Dr. Zaineb Shatawi, a fourth-year general surgery resident at Memorial Hospital West in Pembroke Pines, sat down at the console of a da Vinci simulator, removed her shoes to use the blue and yellow pedals, and immersed her face into a space that shows a 3D view of a virtual patient.
“You’re looking through this eyepiece, and then in this simulator you have three instruments in the patient’s body,” Shatawi explained. “So you can control two at a time and then if you want to use a third one you can switch between controls.”
Shatawi put her hands on the control, which moves as smoothly as a wrist. Hand movements and foot pedals can control the camera, like adjusting the focus.
Decades ago, the thought of robotic surgeries may have conjured images of operations happening at the hands of a machine. Today, surgeons are increasingly using mechanical arms with tools attached to do all kinds of procedures. It's helping patients with less-invasive operations and providing surgeons with a pinpoint-accurate tool to do their work.
Dr. Holly Neville, program director for general surgery and chief of pediatric general surgery at Memorial Healthcare System, said robotic machines enable surgeons to make fine, precise incisions “that allow for shorter hospital stays, less narcotics, faster return to full diet, faster return to work ─ which, one, it’s better quality, and two, it’s safer for the patient.”
This year, Memorial increased the number of surgical robots from eight to 15.
Return on investment
The hospital system’s investment is for the hospital as well as the patients, Neville said.
Smaller incisions may have fewer complications during surgery, fewer infections and less blood loss. The recovery time is shorter than a typical laparoscopic surgery. What’s more, beds open up sooner to admit new patients for other procedures.
“The robot, of course, is an expensive piece of equipment," Neville said. "There’s zero doubt about that.”
Memorial uses operating income to pay for the machines. Hospitals can choose to raise funds or borrow money for them. Intuitive, which manufactures these machines, also has options like a pay-per-click method that involves a fee for each use.
“The return on investment on the robot has been in the multiples,” said Joe Stuczynski, chief executive officer of Memorial Hospital West. “It is a safer procedure for the patients. So we do see this expansion continuing and going on and on.”
A growing use of the robots does not increase the cost of procedures for the patient, but surgeons need to train to use this equipment.
“We have simulated programs and curriculums where they have to perform certain numbers of tasks and meet certain metrics and get certain scores,” said Dr. Omar Llaguna, a surgical oncologist at the hospital and the assistant director for the general surgery program. He oversees the robotic surgery portion of the residents’ training.
When using a machine like the da Vinci, a surgeon sits at the control center and directs the robotic arms to make incisions with specific tools.
“You need someone there to make the decisions,” Llaguna said. “Patients sometimes ask, ‘Oh, is the robot doing the operation or are you doing the operation?’ We’re doing the operation; we need to guide it. So it’s not an automated thing.”
Surgeons log into the machine before an operation, and it records the doctor’s metrics.
Patients should ask surgeons about their performance using these systems, since doctors have access to their own data, Llaguna said.
A hospital can track how long the surgery took and the number of instruments used.
“Now, we actually have ways we can measure how the surgeons move their hands for the hand controller,” said Dr. Jamie Wong, Intuitive’s senior vice president and senior medical officer. “We can identify or quantify how often the surgeon may move a camera."
Surgeons can study their metrics to improve, "similar to how an elite athlete might look at a video," Wong said.
Not all surgeons want to operate using the robots, but those who do may be pulled to work at hospitals that offer them, said Richard Gundling, senior vice president of professional practice at the Healthcare Financial Management Association in Washington, D.C.
“And retain some top talent — physician retention, satisfaction among the clinical staff using the robotics,” Gundling said. “When you’re in a very competitive labor market, money only goes so far.”
These machines don’t work for all surgeries. Gundling stresses that patients who do qualify, shouldn’t feel that this is their only option.
“Anytime you blend technology with your health, I think always talk to your physician, have a very important conversation whether robotic-assisted surgery is right for you,” he said. “It’s not a catch-all, one-size-fits-all for someone.”
Full recovery
Bob Garrison lived in Pembroke Pines throughout most of his life and now resides in Central Florida. Last year, he had a surgery at Memorial with Llaguna, who removed a growth on the lower end of his pancreas using a da Vinci machine.
The surgery involved punctures instead a large opening to access the abdomen. One of the punctures had a drainage tube attached to a bag that he carried around for about a week “and actually hung it off of a costume jewelry necklace that my wife gave me,” he said. “So that was about the only discomfort from the surgery.”
Llaguna called soon after the surgery with good news: The growth was benign.
“It was not cancerous, so that was a huge relief,” Garrison said. “I also wanted to stick around long enough to vote in this upcoming elections.”
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