Science Feature - May 2007
Arlington obstetrician-gynecologist Gary Donovitz, MD, has found what may be the coolest "video game" ever invented. It's got a three-dimensional display that shows objects at 10-power magnification. And the "joystick" has fingertip controls that allow objects to replicate his every hand movement, providing incredible precision for every action.
But when Dr. Donovitz and other surgeons sit down to "play" with this machine, they're doing something much more serious than playing "Space Invaders" or "Madden '07." Instead, they're restoring patients' health and saving lives.
Dr. Donovitz is one of a growing number of surgeons using robots to perform delicate surgical procedures with minimally invasive techniques. And, they say they're getting better results with less pain and faster recovery times than with either open surgery or conventional minimally invasive techniques.
Robotics entered the surgical realm in 1996 when California-based Computer Motion Inc. introduced the first surgical robot called Aesop, a device to control the position of a laparoscopic camera. The company later rolled out Zeus, the first full-function teleoperated robotic system.
In 1998, Intuitive Surgical Inc., of Sunnyvale, Calif., joined the surgical robotics field with its da Vinci Surgical System, a three- or four-armed surgical robot that surgeons operate from a video console in the operating room. The first surgeries using da Vinci were performed in Europe. The device was not used in the United States until 2000, and the U.S. Food and Drug Administration did not approve it for use until 2001.
In 2003, Intuitive Surgical and Computer Motion merged, and phased out the Aesop and Zeus machines. The merger has left Intuitive with the lion's share of the robotics market, physicians say.
Since its introduction, da Vinci has been adopted by more than 500 hospitals and health care institutions worldwide, including 19 in Texas. Memorial Herman Medical Center and Methodist Hospital in Houston each have three of the robots, as well as training centers where surgeons can learn to use the devices.
Trinity Mother Frances Hospital in Tyler also has three robots, while The University of Texas Medical Branch at Galveston and USMD Hospital in Arlington, where Dr. Donovitz practices, each have two. The University of Texas Southwestern Medical Center in Dallas also is among Texas facilities using the robot.
The da Vinci system - so named because Leonardo da Vinci was the first to design a robot - has three components: the robot itself, which holds the surgical instruments and carries out the procedure under the surgeon's control; a console where the surgeon sits and operates the machine; and a tower that holds the video and other equipment that links the console and robot.
Unlike conventional laparoscopic or endoscopic surgeries in which a two-dimensional camera is inserted into the patient through a small incision, allowing the surgeon to view what he or she is doing on a flat-screen video display, the da Vinci system provides a three-dimensional display, says Nora Distefano, corporate events manager for Intuitive. And, the display is shown at 10 times magnification, rather than four times, as with conventional laparoscopic devices, she says.
"The instruments also are designed to have seven degrees of motion, which allows the surgeon to turn the instruments even further than he or she would be able to do with his or her wrists," she added. "It reduces any tremor whatsoever. It gives absolute stability."
Surgeons using the robot first make small incisions or "ports" in the patient and then connect the robotic arms to those ports. One arm holds the camera that provides the video display; the others hold surgical instruments. The surgeon then moves from the operating table to the console where he or she controls the robot and performs the operation.
Gaining Market Share
Robotic surgery has been popularized by urologists, who widely use it for prostatectomies and other urological procedures. Ms. Distefano says the number of prostatectomies performed with da Vinci has grown 300 percent in the past two years. Her company expects as many as 30 percent of such procedures performed in the United States this year will be done with the da Vinci robot.
Now, the machines are gaining popularity among other specialties, including gynecology, cardiovascular surgery, and general surgery.
Dr. Donvitz says he uses robotics for hysterectomies, fibroid tumor removal, tubal reversals, and other gynecologic procedures.
"I still do laparoscopies for pelvic pain and sterilization and endometriosis surgery, sometimes," he said. "But if I'm doing a hysterectomy or myomectomy, I use da Vinci. It's just better."
Dr. Donovitz says the robot allows him to be much more precise when cutting around blood vessels or other important tissue structures, which means much less bleeding. "For most of our hysterectomies, the bleeding is less than 25 to 50 cc," he said.
Dr. Donovitz began using da Vinci about 18 months ago and has done 120 procedures to date. UT Southwestern surgeons have performed more than 100 urologic procedures using the robot and now use it for gastric bypass and other general surgical procedures, a spokesperson says.
In 2005, Sudhir Srivastava, MD, chair of the Department of Cardiovascular Surgery at Alliance Hospital in Odessa, performed the world's first triple vessel coronary bypass using the da Vinci system.
Cost Versus Outcome
While a robotic system is quite an investment for a hospital - the da Vinci system costs about $1.5 million - and procedures performed with the device are more expensive than conventional laparoscopy, Dr. Donovitz says the benefits for the patient are many.
Patients who have robotic surgery normally require less pain medication postoperatively, have shorter hospital stays, and return to work or normal life much more quickly, he adds. For hysterectomies, for example, patients usually return to work in one to two weeks rather than four to six weeks with conventional procedures.
And, patients seem to be widely accepting of this new technology.
"Once they understand the precision of the whole thing and the fact that they're going to do better postoperatively, I've never had anybody who was worried about the robotic issue," he said. "Most people are excited because they were expecting a much more prolonged and traumatic recovery."
Ken Ortolon can be reached by telephone at (800) 880-1300, ext. 1392, or (512) 370-1392; by fax at (512) 370-1629; or by email at Ken Ortolon.
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