Known as the da Vinci Si Surgical System, this futuristic technology -- the first of its kind in northwest Georgia -- made its debut in Cartersville earlier this month. Billed as "the most advanced and state-of-the-art robotic surgical technology available," the da Vinci Si Surgical System is a tool for robot-assisted surgeries, currently aiding in gynecological and urological procedures at CMC.
Benefits of the minimally invasive procedure include less pain, less risk of infection, less scarring and a quicker recovery time. Surgeons benefit from the da Vinci system's visual clarity, added precision and dexterity.
"We are excited to offer this technology at Cartersville Medical Center," CMC CEO Keith Sandlin stated in a press release. "Robot-assisted surgery is a less-invasive option for many of our patients. This is a significant arrival because of the value it offers our surgical staff and the communities we serve."
Dr. David Warren and Dr. Steven Spivey, both Harbin Clinic OB/GYNs on staff at CMC, have together performed eight operations at CMC utilizing the da Vinci system. Last week, The Daily Tribune News was allowed to observe a hysterectomy performed by Spivey as console surgeon with Warren at bedside assist, although Warren too has spent time at the helm.
With robotic-aid, Spivey, the operating surgeon, sat at a console several feet from the patient -- face pressed into a viewfinder displaying a magnified, high-definition, 3-D image from within the patient's abdominal cavity. Above the patient, under general anesthesia and a nerve blocker, were several robotic arms inserted through four small incisions, one measuring 12 mm in diameter and three others only 8 mm wide. At the ends of these arms are tools typically held by a surgeon's hand, forceps, scalpel and a suction hose among others in addition to an HD camera.
The surgeon at his console grasped the controls with which he can manipulate his tools. Pedals at his feet control other movements capable by the machine. By pinching, rotating, lifting, turning, pulling and pushing the hand-held controls, Spivey successfully completed the operation without physically touching the patient or his tools.
Patient, physician perspective
Boasting patient benefits related to minimally invasive procedures, the da Vinci system also brings technical improvements to the table.
Surgeons note "significantly less" blood loss in robot-assisted surgeries and complicated operations are made safer. Spivey asserts that more than half of all hysterectomies performed in Atlanta are completed using the machinery that can now be found in Cartersville. That rate, however, is bolstered within major markets due to referrals involving complicated operations.
The operation observed last week offered in itself a unique example of this situation. If begun using traditional laparoscopic measures, Spivey believes the surgery could have warranted an open incision due to unforeseen scar tissue creating complications during surgery. Those complications, however, were minimized by the use of the da Vinci system.
"The case that you saw was fairly complicated, actually it was a surprise. [The patient] was not having much pain or anything. Usually, people with that much scar tissue are having a lot more pain," Spivey said. "That's one that is a good example of how advantageous the robot is. It is very safe to operate that way because you have the increased magnification, you're able to see what you're working on. So, I think it ends up being a lot better for the patient. There are plenty of situations where a patient, like the one [last week], with that much scar tissue might otherwise require an open incision."
The patient in question was Lisa Steele-Edmondson, Cartersville resident, wife, full-time employee and mother. Her surgery was scheduled originally for a traditional laparoscopic procedure until she was approached by her physician about the opportunity to undergo a robot-assisted operation. Speaking prior to her surgery, she described her emotions as "anxious but excited."
"Once I started looking things up for myself, the biggest factor for me was that it's less invasive, less chance of scarring and infection, recovery time is much better than traditional hysterectomy and a huge plus is being able to have it here at home," Steele-Edmondson said. "I have a 10-year-old daughter, I work full time -- just being able to take care of my daughter and do my daily things with her is a huge thing for me."
For Spivey, the biggest misconception he finds is the belief that the robot replaces the surgeon. The operation is much the same as it was, said Spivey, only the tools have changed.
"I think people have a crazy misconception that the robot just does stuff. It's not doing anything you don't tell it to do. You don't hook it up and say, 'Do a hysterectomy,' and it just goes to town. It's still continuously under the surgeon's control," Spivey said. "It's the same procedure we're doing, it's just a machine that enables us to do it better."
Because the procedure hasn't changed, surgeons have only had to learn proficiency with the surgical console. Mastering the controls includes time observing an experienced surgeon, completing online training modules, conducting hands-on training procedures and having experienced surgeons proctor initial operations.
da Vinci Si Surgical Systems
There currently are about 2,300 da Vinci Si Surgical Systems in use worldwide. Although the majority of those are in the U.S., the da Vinci system has made its way into more than 30 countries and every continent except Africa and Antarctica.
The robotic surgery system was originally developed by use on the battlefield through a research venture between the U.S. military and Stanford University. A surgeon operating the console controls does not even have to be in the same area as the patient undergoing surgery. This feature is where original development began with the intent of operating on soldiers in the battlefield where surgeons may not be readily available. On call at a hospital within the safe zone, battlefield surgeons could then operate on wounded soldiers without a full medical evacuation.
Although, the technology has not been fully implemented in that function, the research was purchased for private use by those now creating the da Vinci Si Surgical System. In the spirit of its original goal of remote operation, a successful trial has even been conducted with an operator in New York City and the "patient" in Paris, France. Current laws, however, do not allow for remote use on patients within the U.S. and technology is progressing to eliminate a 2 millisecond delay experienced during that remote trial, but the feat remains a testament to the future of medical technology.
Current models in use at hospitals around the world include safeguards programmed into the machinery to protect the patient. To ensure that movements are intentional, the da Vinci system operates on a 3-to-1 ratio. Each move made by the surgeon at the console requires 3 inches of movement for each inch the tools actually move. The robotic arms also are designed to assert no more than a designated amount of pressure. Once that predetermined limit is reached, the arms will stop applying pressure.
For more information about the da Vinci Si Surgical System at Cartersville Medical Center, visit www.cartersvillerobotics.com, or for a free physician referral, contact MedLine at 800-242-5662.