da Vinci Technology

Published: Synapse 2012, Vol. 1

Legendary artist Leonardo da Vinci is revered for transforming the art of painting with his mastery of the human body and the use of three-dimensional detail to bring his works to life. His study of human anatomy led to the design for what is considered the first robot in recorded history.

da VinciInspired by da Vinci's unprecedented understanding of human anatomy, the da Vinci robotic surgical system is a revolutionary technology that is changing the way surgery is performed in the operating room. The computer-enhanced system combines high definition 3D imaging, remote control technology and robotics to give surgeons unparalleled precision, dexterity and control. The technology enables surgeons to perform delicate procedures that are more exacting than conventional laparoscopy and less invasive than traditional open surgery.

A Program Built on New Technology and Existing Expertise
The latest and most sophisticated da Vinci Si Surgical System is now available through the Robotics Surgical Program at The Chester County Hospital. The program was officially launched in September 2011, but the Hospital's commitment to establishing the program began long before - with a dedication to detail and quality that would make the great master Leonardo himself proud. As a result, the program opened with a skill level rivaling similar programs that have been around a lot longer.

"Surgical robotics is the next generation in minimally invasive surgery," says Mary Kehner, Surgical Services Director at The Chester County Hospital. "From the very beginning, our vision was to build a robotics program that would provide the most advanced technology and surgical proficiency; but, most importantly, a program that would ensure the best possible outcomes for our patients."

da VinciA high level of expertise in robotic surgery already existed at the Hospital prior to the formation and official launch of the program. Surgeons on staff at the Hospital had been performing robotic surgery for years. George Trajtenberg, MD, Medical Director of Surgical Services, says, "Their knowledge and experience helped to create the foundation on which the Hospital began building its program. These hands-on experts were involved in all the planning and orchestration of the program, and they joined forces to select and train the rest of the Operating Room staff."

Utilizing the knowledge and experience already in place, the program quickly gelled. The Hospital's Robotics Surgical Program was able to meet the high standards and stringent parameters set up by the Hospital far ahead of initial expectations. By the program's launch, the team was functioning at a level equivalent or above other programs that had been around far longer - which, according to Kehner and Trajtenberg, made for a pretty remarkable start to the program.

Physician Assistant Jim Kozub, a robotic surgery coordinator with 30 years experience in the surgical field, was brought on board early in the process to help build the Hospital's robotics program. Kozub had been instrumental in building successful programs at other hospitals. He was immediately impressed with the dedication and commitment to the program shown by the surgeons, administrators and staff at The Chester County Hospital. "It has been exciting to be part of all this, because the Hospital is so firmly committed to the program. We have had the Hospital's full support from the start," Kozub says. "Absolutely everything you could ask for in a robotics program is here. Our patients can be sure of what they are getting. Really, really great care."

According to Kozub, the numbers speak for themselves. "Just look at what we have accomplished for our patients already. In our first five months, we performed more than 100 surgeries, which was the volume expected for our first year. And the number keeps growing," he adds. "We are achieving a volume that allows the program to continue to build and maintain a high level of expertise that is very unique for a community- based hospital. And our patients are seeing excellent outcomes."

Reaping Benefits in a New Era in Surgery
Robotic surgery is not the answer for every patient requiring surgery. But, for those who qualify for it, robotic surgery may offer significant benefits over other types of surgery. In many cases, there is less pain and discomfort associated with robotic surgery, as well as a faster recovery, a lower chance for complications, reduced risk for infection, less blood loss, shorter hospital stays, and diminished scarring.

"With all its benefits, however, robotic surgery is only as good as the human hands controlling the system itself," says Christina Ellis, MD, a robotics-credentialed Ob/Gyn. Although the technology is called "robotic," it takes a skilled surgeon with knowledge and experience to maneuver the technology. "It is always the surgeon, not a robot, performing every aspect of surgery. In fact, the system does not make any surgical maneuvers without my direct control, whether it is to delicately grasp a miniscule blood vessel or to use tiny scissors to dissect around sensitive structures. The degree of precisions is unparalleled."

When performing robotic surgery, the surgeon does not operate by hand at the patient's side, as is the case with traditional laparoscopic and open surgeries. Instead, the surgeon performs robotic surgery by remote control from a console.

The surgeon uses the console's master controls to maneuver four robotic arms attached to surgical instruments that actually perform the surgery through tiny incisions in the patient's body. The system translates the surgeon's hand, wrist and finger movements to direct the robotic arms and instruments with mirrored precision and a range of motion exceeding that of the human hand. As the surgeon works, a high definition monitor provides magnified, three dimensional images in real time from inside the patient via a mini camera inserted within a small incision.

Although the surgeon remains at the console a few feet away, the patient is never alone. A full surgical team is at the patient's side as the surgeon controls the robotic arms and maneuvers the instruments inside the patient. Team members are responsible for tasks that require close proximity to the patient, such as exchanging instruments as needed during the procedure.

"There's a nurse anesthetist. A physician assistant. An operating room nurse. And everyone is busy doing what they would normally do during any other type of surgical procedure. They are making sure the patient is well taken care of at all times," explains Kozub. "And there are speakers built into the robot so the surgeon and team can speak directly with one another. They are in constant communication at all times."

Extending the Surgeon's Reach and Control
Melissa Delaney, DO, an accomplished Ob/ Gyn surgeon in the robotics program at The Chester County Hospital, is a strong advocate of robotic surgery and sings the praises of the da Vinci system. "As a surgeon, I love this technology. It's like I am able to shrink myself down to a miniature me and really get in there so I can see everything in magnified detail and manipulate tissue in ways that are far beyond my actual human capabilities," says Dr. Delaney. "Just by maneuvering my fingers at the console, I can rotate my instruments to a degree that is impossible for my own wrist. I can get into spots that would be virtually impossible otherwise. I know I am a better surgeon with the robot, hands down."

Dr. Delaney is also enthusiastic about the recovery process her patients experience following robotic surgery. "I am always impressed with how well my patients are healing. Often, the biggest challenge I face is trying to convince my patients that they have to stay still following surgery. They are in little pain," she insists. "The fatigue of the healing process is the only thing that reminds many of my patients that they have just been through surgery."

Another gifted surgeon playing a significant role in the Hospital's robotics program, Urologist Donald Andersen, MD, is equally as enthused by the surgical capabilities possible with robotics. Dr. Andersen has performed numerous robot-assisted surgeries and sees increased safety as an important plus when it comes to the benefits of the new technology. The da Vinci system uses motion scaling and tremor reduction to minimize the chance of any unintended movements on the part of the surgeon as he or she operates. The system also performs millions of safety self-checks during each surgery.

"As a surgeon, I appreciate that the robot enhances my ability to perform surgery safely and efficiently. And I especially like that the system is always checking itself, constantly monitoring its functions and parts," explains Dr. Andersen. "But as sophisticated as the robot is, it is still a tool, and I am always in total control of what is going on at every step during surgery. I believe it is the blending of the technology with the skills of an experienced surgeon that makes this work so well."

Meeting the Surgical Needs of the Community
Through its Robotics Surgical Program, The Chester County Hospital offers patients access to one of the most technologically advanced and least invasive surgical tools in use today. Robotic surgery is available to patients with varying medical issues, including a wide range of gynecological and urological conditions.

As the Hospital's robotics program continues to grow, more and more types of surgeries will be made available in the future. For patients who are not candidates for robotic surgery, the Hospital's multidisciplinary team of surgeons provides the latest in state-of-the-art minimally invasive laparoscopic surgical options and traditional open surgical procedures.

If you or a loved one has been diagnosed with a condition that may require surgery, the experts at The Chester County Hospital will help you explore all your medical options, including, least invasive and most revolutionary surgical care available.

By Beth L. Eburn
Photos by Rick Davis and John Welsh

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