Mary Greeley Medical Center adds general surgery to its robotic program, making it among the first in the state to offer patients this minimally invasive option.
Dr. James Partridge makes a small incision in the patient's navel. A few steps later, he gently fits a flexible plastic port with several holes in it into the incision. Then he slides several long, slender instruments, including one equipped with a camera, into the holes. The instruments in place, the surgeon says the words that everyone is anticipating:
"Robot in, please."
Dr. James Partridge and nurses Geana
Davidson, Mindy Rash and Chelsie
Stensland with the da Vinci robot.
A nurse wheels the da Vinci surgical robot up to the operating table, and the long arms of the high-tech device are attached to the appropriate instruments. Seated at a console, Partridge deftly manipulates the robot’s controls, and in less than 15 minutes, the patient's troublesome gallbladder has been detached and extracted through her navel. A whole new chapter in Mary Greeley Medical Center’s robot-assisted surgery program has begun.
For several years, Mary Greeley patients who have had urological or gynecological surgeries have been experiencing the benefits for robotic surgery. Now, thanks to the partnership of technology and surgeon skill, the hospital can now also offer those benefits to patients needing general surgery.
A Painful Family History
In Jennifer Kelly's family, having your gallbladder removed has become an unwelcome family tradition.
When the 35-year-old began experiencing pain in her side last spring, she thought it may be appendicitis. But as the pain began to radiate and become more severe—especially after eating—she suspected an issue with her gallbladder. Several tests later, Partridge, a general surgeon with McFarland Clinic, recommended Kelly have her gallbladder removed.
The news came as no surprise for Kelly, who represents the third generation of her family to require the surgery. Kelly was just a baby when her grandmother had the surgery that resulted in a couple weeks in the hospital and substantial scarring from the incision. Kelly was a young adult when her mother had the procedure. While her mother was able to leave the hospital the same day as the surgery, she also experienced considerable scarring.
Neither a long hospital stay, nor the least bit of scarring were worries for Kelly, who was among the first few patients at Mary Greeley Medical Center to benefit from robotic single-site surgery using the da Vinci system.
"Honestly, I wasn't worried about scarring in the first place," says Kelly, a local real estate agent. "Now a few months out from surgery, you can't even tell they were in there."
The Next Generation
Mary Greeley Medical Center invested $1.4 million to acquire the da Vinci system in 2010. The robotic single-site upgrade required an additional $100,000 investment.
While robotic surgery in general, and the da Vinci system specifically, have been around for a number of years, robotic single-site surgery represents the next step forward in improving comfort for patients requiring a variety of gastric, urological and gynecological surgeries.
Previous generations of laparoscopic surgery allowed for minimally invasive approaches, but lacked in providing physicians with a realistic view of the patient’s anatomy.
The robotic single-site surgery is performed by making an inch-long incision in the navel in which a small spool-like structure is inserted. The spool has five holes, each of which hold a tube: One with a camera, two that connect to robot arms controlled by the physician, one controlled by the assistant, and one that pumps carbon dioxide into the abdominal cavity.
After all the tubes are connected, the da Vinci robot is moved in over the patient's right shoulder.
“At that point, I move to the da Vinci console,” Partridge says.
The console is located about 10 feet from the patient. To perform robotic single-site surgery, Partridge leans into the console and looks through two lenses that resemble binoculars. He is able to view magnified images and perform surgery with the use of hand controls and foot pedals. The improvement over traditional laparoscopic surgery—which only offers two-dimensional images—is dramatic.
"With robotic single-site, I have a high definition screen that provides virtual 3-D vision," says Partridge, who is one of only a handful of physicians in Iowa approved to perform single-site gallbladder surgery.
"Additionally, the depth of field is vastly improved, allowing us to be much more precise."
It’s About the Patient
The ability to be so precise with the surgery provides great benefits to the patient; most notably, it reduces post-surgical discomfort. That discomfort is further reduced by using the navel, which has virtually no muscle to separate or divide.
"Because the incision is so small, most patients experience much less pain after the procedure," Partridge says. "Since we began performing our gallbladder removals using robotic single-site technology, it is rare that we receive calls from patients worried about discomfort post surgery."
Kelly says she experienced minimal discomfort after her surgery in June.
"I am very active and busy all the time," she says. "So the hardest part for me was just taking it easy for a couple days. I won't say that it was completely painless, but after about three days I was back up and around.
"In fact, I was feeling good enough to show a house on July 5," she adds with a chuckle. "It was kind of my very own Independence Day."
Just the Beginning
Partridge received intensive training to use the da Vinci system for robot-assisted single-site surgery. In addition to attending lectures and seminars, he was required to complete a number of cases and display a high level of efficiency and effectiveness in using the system. He performed his first robotic surgeries at Mary Greeley Medical Center last June.
In addition to gallbladder removal, Partridge has also used robotic single-site to perform colon resection, adrenal surgery, spleen removal and gastrectomy, a procedure to remove part of the stomach. He says he is impressed with outcomes.
But he is quick to admit the pace with which robotic surgery has advanced was impossible to envision when he was in medical school in the early 1990s.
"I never dreamed of anything like this," Partridge says. "I can see a time when surgeries will be performed with a physician offering assistance remotely without even being in the same hospital as the patient. While that is not something that appeals to me, I can certainly see the technology moving in a direction that will make that possible."
In the more near future, Partridge expects most every surgery that is now done laparoscopically will be offered using robotic single-site technology. He says having the surgery available in Ames speaks highly of the commitment of Mary Greeley Medical Center and McFarland Clinic to keep pace with medical advancements.
"Robotic single-site represents the gold standard," Partridge says. "We are committed to offering our patients the highest in quality. By investing in robotic single-site technology, we have the most advanced tools available to serve our patients."
Kelly says she is thankful single-site surgery was available for her.
"I was confident I was in good hands," she says.
daVinci in action
We take you inside the operating room with this video featuring Mary Greeley’s robot-assisted surgery program. Watch an actual surgery using the da Vinci robot. Viewer discretion is advised.