Published: Sunday, July 5, 2009
By Jillian Kushner, Special to The Oakland Press
Robotic surgery performed on Intuitive Surgical’s da Vinci system has been gaining popularity in the fields of urology, neurology, cardiology and now gynecology since the Food and Drug Administration approved the system in 2005.
Five years ago, just 5 percent of prostates were removed robotically. That number has since spiked to 85 percent, according to Jason Catana, north Oakland County’s Intuitive representative. Now that it has cornered the urology market, Intuitive is looking to expand into gynecology, said Dr. Evan Theoharis, of Henry Ford Hospital in Detroit.
“Intuitive recognizes that gynecology is where the future expansion of robotic surgery lies,” he said.
Though still in the early stages, with only 10 percent of gynecologists trained to perform robotic surgeries, Theoharis said the da Vinci surgical system offers several advantages for patients undergoing gynecological procedures such as hysterectomies and myomectomies.
“The da Vinci surgical system offers less invasive surgery, more precision, a shorter recovery time, less blood loss and with all these factors together, the patient recovers more quickly and with less pain,” said Dr. Paul Corsi, who has been performing these surgeries at St. Joseph Mercy Oakland in Pontiac for two years.
Instead of staying at the hospital for three to four days after surgery, Corsi said patients can leave the next day and return to work within one to two weeks. In the past, it took six weeks to recover from open surgeries.
Veronica Torrez of Pontiac, a patient of Corsi who underwent a myomectomy, can attest to the ease of recovery. Torrez said she was able to return home the morning after her surgery.
“When I went to my two week check-up, I was feeling good,” she said. “The recovery was very easy, and I felt back to normal in two to three weeks.”
Using the da Vinci surgical system, gynecologists can perform myomectomies — the surgical removal of fibroids or benign tumors from the uterus — through four, 1⁄4 to 1⁄2 centimeter incisions instead of the large abdominal incisions made during open surgery.
According to Corsi, this particularly benefits patients hoping to preserve the uterus and reproduce in the future.
Theoharis agreed robotic surgeries are particularly beneficial in preserving the uterus.
“I don’t think it’s for everybody,” he said. “If you are looking at a laparoscopic supra-cervical surgical hysterectomy, I do not think that the robot offers any advantage. But for total hysterectomies, it offers you benefits, and clearly I think for robotic myomectomies in almost all cases if patients are candidates for laparoscopic surgery, then they would be better candidates for robotic surgery.”
Theoharis said he believes robotic procedures will have an even larger impact on removing malignant tumors.
“If you want to look at where it has the most significant impact in gynecology, there are clearly more advantages in the area of gynecologic oncology,” he says.
But the thought of having a robot perform their surgery might leave some patients a little uneasy.
Corsi said he assures patients that the surgeon is still completely in control.
“The robotic instrument will never take over. Every movement I make the robot will make. If anything, it has so many checks and balances that it protects you,” Corsi said.
The system performs a check 100 times per second and if there is anything wrong, it will stop, according to Catana. He said so far there have been no complications due to the robot.
While the surgeons said the benefits offered by robotic surgery for patients clearly outweigh the cost of equipment, hospitals still must take into account the $1.7 million initial outlay for the da Vinci surgical system and the additional maintenance costs.
Officials at St. Joseph Mercy Oakland said their initial analysis indicates the direct cost per procedure runs between 50 percent to 70 percent higher for da Vinci versus traditional surgery.
“What we have not been able to quantify yet is the overall cost savings as the patients have a shorter length-of-stay and less complications. With the program in its first year, we do not yet have enough cases to make assumptions,” hospital officials said.
But patients will not have to shoulder the extra cost of these procedures, billed the same as open myomectomies and hysterectomies — procedures usually covered by insurance companies as well as Medicare and Medicaid.
“We are not compensated any more for a robotic procedure. We try to reduce other costs such as length of stay to offset expense,” said Jack Weiner, president and CEO of St. Joseph Mercy Oakland.
Currently three hospitals in Oakland County have da Vinci surgical systems: Royal Oak Beaumont, St. Joseph Mercy Oakland and Providence in Novi.
Theoharis said he believes patients are seeking doctors who perform robotic procedures because they are perceived to produce the best results.
“I think that doctors who do not learn how to use the robot will be behind,” he said.
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