Saint Mary's Da Vinci times two

June 14, 2009
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Saint Mary’s Health Care is the first West Michigan hospital to own two da Vinci Surgical Systems for robotic surgery.

The $1.5 million machines, first introduced in 1999, are appreciated in operating rooms for their minimally invasive benefits, getting patients back to their lives sooner than with open surgery, said Dr. Kevin Brader, a surgeon who has logged more than 330 da Vinci surgeries.

Brader, who specializes in gynecological oncology, said he was using the da Vinci so much, the hospital decided to add another so that colleagues had access for their urology, pulmonary and other gynecological patients.

“It was mainly because I was doing so many cases, and then with urology … and then we had other people coming in. We really had too great a need for the one machine,” said Brader, who operates via da Vinci four to six times per week.

“I think we know how to utilize it better here than anywhere I’ve seen. The OR staff knows how to set it up.  They’ll do it any time of day. It’s just like anything else we use now. It’s not like any big deal. Even with that flexibility, one was not enough.”

Over the past several years, the family foundation of long-time Grand Rapids jeweler Tom Fox, his wife, Mickie, and their children has donated $1 million apiece to Spectrum Health, Saint Mary’s and Metro Health Hospital to bring the da Vinci technology to Grand Rapids. Saint Mary’s second machine was purchased by the hospital and arrived last fall, Brader said. The da Vinci systems are made by Intuitive Surgical, based in California.

Metro Health Hospital recently hosted its 100th  da Vinci procedure, said Dr. Thomas Maatman. He has devoted himself to learning and training others in the use of the da Vinci, particularly at Metro since the machine arrived there in early 2008, attending 10 da Vinci courses and meetings in the past three years. He now teaches surgical residents and observes experienced surgeons during their first few da Vinci surgeries as a proctor.

Maatman said Metro Health has provided special training for a team of eight to 10 registered nurses, anestheticians and surgical technicians in use of the da Vinci.

“This is an interesting concept. It’s so radically different than anything people are used to, even if they have a ton of experience in surgery,” Maatman said. “It’s something that’s going to take time to learn and adapt to and be competent in.”

He primarily uses the machine for full or partial prostate removal, but it also is used at Metro for kidney surgery. Some 100,000 prostate surgeries are done in the U.S. annually, but with around 600,000 hysterectomies nationwide, the da Vinci may actually have a bigger market among women, he said.

Maatman said he recently published a study in a peer-reviewed journal that compared the last 50 prostate removals he did with conventional surgery with the first 50 he did using the da Vinci. He said patients fared better with the robotic surgery.

Spectrum Health announced in February that it would expand use of the da Vinci system in cardiac surgery such as mitral valve repair, tumor removal and hole repair. It’s the only location in the state outside of southeastern Michigan to provide the minimally invasive procedure for cardiac procedures.

“This approach offers a number of potential benefits over traditional open chest heart surgery including less pain and scarring but the speed of recovery is most dramatic. Patients are able to leave the hospital with no restrictions on their activity,” Dr. Edward Murphy, a cardiothoracic surgeon, said earlier this year.

Brader said the da Vinci is useful on more of his patients than regular laprascopic surgery, and its “wristed” instruments are easier to maneuver than the “straight sticks” used in the former.

“Since the first uterine cancer case I did in May of 2007, I’ve done every single uterine cancer case that way. I haven’t been selective at all. And that’s the same with cervical cancers, where we do radical hysterectomies,” Brader said. “It’s a very elegant operation using the da Vinci.”

In fact, patients who face many challenges in the process, such as pre-existing medical conditions or obesity, benefit the most from the da Vinci’s minimally-invasive procedures, he said. “They’re the ones that really benefit. A nice, thin, healthy patient does well no matter what you do … These really obese patients with a lot of medical problems, they’re the ones that really benefit.”

Brader’s training included observation, practice on inanimate objects and animals, then with an advisor on his first few cases.

The da Vinci also is now commonly used for prostate cancer operations and for female pelvic support operations. Thoracic and cardiac uses are growing applications, as is head and neck surgery, he said.

He said he thinks Saint Mary’s could handle as many as four cases per day per da Vinci robot, thanks to the broad staff training and “a level of comfort” with its use.

“For awhile, it was such a big deal to be doing these robotic cases, and now it’s just how we do it,” Brader said. “I can’t imagine not having it.’

But the experience of robot surgery is still novel for patients, he added.

“I still get people who don’t want to be sedated when they’re back into the OR, so they can see the robot.”

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