In the not-too-distant past, the only way to perform many operations—especially those in the abdominal or pelvic areas—was for the surgeon to make a large incision. Without doing so, he or she couldn’t effectively see or access the target area. Patients undergoing this traditional type of “open” procedure could reasonably expect to be in the hospital for several days—or perhaps even longer, depending on the severity of the surgery.
That’s no longer the case at Sentara RMH Medical Center, thanks to two significant medical advancements over the years: laparoscopy (also known as “keyhole” surgery) and, more recently, medical robotics. While laparoscopy has been used for years at Sentara RMH, the da Vinci robotic surgical system is new to the medical center, now enabling minimally invasive surgery to be employed in complex procedures more than ever before.
Doctor da Vinci?
Yes, that’s actually a robot standing there in the operating room, its long, delicate “fingers” waiting patiently to perform the most intricate of procedures. However, the robot doesn’t really operate on you—at least, not independently. That function is still within the purview of the surgeon. But with the da Vinci surgical system, Sentara RMH’s skilled surgeons can accomplish a wider range of surgeries with a higher degree of accuracy and fewer, smaller and less-debilitating impacts.
“It’s important for people to know that the surgeon is still doing the job,” says Robert Garwood, MD, Sentara RMH Medical Center’s chief of surgery. “The robot doesn’t do anything on its own—it simply helps the surgeon do a better job.”
According to Dr. Garwood, any urological, gynecological or general surgical procedure the surgeons at Sentara RMH can do laparoscopically now can be performed using the robot, allowing the surgeon “to accomplish things inside the human body laparoscopically that we couldn’t do before.”
He adds that the robot can be used for “procedures as simple as hernia repair and gallbladder surgery, and for more complex surgeries like removing a cancerous colon, performing bariatric surgery or repairing a hiatal hernia.”
Dr. Garwood explains that the da Vinci system has three components: an ergonomic surgeon’s console, a patient-side cart with four interactive robotic arms, and a sophisticated vision system.
Once the surgeon is comfortably seated at the console, he or she can control every aspect of the laparoscopic surgery. Using images provided by two offset cameras, the surgeon can see the surgical field in remarkably clear, three-dimensional, high-definition detail. Each of the surgeon’s hands slips into a master controller that is not unlike a virtual-reality glove; these controllers precisely translate the surgeon’s hand movements to the four robotic arms on the patient cart.
“The system uses computer processors that make very precise movements possible,” explains Dr. Garwood. “These processors also perform millions of safety checks over the course of a procedure, ensuring that every surgical maneuver is under the direct control of the surgeon, and that there is no independent movement of the robot.”
The da Vinci’s arms and the wide range of surgical accessories they can accommodate are designed with a patented “wristed architecture,” which provides the surgeon with a fluid range of motion even greater than that of the human hand.
Foot pedals on the console provide additional control and allow the surgeon to perform a variety of additional surgical tasks, such as cauterization.
“The da Vinci system enables surgeons at Sentara RMH to provide care with the most advanced components and technology available, giving patients a better outcome,” says Dr. Garwood. “It also allows the hospital to recruit surgeons who are skilled in this technology and who want to bring enhanced technology here, further expanding our ability to deliver high-quality, technically advanced health care to this community.”
Although the da Vinci system is a recent arrival, robotic technology is nothing new to Sentara RMH. The hospital first invested in robotics 18 years ago with a $1 million pharmacy robot that could hold and dispense 12,000 units of prescribed medications. The medical center’s ongoing investment in technology—this time with the da Vinci surgical system—continues to provide a streamlined medical experience that benefits everyone—the hospital, the operating room team and, most importantly, the patient.
Dr. Garwood, who calls the da Vinci system “the next step in minimally invasive surgery,” also pointed to a bright and exciting future for this type of surgical system. One day, he said, it may even be possible to operate remotely, with the surgeon and console in one location, and the patient and robot in another.
“We’re not there yet,” he says, “but it’s not impossible. With technology advancing the way it is, it could happen sooner rather than later.”
Now is the Time
Another area surgeon skilled in performing surgeries with the da Vinci system at Sentara RMH is Brian Stisser, MD, a urologist with Blue Ridge Urological Associates. Even though Dr. Stisser’s experience with robotic surgery goes back nearly 20 years, he says the ever-improving technology and resulting boons to medicine never cease to amaze him.
“This type of surgery seems so advanced, yet it’s actually very similar to open surgery, from a mental standpoint,” notes Dr. Stisser. “Once you get over the mental hump that it’s not truly your hand in there doing the procedure—and you see that the instrument is really doing exactly what you want it to do—it becomes almost like open surgery, except better. It’s almost as if you’re miniaturized inside the human body and doing the sort of fantastic things people only used to write about in science fiction.”
Surgeons must, of course, have training in order to use robotic surgical systems like da Vinci. Dr. Stisser says many physicians have received training within the last 10-15 years as part of their residencies. But for those who didn’t receive robotic surgical training that way, he says there are a variety of new training programs throughout the country—programs that are turning experienced doctors with certain skill sets into imminently qualified experts.
Dr. Stisser points out that now really is the time for robotic surgery, noting that more than 90 percent of prostate cancer surgeries are currently performed through robotic assistance, and that the numbers for other types of surgeries are constantly rising.
If you’re still asking yourself why any hospital would use a robotic system, Dr. Stisser has an answer for you.
“It’s about precision. If you look at robotic data compared to standard laparoscopic data and open surgical data, you will see improved outcomes for the patient,” he says. “When you perform surgery on someone, obviously you’re trying to correct the pathology, whether that’s oncological or some sort of a lifestyle issue. Those outcomes are improved.”
“But then you see the improvements in the specific outcomes we use as metrics in the operating room: blood loss, how much pain the patient experiences and how long the patient had to stay in the hospital after robotic surgery,” he adds. “Those improved outcomes are pretty magical enhancements for both the patient and the hospital.”
Dr. Stisser commended Sentara RMH for “being introspective enough to realize that they have to reinvest to fully be able to address the needs of the community.”
“They realized that now was the right time, and that we had the right mix of people involved in the organization,” he says. “I’m proud to be part of that as well—to be able to say that now is our time.”
Benefits of Robotic Surgery
- Shorter procedure time and less time under anesthesia, reducing both risk and cost to the patient.
- Less pain. Incisions are smaller, surgical trauma is reduced, and patients may not need extraordinary pain medication following the procedure.
- Quicker recovery time. Patients get back to normal more quickly, and a stay in the hospital following the procedure may not be necessary.
- Less risk of scarring.
- Less bleeding during the procedure.
Applications for Robotic Surgery
The da Vinci robot can be used to perform any urological, gynecological or general surgical procedure that is normally done laparoscopically. It can be used for procedures as simple as inguinal hernia repair or gallbladder surgery, or more complex surgeries like removing a cancerous colon, performing bariatric surgery or repairing a hiatal hernia.
Surgeons must be specially trained to perform robotic surgeries, and more and more are now getting this special training. Currently at Sentara RMH, four surgeons are trained in robotic surgery. In addition to Dr. Garwood and Dr. Stisser, Justin Deaton, DO, and Bryan Maxwell, DO, of Shenandoah Women‘s Healthcare, perform a number of gynecological procedures using the da Vinci. These procedures include hysterectomies for various conditions, such as heavy or irregular menstrual cycles; uterine prolapse, pelvic pain and fibroids; ovarian surgery for cysts and removal of fallopian tubes; and various procedures for endometriosis.