Sunday, December 4, 2005

R2-D2 at work in the O.R.

December 4, 2005

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Not long after she had 14 inches of her colon taken out, Marci Grace says she feels "like a miracle" and "a very successful pioneer."

She owes this to a peculiar, cutting-edge procedure done this spring at Community Memorial Hospital in Ventura, Calif.

Her primary surgeon, Dr. Gosta Iwasiuk, wasn't even at the operating table, and his hands never entered her body, yet he displayed a deft touch that he likens to that of a "super expert." Helping him was what he termed a "praying mantis."

Grace has other words for the 6-foot, four-armed apparatus that probed her body. She starts with "octopus." With its 21st-century technology and bevy of attached gizmos, it sported, she says, a special-effects look "straight out of 'Star Wars.'"

She recounts the disbelief that registers in others' faces when she tells them what was done to her. Or as Grace sums it up, "How many people do you know have been operated on by a robot?"

The so-called da Vinci robot doesn't move or squeak and isn't quite R2D2-lovable, but it does plenty to impress. It can cut, sew, grasp and help minimize blood flows deep in the body during surgery.

The computer-enhanced system magnifies operating fields, gives doctors greater ability to see things and moves instruments in tight spaces, and, as in Grace's case, shortens patients' hospital stays and gets them back to work sooner.

Called the latest advancement in what's known as minimally invasive surgery, the da Vinci robot and its ilk, says Community Memorial CEO Gary Wilde and others, are clearly the wave of the future.

"I believe we will see this type of equipment in virtually every hospital in the country within five to 10 years," Wilde said. "Every hospital will have some form of robotic surgery."

Ventura-based urologist Dr. Cedric Emery, who was the first to use the da Vinci robot after Community Memorial acquired it last fall, agrees.

"Ten years from now - you wait - this will be the standard of care," Emery says.

Increasing use

A growing number of hospitals are using the robots. The da Vinci's maker, Sunnyvale, Calif.-based Intuitive Surgical Inc., said that almost 275 da Vinci systems are in use at hospitals and similar facilities throughout the United States, Japan, France, Canada, Australia, Belgium and other countries.

Its use jumped from 1,500 procedures in 2000 to about 20,000 last year, Business Week reported earlier this year. Intuitive recently received Food and Drug Administration approval to begin using the da Vinci technology on gynecological procedures, said Nora Julian, the company's corporate events manager.

Doctors marvel at the things the $1.2 million da Vinci robot can do. For instance, it has the ability, via sensors, to factor and compensate for tremors in the surgeon's hands.

"It's new and modern and pretty exciting," says Iwasiuk, a Ventura-based general surgeon. "The imagination is the only limiting factor in what we can do with this."

How it works

The da Vinci system has three components: the surgical cart, or robot, that has four arms that execute the surgeon's commands; a vision cart, which provides three-dimensional images of the operating field, and the surgeon's console.

The robot stands at one end of the operating table, arms extended toward the patient. Several tiny incisions, or ports of entry, are made in the abdomen. Using tube-enclosed trocars - "a pipeline, if you will," explained David Vie, a registered nurse who is a clinical specialist for Community Memorial's da Vinci program - the instruments are plunged into the abdomen through the ports. One of the arms is for the camera. The other robotic arms have tiny knives at their tips. They can also be fitted to hold clamps, sutures, graspers and dissectors; each arm mimics the dexterity of the human hand and wrist. A typical operation has three or four sites, or ports, where the trocars are inserted.

The lead surgeon sits at the console - typically 10 to 20 feet away from the operating table in the room setup, Emery said. Peering into binocularlike lenses for views provided by the camera inside the patient, the surgeon sees the operating field, body organs and instrument arms in three dimensions, magnified 10 times.

Just below the lens display, the surgeon's fingers grasp the master controls. Using thumb, finger and wrist movements at the console, the surgeon manipulates the robotic arms stationed above the patient at the operating table. The surgeon manipulates the camera using a foot pedal.

The arm instruments can rotate 360 degrees and offer greater precision. Iwasiuk says it allows him to sew stitches with a much finer touch, for example.

By using the da Vinci robot, he said, "The rest of us are brought up to par with the super experts."

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