Friday, March 7, 2003

Robotic surgery comes to TriHealth



By Tim Bonfield
The Cincinnati Enquirer

[photo] Dr. J. Michael Smith, director of robotic technology at Good Samaritan Hospital, sets up the da Vinci surgical system for a demonstration.
(Gary Landers photo)
| ZOOM |
The patient is prepped and ready for the operation. But the surgeon isn't standing at the operating table.

Instead, a 7-foot-tall gray robot with three black arms hovers over the patient, with probes extended into the chest or abdominal cavity.

The surgeon controlling the robot sits several feet away peering into a console a bit like the eye test devices at the motor vehicle bureau. His or her fingers reach into ring-shaped grips attached to control arms that move so smoothly they almost float.

Each time the doctor extends an arm, twists a wrist or pinches fingers, the robot arms mimic the movement. Instantly. Fluidly. Silently.

Robotic surgery may sound like science fiction, but within days it will become reality at TriHealth - the first Greater Cincinnati hospital system to acquire a da Vinci robotic surgery system, made by California-based Intuitive Surgical Inc.

"It's almost as if my hands were inside the chest, except that the robot's hands and wrists are no bigger than the tip of my finger," said Dr. J. Michael Smith, a cardiothoracic surgeon and TriHealth's director of robotic surgery.

On March 14, Smith is scheduled to use the $1.2 million system at Good Samaritan Hospital on the hospital's first human patient. But by year's end, robotic surgery is expected to be an everyday event in Greater Cincinnati.

TriHealth already has started fund-raising to install a second system at Bethesda North Hospital. Within several months, University Hospital plans to install a robot surgery system as part of a larger surgical innovation center.

"The notion of robots assisting surgeons in surgery is revolutionary, but not as science fiction as it may seem," Smith said. "These surgical systems are not designed to replace physicians, but to assist in making the job easier and more efficient."

As amazing as the technology sounds, Greater Cincinnati's entry into robotic surgery comes years behind other leading medical centers. Since its first, limited-use approval in 1997, the da Vinci system has been installed at about 130 hospitals in the U.S., Europe and Japan - including systems at Ohio State University and the Cleveland Clinic.

The U.S. Food and Drug Administration (FDA) has approved using the robot for several kinds of minimally invasive surgeries including prostate surgery, mitral valve repair and lung cancer surgery. U.S. clinical trials continue for using the robot for coronary bypass operations.

TriHealth doctors are training to use the device primarily for cardiac and urological surgery. Advocates say using robots during surgery benefits patients in several ways:

• Small incisions mean quicker recovery - potentially cutting a four-day stay after prostate surgery to a single overnight stay.

• Small incisions also mean reduced risk of infection, less blood loss and fewer mistakes because robots don't tremble or slip and won't get tired, bored or distracted during tedious procedures.

• Robotic tools can be more precise. For prostate surgery, that can mean less risk of damaging nerves that control urinary and sexual function.

• Eventually, robotic surgery could allow truly remote surgery. For example, a surgeon in a big-city medical center could control a robot placed at a smaller rural hospital, near a battlefield or even in orbit.

But robotic surgery also has its limitations:

• The technology to allow remote control across long distances remains in development.

• The machines are expensive. The tiny tools used by the robot arms need constant replacement, sometimes after as few as 10 uses.

• While smaller and often more precise, the machines aren't necessarily faster than human hands - especially at tricky tasks like tying knots in sutures.

• Some people are scared by robots.

"I've had a lady say, `I don't want a robot operating on me. I want you,' " Smith said. "People think the whole thing is automated. But there is still a person running the equipment."

Technology vs. economics

Many hospitals have found it difficult to invest in robotic surgery, said Dr. Jeffrey Matthews, chairman of surgery at the University of Cincinnati Medical Center.

Given the research and training possibilities, UC plans to install a robotic surgery system this year, possibly this summer. But finding ways to make the robots pay for themselves remains difficult.

"So far, it hasn't proven to be a major advantage over (human-performed) minimally invasive surgery. And the technology is constantly evolving.

"So when to jump in? These are major capital expenses when hospitals are cash-poor," Matthews said.

The fact that it took until 2003 for Greater Cincinnati to get its first da Vinci system is striking. In fact, a previous effort to bring the robot to town fell through a few years ago.

In 1999, Dr. Randall Wolf, then a heart surgeon at Christ Hospital, traveled to Europe to become the first U.S. surgeon to use the da Vinci to complete a cardiac bypass. But Wolf left for Ohio State later that year after officials at Christ Hospital decided not to buy the machine.

The team at Ohio State went on to grab several headlines for advances in robotic surgery while Wolf's departure became another example in a long-running debate about specialists leaving town and cash-pinched hospitals struggling to keep up with technology.

But even though the da Vinci robot is here, that doesn't mean TriHealth could afford it any more than Christ Hospital could.

In fact, the purchase happened only because the Good Samaritan Foundation got three contributions for the project - from Pam and Rob Sibcy, Claire Phillips and the Castellini Foundation.

E-mail tbonfield@enquirer.com




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