Rise of The Machines
By MICHAEL MILLER Staff Writer |
ATLANTIC CITY — When Dorothy Owens needed surgery last year, her doctor suggested she turn to a robot.
Owens, 67, of Galloway Township, said the hulking surgical instruments seemed odd at first. The robotic-assisted surgical system used by AtlantiCare Regional Medical Center in Atlantic City stands as tall as a human with four jointed, spiderlike arms that provide a full range of motion like a human arm. Each is fitted with surgical instruments such as clamps or scissors the size of Abraham Lincoln’s head on a penny. The machine also has a tiny lighted camera called an endoscope that gives the surgeon a three-dimensional view of the operation.
“It’s not necessarily alien, but it was different,” she said. “What is that thing? Your normal mind can’t grasp it.”
Equally unusual is the way doctors use the machine. While the surgical team tends to the patient on the gurney, the surgeon operates from the other side of the room at a console that resembles an arcade video game.
“That boggles your mind to think about it. How are they really going to do this?” Owens said.
AtlantiCare Regional Medical Center relies on a robot called the da Vinci Surgical System, made by Intuitive Surgical of Sunnyvale, Calif. The company calls its surgical system da Vinci after the Italian artist, sculptor and inventor who is credited with designing the world’s first robot.
The company has sold 1,285 machines in the United States, including 35 to New Jersey hospitals. Even Wyoming, which for most of its 121-year existence as a state has been the least populous, has one.
The company is expanding its machines’ applications every year, from urology and gynecology to thoracic and cardiac medicine.
Dr. Seva Milov, an obstetrician and gynecologist for AtlantiCare, has been using the robot since 2008, when the hospital was the first in the region to employ it.
Milov said he quickly became a fan.
“It’s like playing a video game. The robot does follow your commands,” he said.
The surgeon uses two handles with tiny cups for the forefinger and thumb to manipulate scissors or clamps. Foot pedals manipulate the lens on the tiny camera.
“You open your fingers and it opens the clamp. Spin your wrist and it follows your commands,” he said. “In theory, someone in San Francisco could do the surgery here.”
Intuitive Surgical says its system is not robotic surgery in the technical sense, since the “robot” never makes any decisions or has any independent control over the procedures. The robotic arms merely mimic the movements of the surgeon’s hands.
Surgeons are known for having steady hands, but Milov said even the best has a slight quiver. But the machine adjusts to remove these micro-tremors detected in the surgeon’s controls.
“If you look at the old-fashioned philosophy, surgeons operate with chopsticks. They’re very long instruments and they can only open their jaws and close or rotate their jaws,” he said. “The da Vinci is really closer to the human hand with 180-degree movement.”
But Milov said he likes the system because it is easier on patients who must recover from the trauma of surgery.
“If you do old-fashioned surgeries, you might spend a few days in the hospital. It would require a big incision to remove a fibroid,” he said of a common, benign tumor.
“But with da Vinci, you have a small skin incision of a half-inch. The patient can go home the same day with less pain and less chance of infection,” he said.
That means patients typically heal faster, too, which was Owens’ case after she had major surgery for a prolapsed bladder.
Owens said she would recommend a robot without hesitation.
“I’ve got four very tiny little marks and that was it,” she said. “It was like nothing. It just feels unbelievable. I healed a whole lot faster and with less pain.”
More hospitals are turning to robotic surgery for the precision, flexibility and accuracy it provides in delicate operations.
The Community Medical Center in Toms River, Ocean County, and South Jersey Healthcare Regional Medical Center in Vineland also use them. Cape Regional Medical Center in Middle Township and Shore Memorial Hospital in Somers Point do not, but Shore Memorial is making sure the operating rooms at its new surgical center are big enough to accommodate this new technology, spokeswoman Courtney Spahr said.
Dr. Hema Jonnalagadda at South Jersey Healthcare said she was interested in robotic surgery because of the prospect of performing entire operations with a single, small incision.
“There is a lot more research going into single-incision surgery,” she said.
For patients, that means less time in the hospital and more time back to their normal lives, she said.
“You’re looking at two weeks of recovery as opposed to six to eight weeks,” she said. “They can go back to work fairly early.”
Each machine sells for as much as $2.3 million, Intuitive Surgical says. This drives up the costs of robotic surgery, said Donna Howell, executive director for surgical services at AtlantiCare. Robotic surgery is typically covered under health insurance plans, she said.
“It’s more expensive strictly by cost,” she said. “But if you add in the fact that the patient doesn’t need a blood transfusion or an additional night’s stay and can return to work in a few days instead of a few weeks, all those things need to be factored in.”
Howell said AtlantiCare is considering expanding its use for bariatric surgery or lap-banding of the stomach.
Dr. William Aarons, chairman of the department of surgery at AtlantiCare, said training to use the robotic system has a steep learning curve.
“The procedures take a lot longer initially using the robot,” he said. “But once you get over that learning curve, procedures don’t take as long.”
Aarons said robotic surgery is part of the ongoing evolution of medicine.
“The robot is just another phase as we improve the capabilities of medicine worldwide,” he said. “This is another technology on the way to gradually making things better. The robot is another step in technological improvement.”
Milov sees the machine as just another surgical tool at his disposal.
“Any kind of surgeon has to have good hands. You have to be a handyman,” he said. “But you have to have an engineer’s brain to plan the surgery.”
And robotics for surgery will only get better, he said.
“The first robot I used was heavy, awkward and difficult to work with. Now the machines are getting smaller,” he said. “I hope one day we can do the same types of surgeries with one incision, a small hole in the abdomen, and with these special instruments, you can do it with minimal trouble.”
Contact Michael Miller:
ATLANTIC CITY — When Dorothy Owens needed surgery last year, her doctor suggested she turn to a robot.
Owens, 67, of Galloway Township, said the hulking surgical instruments seemed odd at first. The robotic-assisted surgical system used by AtlantiCare Regional Medical Center in Atlantic City stands as tall as a human with four jointed, spiderlike arms that provide a full range of motion like a human arm. Each is fitted with surgical instruments such as clamps or scissors the size of Abraham Lincoln’s head on a penny. The machine also has a tiny lighted camera called an endoscope that gives the surgeon a three-dimensional view of the operation.
“It’s not necessarily alien, but it was different,” she said. “What is that thing? Your normal mind can’t grasp it.”
Equally unusual is the way doctors use the machine. While the surgical team tends to the patient on the gurney, the surgeon operates from the other side of the room at a console that resembles an arcade video game.
“That boggles your mind to think about it. How are they really going to do this?” Owens said.
AtlantiCare Regional Medical Center relies on a robot called the da Vinci Surgical System, made by Intuitive Surgical of Sunnyvale, Calif. The company calls its surgical system da Vinci after the Italian artist, sculptor and inventor who is credited with designing the world’s first robot.
The company has sold 1,285 machines in the United States, including 35 to New Jersey hospitals. Even Wyoming, which for most of its 121-year existence as a state has been the least populous, has one.
The company is expanding its machines’ applications every year, from urology and gynecology to thoracic and cardiac medicine.
Dr. Seva Milov, an obstetrician and gynecologist for AtlantiCare, has been using the robot since 2008, when the hospital was the first in the region to employ it.
Milov said he quickly became a fan.
“It’s like playing a video game. The robot does follow your commands,” he said.
The surgeon uses two handles with tiny cups for the forefinger and thumb to manipulate scissors or clamps. Foot pedals manipulate the lens on the tiny camera.
“You open your fingers and it opens the clamp. Spin your wrist and it follows your commands,” he said. “In theory, someone in San Francisco could do the surgery here.”
Intuitive Surgical says its system is not robotic surgery in the technical sense, since the “robot” never makes any decisions or has any independent control over the procedures. The robotic arms merely mimic the movements of the surgeon’s hands.
Surgeons are known for having steady hands, but Milov said even the best has a slight quiver. But the machine adjusts to remove these micro-tremors detected in the surgeon’s controls.
“If you look at the old-fashioned philosophy, surgeons operate with chopsticks. They’re very long instruments and they can only open their jaws and close or rotate their jaws,” he said. “The da Vinci is really closer to the human hand with 180-degree movement.”
But Milov said he likes the system because it is easier on patients who must recover from the trauma of surgery.
“If you do old-fashioned surgeries, you might spend a few days in the hospital. It would require a big incision to remove a fibroid,” he said of a common, benign tumor.
“But with da Vinci, you have a small skin incision of a half-inch. The patient can go home the same day with less pain and less chance of infection,” he said.
That means patients typically heal faster, too, which was Owens’ case after she had major surgery for a prolapsed bladder.
Owens said she would recommend a robot without hesitation.
“I’ve got four very tiny little marks and that was it,” she said. “It was like nothing. It just feels unbelievable. I healed a whole lot faster and with less pain.”
More hospitals are turning to robotic surgery for the precision, flexibility and accuracy it provides in delicate operations.
The Community Medical Center in Toms River, Ocean County, and South Jersey Healthcare Regional Medical Center in Vineland also use them. Cape Regional Medical Center in Middle Township and Shore Memorial Hospital in Somers Point do not, but Shore Memorial is making sure the operating rooms at its new surgical center are big enough to accommodate this new technology, spokeswoman Courtney Spahr said.
Dr. Hema Jonnalagadda at South Jersey Healthcare said she was interested in robotic surgery because of the prospect of performing entire operations with a single, small incision.
“There is a lot more research going into single-incision surgery,” she said.
For patients, that means less time in the hospital and more time back to their normal lives, she said.
“You’re looking at two weeks of recovery as opposed to six to eight weeks,” she said. “They can go back to work fairly early.”
Each machine sells for as much as $2.3 million, Intuitive Surgical says. This drives up the costs of robotic surgery, said Donna Howell, executive director for surgical services at AtlantiCare. Robotic surgery is typically covered under health insurance plans, she said.
“It’s more expensive strictly by cost,” she said. “But if you add in the fact that the patient doesn’t need a blood transfusion or an additional night’s stay and can return to work in a few days instead of a few weeks, all those things need to be factored in.”
Howell said AtlantiCare is considering expanding its use for bariatric surgery or lap-banding of the stomach.
Dr. William Aarons, chairman of the department of surgery at AtlantiCare, said training to use the robotic system has a steep learning curve.
“The procedures take a lot longer initially using the robot,” he said. “But once you get over that learning curve, procedures don’t take as long.”
Aarons said robotic surgery is part of the ongoing evolution of medicine.
“The robot is just another phase as we improve the capabilities of medicine worldwide,” he said. “This is another technology on the way to gradually making things better. The robot is another step in technological improvement.”
Milov sees the machine as just another surgical tool at his disposal.
“Any kind of surgeon has to have good hands. You have to be a handyman,” he said. “But you have to have an engineer’s brain to plan the surgery.”
And robotics for surgery will only get better, he said.
“The first robot I used was heavy, awkward and difficult to work with. Now the machines are getting smaller,” he said. “I hope one day we can do the same types of surgeries with one incision, a small hole in the abdomen, and with these special instruments, you can do it with minimal trouble.”
Contact Michael Miller:
