Robotic surgery gains popularity

Robotic surgery gains popularity
Bob Gilbert — The Capital

Dr. Paula Radon, right, preps a patient at Anne Arundel Medical Center for surgery using the da Vinci robot. AAMC has been using the machine since 2006 and has performed more than 300 surgeries with the robot.
SLIDESHOW
Robotic Surgery
Robotic surgery quickly is gaining popularity with patients at the county's two hospitals. Anne Arundel Medical Center installed a da Vinci surgical robot in April 2006 and has used it for 342 procedures.

Annapolis
AAMC, BWMC increase use of machine-assisted procedures
By EARL KELLY, Staff Writer
Published January 04, 2009

Robotic surgery quickly is gaining popularity with patients at the county's two hospitals.

Anne Arundel Medical Center installed a da Vinci surgical robot in April 2006 and has used it for 342 procedures, covering the gamut of thoracic, gynecologic, urologic and general surgeries.

"We have one of the East Coast's most advanced robotic programs - truly multidisciplinary," hospital spokesman Justin Paquette said.

Baltimore Washington Medical Center started using a da Vinci robot in late October, and has performed 10 surgeries - all of them urological.

A number of physicians who perform robotic surgery practice at both hospitals.

The da Vinci robot allows doctors to make a few small incisions, depending on the type of operation, instead of having to open the body cavity. Patients experience less bleeding and heal faster, with less likelihood of infection. Also, they don't accumulate massive scar tissue that can complicate future medical procedures.

Some hospitals use the da Vinci S robot for bypass surgery, so that patients will not have to have their sternum, or breastbone, cracked open.

Laparoscopic surgery, another type of minimally invasive surgery, has been around for years and also allows doctors to operate without making large incisions. Only, the tools have limited mobility and doctors describe the procedure as "like operating with chopsticks" when compared to the robot.

The da Vinci's surgical tools have more articulation, or range of movement, than even the human wrist. The result is that doctors can use these tools to work under and around organs, and to suture the patient at the end of the procedure.

The $1.7 million machine consists of the main robot, which stands next to the patient and holds the surgical instruments at the ends of its arms. It is attached by a data cable to the remote console, where the doctor controls the instruments with levers similar to joy sticks.

Baltimore Washington Medical Center held a contest to name its robot in late October, and the winner, Sarah Price, 6, of Glen Burnie, came up with the winning name "Poppy," because the machine's arms "pop out" when unfurled, and help cure sick people. A sign on the operating room door reads "Poppy in progress."

While repairing a man's kidney at BWMC earlier this month, Dr. Alice Tsao said she liked the 3D high-definition field of vision the robot provided.

"You can really see well, and the (roughly 10-power) magnification is so great," she said. "With some types of surgeries (without the robot), you are literally having to look into a hole."

The patient, Glen Burnie resident Corey Snowberger, 29, was born with a defective ureter, or muscular tube leading from the kidney to the bladder. In essence, the tube was nearly closed at the base of the kidney, and stones formed over the years as urine kept backing up. The kidney also became bloated and painful.

Dr. Tsao began the surgery by making four small incisions in Mr. Snowberger's abdomen, through which tubes, or trocars, were pushed into the abdominal cavity.

Slender, robotically controlled surgical tools and a camera were inserted through the tubes, but stayed attached to the robot's arms.

Then, the body cavity was inflated with carbon dioxide like a balloon, increasing the area Dr. Tsao had available.

With her face buried inside the operating console, Dr. Tsao gently cut some of the connective tissue binding the large intestine to the other organs until she could move the bowel aside. Then, she used the small remote tools to slowly tease back more connective tissue, until the kidney and ureter were in full view. When necessary, she would apply heat through the tiny instruments, thereby cauterizing any tiny vessels that were oozing blood.

Any time Dr. Tsao lifted her face from the console, whether to talk with the staff or to stretch her neck and shoulders, a fail-safe device would lock the surgical tools in place, keeping them from moving until the doctor was back in position and activated the controls.

Also, according to surgeons watching the procedure, if a robot ever breaks down, the surgeon would immediately convert the procedure to a laparoscopic procedure and proceed.
A gentle touch

Mr. Snowberger's operation involved removing the defective section of the ureter, a soda-straw sized tube, and splicing the healthy ends together again.

If that task wasn't complicated enough, there were more challenges ahead.

X-rays showed that Mr. Snowberger had about a dozen kidney stones, and Dr. Tsao wanted to remove them, if she could. If not, she said, Mr. Snowberger likely would have to undergo a separate procedure sometime in the future.

Cutting the kidney open to gain access to the stones was not an option, because of bleeding and possible complications.

Dr. Tsao gently inserted a probe through the area where the kidney attached to the tube, at the renal pelvis.

"I am working by touch," she said, even though she was several feet from the patient, and was probing into Mr. Snowberger's kidney with steel tools.

As she gently probed into canyons inside the kidney, the nurses and technicians got to kidding Dr. Tsao about her ability at playing video games.

She translated for a visitor: "I totally suck at video games," she said. "I am the worst ever!"

With that, this woman who can't play video games kept "feeling" her way inside Mr. Snowberger's kidney.

Dr. Tsao, 33, trained in robotic surgery at the prestigious Mayo Clinic, was recruited to come to BWMC because of her proven skills.

She kept gently probing.

"There we go!" she said as she used a small pliers-like robotic instrument to pull two BB-sized stones out of Mr. Snowberger's kidney.

She kept working and said, "There's some more of those suckers," as she removed them from the patient.

When Dr. Tsao was done, she had removed about 12 stones from her patient, then set about stitching the tiny tube back together.
Whole new life

One woman, who asked not to be named, had a hysterectomy performed at AAMC four months ago to remove her tumor-laden uterus. A reporter and photographer from The Capital also observed that procedure.

The benign tumors were so large, they couldn't be removed through a trocar, so the surgeon, Dr. Paula Radon, used a device - called a morcellator - that chomped and chewed on the tissue until it was stringy enough to pass through the trocar.

This device would never be used on cancerous tissue, she said, for fear of releasing harmful cells into the body.

The patient, a then-49-year-old public accountant, said she had gone to a different doctor for years, but that physician would never recommend having a hysterectomy.

"I adore Dr. Radon - I wish I had found her sooner," she said.

In a follow-up interview, the woman said recently, "I haven't felt this great in years. I was at a Christmas party last night talking to a woman about my procedure, and how it was the best thing I have ever done."

In recent years, the woman had been unable to pursue her hobbies, bicycling and crewing on an outrigger canoe, because of pain and inopportune bleeding.

"Sometimes, I was bent over in half from the pain, and I would have to pull myself back up," she said.

The woman said she felt so much better since her operation, she has had to have surgery performed again - to mend a torn ligament in her hand suffered while playing an aggressive game of volleyball.

"That should tell you that the surgery has changed my life!" she said. "At 50, playing like I was 20!"

Surgeons said patients should never take robotic surgery lightly, however.

Dr. Eric J. Schwartz of Anne Arundel Medical Center said the side effects of prostate removal, for example, remain very real.

"There is still the incontinence worry, and the lack of erection worry, as with conventional surgery," Dr. Schwartz said. "It is too early to say it is truly better with robotics ... I believe it is better, but I can't prove that to you."

When surgery is a must, though, doctors say they prefer the da Vinci - an operation takes about the same amount of time as traditional surgery, or perhaps a little longer, but the results are better for the patient.

Some anesthesiologists say they prefer robotic surgery because patients need less medication for pain afterward.

Some general surgeons, too, are big fans.

"I do a lot of gallbladder surgery," said Annapolis general surgeon Dr. Glen Gibson. "Operating on livers, stomachs and colons used to be stem-to-stern incisions; I have had to take out (only) one gallbladder by traditional surgery in the last three years."

For more information about the surgeons trained to use the da Vinci S robot at Anne Arundel Medical Center, call 443-481-4000 or 1-800-MDNURSE, or visi

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