Health Matters (Jan. 2015)

Health Matters To Help People Be Healthy

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January 2015

New technology.

New approaches.

HaysMed

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Evolution toward robotics S urgery: It’s one of those experiences no one ever looks forward to. As a patient, the nerves and anticipation leading up to an operation can be quite overwhelming, and sometimes a little positive reassurance and peace-of-mind can go a long way.

When preparing oneself for a surgical procedure, most would agree they prefer the process to be as safe and pain-free as possible. A limited hospital stay, short recovery time and quick bounce-back are targeted goals for anyone anticipating the process of an operation.

For years, medical minds have rallied together to perfect the techniques of surgery, strategizing to overcome inconvenient conditions and life-threatening risks. The advancements have not come easy, however, and significant trial and error is to thank for bringing this everevolving medical world to the point where it stands today.

Through time, the need for necessary alterations to medical procedures, in hope of eliminating risks associates with surgery, has grown to be crucial. Therefore, extensive strides in the sophistication of surgical equipment and procedures have been made to counteract these medical problems.

Hays Medical Center is using these cutting-edge techniques to ease the worry about surgery and everything involved with it.

“The first surgeons did not know that skin had bacteria on it,” said Dr. Larry Watts, chief medical officer at HaysMed. “They would just cut a patient open, and people would then die from infection.”

Eventually, through much success and failure, doctors learned how to properly sterilize and prepare the human skin for operations, Watts said.

Additionally, “Way back when, there was no anesthesia,” he said. “People were given alcohol and made drunk, or took ether or chloroform, and they would sometimes die from overdosing.”

So, anesthetic techniques evolved and transformed through the years, as well.

The act of sedating or suppressing the body results in an unconscious patient, Watts said. With the use of anesthesia, Page 2

Photo by JOLIE GREEN The patient cart of the da Vinci® Surgical System, which includes the robotic arms, sits in the robotic operating room at Hays Medical Center. a patient has no feeling or sensation, which makes for a virtually painless surgery.

Countless surgical advances have come together to create safer, less painful methods for those undergoing a procedure. Most recently, surgeons at Hays Medical Center have taken a step

History

into the world of robotics.

“When I was first trained years ago, the idea was to make a big incision so you could see everything,” Watts said.

“We quickly discovered that this was good for the surgeon, but bad for the patient.”

EVOLUTION, page 5

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Photo by JOLIE GREEN Megan Richard, RN and robotic circulator at HaysMed, demonstrates how a surgeon uses the control module to dictate the motions of the robotic arms during surgery.

What is robotic surgery?

W ith the assistance of the da Vinci® Surgical System, Hays Medical Center is the only hospital in western Kansas that offers robotic surgery for a variety of women’s, urological and general operations.

Through a highly advanced and technical control module, surgeons are able to operate and guide miniaturized medical instruments that allow for extremely accurate and precise movements, said Dr. Larry Watts, chief medical officer at HaysMed. “The robot basically extends the physician’s hands,” he said. “It gives all the benefits as if you are opening the patient up, but you’re really doing it micro-invaHealth Matters

sively.”

Dr. Faris Azzouni, urologist at HaysMed, said the robot allows him to operate like a three-handed surgeon.

“It helps me to perform all the tasks that I can do with my own hands, but it also gives me an additional arm,” he said.

Surgeons control the arms of the robot through a computer module. This module allows the doctor to conduct normal motion associated with surgery through the robot’s extensions.

“The robot’s arms are like human arms,” said Dr. Zurab Tsereteli, surgeon in general robotics. “It has a complete degree of freedom and movement, just like our arms have.”

Description

The robotic surgical system is the most advanced form of minimally invasive surgery available in today’s medical world, Watts said.

Additionally, surgical complications happen far less with robotic surgery because the surgeon is able to see more clearly thanks to the advanced cameras in place.

“Visualization is extremely magnified,” he said. “The camera is like a 3D and HD television — the surgeon can see depth, as well as all sides.”

As a surgeon, Azzouni said the cameras give him “10-times magnified vision.”

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A

Influence of robotics

s Hays Medical Center continues to pursue advances in surgical technology, every step along the way helps benefit the hospital, surgeons, patients and families.

Almost a year has passed since HaysMed first introduced the da Vinci® Surgical System in February. Since then, surgeons have robotically conducted more than 250 operations.

Dr. Faris Azzouni, urologist, was the first surgeon to partake in a surgery using the advanced robotic equipment.

“We were the first hospital to get the robot here in western Kansas,” Azzouni said.

The robotic advancement provides numerous benefits for the people of Kansas, he said. With the technology being attainable nearby, patients can come to Hays for their procedures, instead of traveling to Wichita, Kansas City or Denver.

“It is more convenient for patients and their families,” he said. “We can deliver what the other hospitals in Kansas can here at Hays Medical.”

Not only is the close proximity a plus, but robotic surgery, in general, is less complicated and more convenient for a patient undergoing a procedure.

When discussing the da Vinci® Surgical System with a patient, Azzouni said there are several benefits he likes to address.

“I make a simplified comparison between the robotic approach and the open approach,” he said. “We discuss length of the operation, blood loss, outcomes of cancer control, duration of hospital stay, pain requirement, return to employment and more.”

“Basically, I let them choose what they want,” he said. “Usually, they all realize that they want the robot.”

Surgeons agree the primary selling point for robotic surgery is the quick recovery time and shortened hospital stay.

Because of the small incisions and advanced equipment, the pain and healing process is greatly reduced.

“Robotically, there is not as much retraction and moving around. So post-op, there will be more comfort,” said Bill Norris, director of surgery at HaysMed. “The bigPage 4

Photo by JOLIE GREEN Marlis Norton, RN First Assistant at HaysMed, demonstrates how to drape the arms of the da Vinci® surgical robot to sterilize it. gest benefit that I see is the short hospital throughout Kansas to have their procestays.” dures done, Watts said.

Thus, patients have less interference in “It is important to our community betheir lives when they undergo an operacause Hays Medical Center covers such a tion and can return to normal day routines large area of land,” Azzouni said. “We go to and activity more promptly. so many towns in our outreach clinics.”

“Most people want to get back to their In addition to the many examples of lives as fast as they can,” said Dr. Larry robotic surgery positively influencing Watts, chief medical officer at HaysMed. patients, HaysMed and the surgeons em“Robotically, we feel, is the fastest way to ployed there also reap benefits from the get back to your normal state with these da Vinci® Surgical System. types of surgeries.”

Economically, studies have been “The robot is the way to go,” Azzouni conducted that prove robotic surgery said. “For the patient, it means better decreases overall costs, Azzouni said. outcomes — shorter hospital stays, less “It’s very important for us as a hospital,” post-operative pain, less requirement of he said. “More patients are aware of the pain medication and an earlier return to technology, so they are demanding it. And work.” in order for any hospital to stay competiSince the robot has come to Hays, the tive, they have to have it. medical center has patients coming from INFLUENCE, page 5

Influence

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Photo by JOLIE GREEN Richard demonstrates how a surgeon uses the master controls.

ROBOTIC “It’s like I have additional, longer, finer arms and eyes that can see 10 times better,” he said.

Because of the increased ability to see, Tsereteli said many surgeries are completed faster, as well.

“The surgeon can see better, and it helps access a more precise dissection,” he said. “It makes the process go more quickly.”

“I can’t believe what you are able to see,” said Bill Norris, director of surgery at HaysMed. “Everything is right there in front of you,” he said in reference to the vivid, high-quality visualization.

Examples of women’s operations that can be conducted robotically are hysterectomies and surgeries for ovarian cysts, pelvic scar tissue, tubal litigation, pelvic pain evaluation and endometriosis.

Urological surgeries conducted through the da Vinci® Surgical System include adrenalectomies (for adrenal cancer or

masses), cystectomies (to remove the urinary bladder with urinary diversion for bladder cancer), nephrectomies (for kidney cancer), prostatectomies (for prostate cancer), pyeloplasties (a type of reconstructive urologic surgery), sacrocolpopexies (a type of reconstructive urologic surgery) and ureteral reimplantation.

Lastly, general surgeries operated robotically include biliary surgeries (for bile duct and gallbladder), bowel resection (for colon, rectum and small bowel), foregut surgeries, hernia and solid organ operations.

According to HaysMed, not all individuals are candidates for robotic surgery. For a patient to find out if he or she is a qualifying candidate, the patient should speak with a doctor.

“The robots are here to stay. They are not going anywhere,” Azzouni said. “If anyone has questions or concerns, I would be happy to speak with them.”

• By MAGGIE GEBHARDT

INFLUENCE “I think the robot will grow our patient volume. There will be individuals that need the surgery and will demand that it be done robotically.”

In addition to an increase of patients, Azzouni said he thinks there will also be an increase of well-qualified young surgeons looking for employment with HaysMed. “It might also help with doctor recruitHealth Matters

ment,” he said. “I think new graduates these days are thoroughly trained on the machine and would probably not go to a hospital that does not have this technology.”

“We are hoping that we are able to track new surgeons, new patients and ultimately help western Kansas folks,”Watts said. “I believe robotics is the future of surgery.”

• By MAGGIE GEBHARDT

Conclusion

Photo by JOLIE GREEN Britney Pruitt, surgical technician at HaysMed, demonstrates how the viewing monitor is used during surgery to display the operating field.

EVOLUTION

“We had only laparoscopic instruments, which were not as complex as compared to the robot,” he said.

The use of a robot eliminates the need for large incisions during the process of many of today’s most common and urgent surgeries.

“Surgeons learned that the smaller the incision, the faster the recovery time,” Watts said.

Instead, surgeons use minimally invasive techniques to assist with operations including select women’s conditions, gynecologic cancer, colorectal cancer, prostate cancer and general surgeries.

All medical advances made throughout the history of surgery have led up to this point — precision and accuracy through the hands of a surgeon with the help of the extended arms and magnifying eyes of a robot.

The functions provided through the robot benefit the patient by virtue of a smaller incision which can result in a faster recovery, the chief medical officer said.

HaysMed excitedly introduced the da Vinci® Surgical System in February. The robotic form of surgery provides a convenient option for patients and creates a positive reassurance and peace-of-mind everyone is looking for.

• By MAGGIE GEBHARDT Page 5