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Robotic surgery debuts in upstate NY

Only Strong Memorial is using technology for cardiac, urology, general surgery cases

Tuesday, September 30, 2003

Surgeons at Strong Memorial Hospital of the University of Rochester Medical Center are the first in upstate New York to use robotic technology laparoscopically to assist in the operating room.

The first cardiac case – a mitral valve repair – was performed Thursday by a cardiac team led by surgeons Peter Knight, M.D., and George Hicks Jr., M.D. The patient, a 60-year-old woman from Rochester, is doing well and was discharged Monday.

“We couldn’t be more pleased with the outcome,” says Hicks, chair of the Division of Cardiothoracic Surgery at Strong Memorial Hospital. “The repair to her heart went perfectly, and her recovery as a result of the less-invasive procedure is going as planned."

The woman underwent surgery Thursday morning using the daVinci Surgical System, now being utilized by the Strong Heart and Vascular Center for cardiac-related surgery, such as atrial septal defect closures, certain types of coronary artery surgery, and mitral valve repair and replacement. It also is being used for general surgery, as well as urology cases, such as radical prostatectomy and pyeloplasty (renal pelvis reconstruction). The procedures are done laparoscopically, eliminating the need for large incisions.

In this case, involving the repair of the patient’s mitral valve, one 2-inch incision and three 1-inch incisions were made under her left arm, in lieu of the traditional 6- to 8-inch chest incision typically made for heart surgeries.

The leading-edge technology consists of a robotic arm that performs surgeries using movements that replicate a surgeon’s motions. The movements are controlled from across the room by a surgeon using virtual images provided by laparoscopic cameras.

The benefits of the technology have a significant impact on patients and their outcomes. Because the cases are done laparoscopically, significantly smaller incisions are made that result in faster recovery time and a lower chance of infection or other complications. The procedures themselves can be even more accurate than traditional surgery, with steadier “hands” at the surgical site being directed by a surgeon.

“This is the future of surgery,” says Knight, who operated the robotic technology Thursday. “The benefits to patients are enormous, highlighted by less-invasive and more accurate surgery and improved recovery. We are pleased to offer this to patients who require heart, general or urological surgical treatment.”

How it works

The daVinci Surgical System has been incorporated into the new operating room facilities at Strong Memorial. Patients are positioned as they would be during traditional surgery, with medical personnel surrounding them, yet a surgeon is located at a console a few feet away.

Although the surgeon is not physically in contact with the patient, the daVinci control console allows the surgeon to actually see the surgical field in enhanced detail as a result of the three-dimensional image transmitted from the laparoscopic cameras. The surgeon manipulates the robotic “hands” in real-time using master controls, seeing minute, 3-D details inside the patient with the aid of the cameras located inside the patient.

Two robotic arms and one laparoscopic arm execute the surgeon’s commands. Supporting surgical team members prepare small incisions in the patient, install the correct instruments, and supervise the laparoscopic arms and tools being used. The instruments are designed with seven degrees of motion that mimic the dexterity of the human wrist. Each instrument has a specific surgical mission such as clamping, suturing and tissue manipulation.

Revolutionizing surgery

The technology allows surgeons to view the surgical site in a way they haven’t been able to in the past.

“It gives the appearance of being inside the patient,” says surgeon Edward Messing, M.D., chair of the Department of Urology. “The three-dimensional view provides a depth perception that is missing in traditional laparoscopic surgery. This brings us as close to the surgical site as we can get.”

The robotic system improves surgical accuracy as a result of the precise movements of the robotic hands, and means quicker and better recovery times, Messing says.

The addition of the daVinci Robotic System revolutionizes the field of surgery, particularly cardiac cases.

“The option to perform mitral valve and atrial septal defect cases using a less-invasive method has a significant impact on patient care,” Knight says. “Although heart bypass operations are not yet approved using this technology, we expect to receive the FDA’s go-ahead within the next year. We will then have the ability to do a number of our present cardiac cases robotically, which will substantially benefit our patients during and after surgery.”

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Karin Christensen

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