Sponsored by
 |
|
 |
|
Surgeons implant robotics
Pain, recovery time less, advocates say
By Jon Van
Tribune staff reporter
Published August 7, 2003
Inside the operating room, Dr. Arieh Shalhav isn't likely to ask for a scalpel or forceps.
But he might ask an assistant to clean his camera.
During a recent surgery, Shalhav sits several feet from the patient, manipulating robotic instrument controls and a miniaturized optics system as he works to remove a cancerous prostate gland.
Robotic surgery--a skill Shalhav is learning--is still a rarity, but it is poised to become more popular as patients push doctors to adopt technology that can make surgery less stressful.
While robotic equipment is expensive, at about $1.2 million a station, it does reduce a patient's pain and recovery time, doctors said.
And robotics also is easier on surgeons, allowing them to sit at a control console while they work.
Those are significant improvements, said Shalhav, who is skilled at using laparoscopic equipment to remove prostates. In laparoscopic procedures, instruments are inserted into the body at the end of tubes and are manipulated by hand.
Like robotic surgery, laparoscopic procedures reduce stress on the patient by avoiding a major cut to enter the body.
But the laparoscopic prostatectomy is difficult to learn and arduous to execute, said Shalhav, who practices at the University of Chicago.
It requires the surgeon to stand so he is directly above the patient to manipulate the tools manually.
"I have to work standing on one leg for four hours," said Shalhav. "By the end, I am very tired."
Shalhav said that even at this early point in his experience with robotics, it seems clear that it is as good as traditional surgery at removing cancerous tissue.
One common side effect of prostatectomies--urinary incontinence--is no more a problem with robotic surgery than with the traditional procedure, he said.
Sexual impotency is also often associated with prostatectomies done in the traditional fashion, and Shalhav said it will take time to determine how well robotic surgery does at avoiding that outcome.
Dr. Greg Zagaja, a University of Chicago urologist skilled in traditional prostate surgery, said he is learning robotic surgery because of the benefits to patients.
"The learning curve is steep," said Zagaja, "but after doing 10 to 20 cases, it should be easy to replicate the results we get from open surgery."
At Detroit's Henry Ford Hospital, where surgeons have done hundreds of robotic prostatectomies, they report the procedure now takes less time than standard surgery.
And, thanks to fewer complications and a shorter recuperation, robotic surgery has become economically attractive--even with the hefty $1.2 million for the equipment, the $100,000 a year in maintenance and about $1,500 per patient procedure in disposable equipment costs.
That is good news for Intuitive Surgical Inc., the Sunnyvale, Calif., firm that makes the da Vinci robotic system, which is now virtually the only product of its kind available.
This summer Intuitive completed a merger with Computer Motion, which had been its major competitor.
Intuitive has more than 160 da Vinci systems placed in hospitals, said Ryan Rhodes, the firm's marketing director. They are used for a variety of procedures treating the heart, lungs, kidneys, gastrointestinal tract and prostate.
The publicly held firm does about $100 million a year in business and pared this year's first-quarter loss to $2.3 million, or 6 cents a share.
Rhodes said his firm's merger with Computer Motion enables it to focus fully on improving its product rather than on distracting lawsuits over intellectual property issues.
Patients take a greater interest in their care than they did in the past, Rhodes said, and robotic surgery's buzz has been building.
"We get calls from patients who've heard about robotic surgery and want to know where it's being done," said Rhodes. "Some hospitals are marketing this."
The technology is bound to get better and easier to use, said Mark Simillie, managing director of Seidler Cos. investment bankers based in Irvine, Calif., an analyst who follows medical technology developments.
"This isn't a one-trick pony," said Simillie. "There are multiple applications, and surgeons will find more. I see it as a gradual build, but within 10 years this could become the standard of care."
Robotic surgery's one major drawback is that the equipment does not supply surgeons with tactile sensation.
Feeling the difference between normal tissue and cancerous tissue can be helpful, said Dr. Charles Brendler, urology section chief at the University of Chicago.
"When you palpate [examine by touching] the tumor, you can make the decision to excise," said Brendler.
The company is working to provide tactile feedback in future da Vinci models, said Rhodes.
Copyright © 2003, Chicago Tribune
|
|
|
|
|
