Mary McCurdy - PinnacleHealth

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physician focus: PinnacleHealth and the da Vinci ® A Q&A with Robert DelRosario, MD, and Gregory S. Willis, DO Just as both of these doctors are committed to providing the best care for their patients, PinnacleHealth is committed to providing the latest technology and training for the doctors working to get them back to optimal health. That’s exactly what the da Vinci ® Surgical System can do. Minimally invasive surgery with the da Vinci allows a patient to get back on her feet faster, reduces the risk for infection and complications, and provides the freedom to return to her family or daily routine faster than ever before. Below, Dr. Robert DelRosario, Obstetrics & Gynecology (left), and Dr. Gregory S. Willis, Gynecologic Oncologist, PinnacleHealth Women’s Cancer Center, explain the technology, who is eligible, how it works and what it means both to women and the surgeons who help them. Describe what “minimally invasive” means when using the da Vinci SI Surgical System. Unlike traditional surgery, which involves making a large incision in order to operate, minimally invasive surgery means doing the same procedures through small incisions with less pain, less blood loss, shorter hospital stays, fewer complications and better accuracy. The da Vinci robotic technology offers improved precision and less abdominal wall trauma. This translates into more complete surgeries with less pain and fewer complications. – DR. WILLIS The instruments are able to move in many directions simulating all those of a human hand when using the da Vinci robot. Doctors gain the “minimal” incision of laparoscopy, with the “hand-movement” capability of traditional “open” surgery. In laparoscopic surgery, doctors place instruments through small incisions allowing for some rotational type capabilities; but, in a “left-to-right” direction, move somewhat akin to chopsticks. Their movements are visible via a small camera also placed through a small incision. – DR. DELROSARIO What kinds of procedures are possible with the da Vinci In Gynecologic Oncology, the da Vinci technology has been a game changer. We are routinely performing cancer staging hysterectomies, radical hysterectomy, lymph node dissections, appendectomy, ovarian cancer staging and restaging. We are using da Vinci for difficult endometriosis, obese patients and uterine fibroids. These are all done traditionally by open surgery, but da Vinci offers a distinct advantage. – DR. WILLIS In my field, some of my most common procedures that can be done with da Vinci include hysterectomies, myomectomies (removal of fibroids of the uterus), surgery for pelvic floor prolapse and endometriosis. I feel it can replace nearly every gynecologic surgery where a large incision would be otherwise required and offers improved dissection and visualization in many cases where traditional laparoscopy would be used. – DR. DELROSARIO Who is a candidate for these procedures In gynecology, if surgery is indicated and the approach would have required a large incision, many of these patients are excellent candidates for robotic surgery. In many laparoscopic surgical cases, the da Vinci offers a better surgical access than the traditional approach. – DR. DELROSARIO 20 (717) 231-8900
SI Surgical System Provide Women with Options Women who are not medically contraindicated to high abdominal pressure, have reasonable cardiac and lung function and are not overly complex in regards to adhesions from previous surgeries and tumor or uterine size are good candidates for robotic surgery. – DR. WILLIS How do you maneuver the machine Is the surgeon really operating the machine The da Vinci is “docked” by the surgeon who places the small ports in the abdomen. The surgeon then sits down at a console with a 3D view of the abdomen. In real time, the surgeon uses the robotic instruments to perform the operation. The robot does not move without the surgeon in complete control. This is kind of like a high tech video game, but far superior to the surgeon’s hands and eyes. The robot does not fatigue, and the vision is magnified to ten times the magnification of the naked eye. We can even see the blood circulate in capillaries! – DR. WILLIS What benefits do the patients receive in having minimally invasive surgery For me, reduction in a woman’s recovery time has been the most rewarding aspect of robotic surgery. Compared to the woman who is healing from a large incision, I have had many da Vinci patients return to work within 1–2 weeks with full recovery by 3–4 weeks, as opposed to a full six weeks for both with traditional surgery. I greatly appreciate the burden of surgery and the patient’s recovery can place upon a person and her family. Having minimally invasive options reduce this burden dramatically. Many women wear several hats— mother, wife, employee and friend. When one woman is “down” due to surgery, we need to replace the responsibilities of four people! I always say bringing the “captain back to her crew” will benefit the entire ship. This means being back to 100% by 2–3 weeks, not beginning to ease into your life at six weeks (as we had with traditional open surgery.) – DR. DELROSARIO The benefits of minimally invasive surgery are: smaller incisions, far less pain, fewer wound related complications, shorter hospital stays, less time off of work, and more thorough cancer staging operations. In our practice, 60% of women who have radical cancer surgeries with the da Vinci require zero narcotic pain medications after discharge. Ninety plus percent of these women are discharged after a single night’s hospital stay. Those who stay longer are usually kept for medical (non-surgical) indications. – DR. WILLIS Historically, what used to be done gynecologically when women needed a hysterectomy, for instance In comparing today’s hysterectomies with those from many years ago, I must say that hysterectomies are now the final stop, when a multitude of more conservative measures have failed. Robotic surgery has helped reduce the pain, blood loss, infection rate, scarring, and recovery time compared with the older approach. The da Vinci platform is the state-of-the-art robotic device for surgery of both benign and malignant gynecologic conditions. Nearly every surgery we would have performed with a large incision can be formed with the use of this device. Many surgeries we performed with traditional laparoscopic instrumentation, we can perform more precisely with this technology. – DR. DELROSARIO In the good old days of gynecologic oncology, the surgical needs of our patients were accomplished with the use of large abdominal incisions. This usually required a three-to-four day plus hospital stay and significant level of pain, blood loss and related infection and complication rate. Particularly for obese women, the open approach represented a significant challenge and sometimes very protracted recovery. We are constantly increasing the type and complexity of patient that we are able to safely offer the benefits of da Vinci. – DR. WILLIS For more information about the da Vinci Surgical System, visit pinnaclehealth.org/robotic.aspx. pinnaclehealth.org 21
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Mary McCurdy - PinnacleHealth

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