With his eyes on a 3-D screen and his fingers grasping two controllers, Dr. Frank Collins clipped stitches with tiny remote scissors and used a wee set of remote forceps to pluck a penny from a pouch.
The tools were much smaller than the penny.
Collins, the chief of surgical services at Meritus Medical Center near Hagerstown, was demonstrating the new da Vinci Xi surgery system. The technology provides robotic assistance that translates the doctor’s movements to a small scale. The goal is to allow surgeons to perform complex procedures inside a patient with more precision and less trauma.
“We had two procedures (last week), and both patients did wonderful,” said Angie Francart, a registered nurse and administrative director of surgical services.
The da Vinci Xi system has been referred to as a robot, but Collins said the surgeon is in control of the movements.
In essence, Collins said, the da Vinci system brings a third type of surgery to Meritus.
“Each has its advantages and disadvantages,” he said.
Traditional open surgery requires a sizable cut into the body so surgeons can do their work. Open surgery will always be needed in some cases, he said.
In recent decades, laparoscopy has become more popular. It allows surgeons to use small incisions and work inside the body with the aid of a camera and small tools at the ends of rods. Laparoscopy is deemed “less invasive” than open surgery. But the rods are straight and the controls are “like a brake cable,” Collins said.
He said the da Vinci system advances laparoscopy a step further. The doctor sits at the 3-D monitor. Speakers allow him to communicate with members of the surgical team, who can swap out the tools and take other actions at the direction of the doctor. And sensors in the machine help make sure some tasks, such as stapling tissue, go more smoothly.
The technology also allows the doctor to spin, bend and flex those tiny tools.
“This gives you your wrists back, which is really what you want,” Collins said.
According to a Meritus news release, the da Vinci system will support bariatric, gynecologic, urologic and general surgeries.
One demonstration Collins ran Monday involved a hernia repair. With the system, he was working inside the wall of the abdomen. A traditional method would have required a larger incision and placing a screen over the hernia from the outside of the abdominal wall, he said.
Dr. Brooke Buckley, vice president and chief medical officer of Meritus Health, said adding the system will help the organization recruit and retain long-term surgical staff members, help the hospital grow its market share, improve quality and reduce total cost to treat patients.
Hospital officials did not disclose the cost but described it as a “significant investment.”
The precision and the minimally invasive approach means better outcomes for patients, according to Francart, the surgical services administrative director.
“It requires less narcotic use post-operatively,” she said. “The patients feel better. They can get home better, faster. And it is small incisions.”
“They’ll still have the three poles, like they would with laparoscopic (surgery),” Francart said. “The difference is, laparoscopic is like working with chopsticks. It’s straight sticks. This allows the surgeon to have articulation with their wrist. So the instruments now are smaller and they’re more mobile, which means less damage to the tissue and the surrounding organs.”
The patient will still be surrounded by a surgical team.
“You’ll still have your anesthesia provider, a surgical first assistant, the surgeon, a scrub nurse and a circulating nurse, so that’s the normal team for a normal procedure. So that does not change,” she said.
Five surgeons are already trained on using the da Vinci system, she said.
“We hope to have six here shortly. And as we bring new providers here to Meritus, they’ll be already trained on the robot. This is pretty standard coming out of medical school now.”
