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ANN ARBOR,
MI - If you walk by one of the University
of Michigan Health System's operating rooms these days, you
might think you're looking in on a science fiction movie. A seven-foot
robot stands right along side the operating team, not as an observer
but as one of the surgeons! It's a new addition that's helping UMHS
pave the way for the future of surgical technology, which may make
many operations less invasive and recovery time much quicker.
The robot joined
UMHS's operating team late in 2001, and has successfully assisted
in several surgeries including donations of organs for transplants,
and prostate and gynecological procedures.
UMHS is one
of the first hospitals in Michigan and the United States to perform
robot-assisted surgery since the Food and Drug Administration approved
the approach. Surgeons at the Health System are also dedicated to
providing valuable research into this new technology, to see how
it compares with more conventional techniques.
This fall,
Juan Arenas, M.D., assistant professor of surgery
at UMHS, began using the robotic device for laparoscopic living
kidney donations, one of the first surgeons in the country to do
so. All of the operations have been successful.
Instead of
performing the surgery by the patient's side, Arenas operates from
a console a few feet away, viewing a three-dimensional image captured
by cameras inside the patient and controlling the surgical instruments.
Although a second surgeon, nurses, and medical assistants are next
to the patient, Arenas performs the entire surgery by operating
the arms of the seven-foot robot remotely.
Laparoscopic
surgery is minimally invasive, performed through several small incisions
versus a single large opening. Surgeons slide a tiny video camera
inside the patient's body through one incision and operate with
small instruments fed through another. In robot-assisted surgery,
the robot actually has three arms - one to hold the camera, the
other two to perform the operation - increasing the possibilities
of this surgery.
"The primary
advantage of robotic surgery is that it provides a full range of
motion similar to a human's wrist. Traditional laparoscopic surgery
doesn't allow that," Arenas says. "But the robot goes
beyond just wrist movement. It can actually rotate 360 degrees,
something human surgeons could never do. This asset gives surgeons
more precise and accurate movements."
The da Vinci
robot is a $1 million device created by Intuitive Surgical Inc.
In July of 2000, the FDA approved its use in laparoscopic surgeries.
But Arenas says the robot isn't intended to replace the surgeon.
"The robot literally gives us an extra set of hands at the
operating table," he notes. "It's the next major step
in surgery for the 21st century."
As of mid-December,
Arenas had used the robot in five laparoscopic living kidney donation
surgeries, and plans to continue to use it in all appropriate cases.
Patients who might be a candidate to donate "robotically"
are given the option after talking with their surgeon.
Jennifer Gerber
is one of Arenas's patients. In late December, she donated her kidney
robotically to her sister, who was in complete renal failure. Jennifer's
mother had also been a kidney donor years ago, and had undergone
surgery in the traditional, open-abdomen manner. Jennifer was encouraged
when Arenas told her robotic surgery would be less painful and have
a quicker recovery than what her mother went through.
"I chose
the procedure because, number one, the healing process was faster,
and second, I was told that the process would be easier on me and,
so far, it has been," Jennifer said from her hospital bed.
"I would encourage anyone and everyone to donate a kidney,
if they're able to."
Arenas isn't
the only surgeon at UMHS using the robot. Arnold Advincula, M.D.,
clinical assistant professor of obstetrics
and gynecology, as well as director of minimally invasive surgery
for the department, recently performed one of the first robot-assisted
laparoscopic hysterectomies in the nation. On the same day, Advincula
performed a second robot-assisted laparoscopic surgery to remove
fallopian tubes.
Advincula feels
the robot advances surgical technology, allowing physicians to approach
gynecological problems in a laparoscopic fashion that previously
would not have been considered an option. He and his colleague Kevin
Reynolds, M.D., hope to help many more women beat these problems
with the least invasive surgery possible.
"Our plans
are to apply robot-assisted surgery to treat difficult hysterectomy
cases, advanced endometriosis, and management of myomectomy,"
he says. "Although many of these procedures are being done
with conventional laparoscopy, the use of robotics will now allow
us to more accurately replicate what is being done with traditional
open cases, but in a less invasive manner."
Advincula also
points out that in both of his first robotic surgeries, recovery
time was extremely speedy. One patient went home the same day the
procedure was performed, the other, the next morning.
Male patients
at UMHS are also benefiting from the new device. Stuart Wolf, M.D.,
associate professor of urology,
and co-director of the Michigan
Center for Minimally Invasive Urology, was the first UMHS surgeon
to use the robot for a prostatectomy back in early October, and
has performed several more since.
Wolf says,
"I am impressed that the robot helps us do some of the more
detailed parts of the procedure, such as sewing the bladder to the
urethra following the removal of the prostate." He hopes to
use the robot for more complicated procedures such as reconstructing
the renal pelvis and ureter if there is a blockage.
Another U-M
urologist, James Montie, M.D., says although robot-assisted surgery
has great potential for the advancement of surgery, it may not be
the answer in all surgical cases. He cautions the robot shouldn't
be turned into a marketing tool or gimmick before concrete data
is collected and analyzed.
"Robot-assisted
surgery has the potential of making great advancements in the operating
room," Montie explains. "However, it remains uncertain
whether or not the long-term results for an operation such as a
radical prostatectomy are any different or better than traditional
methods."
Because robot-assisted
surgery is so new, the exact outcomes are still unknown. That's
why many UMHS departments have initiated research efforts comparing
patient data from robotic surgery to patient data from laparoscopic
and open surgeries. The data collected will ultimately decide if
robots are an improvement in the operating room.
Written by
Carrie Hagen
For more
information, contact Kara Gavin or Carrie Hagen, UMHS Public
Relations, 734-764-2220, or by e-mail.
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