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Future is now

Madison Mathews • Jul 23, 2012 at 10:18 AM

With its multiple robotic arms and state-of-the-art 3-D camera system in place, the da Vinci Surgical System might look like it belongs in the medical bay of a spaceship rather than inside an operating room at Johnson City Medical Center.

In the case of the da Vinci system, the future is now.

“This basic design is to go where no man has gone before. That’s what it’s designed to do. We go down in deep, dark holes with very precise and specific purposes and instruments and we can do things that we’ve never done before,” said Chip Thomason, senior specialty services coordinator of robotics.

After being the first facility in the region to use the da Vinci system in 2008, JCMC is now operating with the da Vinci Si — the latest addition in the surgical system’s product line.

The $1.3 million robotics is equipped with advanced high-definition 3-D imaging capabilities, giving the surgeon an improved look into the patient’s body; better instrumentation designed to enhance dexterity, precision and control; and is fully upgradeable.

The entire system consists of three units: an ergonomically designed surgeon’s console, a patient cart with four interactive robotic arms and the high-quality vision system.

The upgrade is part of JCMC’s $69 million surgery tower expansion, which will have larger operating suites specifically designed to house the bulky robotic equipment.

Since 2008, more than 900 surgeries at JCMC have been performed with the machine, which Thomason said has quickly become the standard for robotics in the operating room.

“As far as robotic surgery in the United States today, this is the latest and greatest, with all of the bells and whistles that you can have,” he said.

With the system’s capability for less-invasive surgeries and its ability to operate in places that a surgeon wouldn’t normally be able to reach, Thomason said the da Vinci unit grown in use since it first hit the market.

Since the machine allows instruments to have more flexibility when inside the patient’s body, smaller incisions are made, meaning there is less pain associated with procedures. Additionally, procedures that used to take an hour have been reduced to about 15 minutes.

This doesn’t mean the level of care has changed, however, the da Vinci system has increased efficiency with minimally invasive procedures.

“When I move my hands, it moves its hands. If I don’t move my hands, it doesn’t move because it’s just an extension of your hands,” Thomason said.

With the ability to do single-site procedures like remove the gall bladder from a single incision in the belly button, recovery time in the hospital has been drastically reduced.

Recovery time following a prostatectomy, or removal of the prostate, used to take about a week, but with the da Vinci, patients are out of the hospital within 24 hours of surgery.

Head and neck surgery, including tonsil cancer and tongue cancer procedures, is another area that has seen major improvement since everything is done through the mouth, reducing the risk of infection during open surgery and leaving no visible scarring.

“It took about eight to 10 hours and the patient would stay in the hospital for days. Nowadays, we do (transoral robotic surgery) in five minutes to an hour-and-a-half. There’s no incision,” Thomason said.

All of this means the cost for care is drastically reduced with shorter hospital stays.

Currently, there are 22 da Vinci-trained surgeons at JCMC, and Thomason said more and more surgeons from a wide array of specialities are beginning to utilize the machine.

But robotics are meant to be used in every surgery.

Thomason said some procedures are just too easy to do the old-fashioned way and there is no clear advantage to using robotics.

“That’s where we have to watch the ethical line. We are very aware that we’re not going to be taking out appendixes with a robot,” he said.

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