Robots in the Emergency Room

Metro Detroit hospitals are driving revenue and profits by drawing patients from around the world to their robotic surgical systems

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It’s 7:40 a.m. on a Tuesday and a 55-year-old man with prostate cancer is fighting for his life in a surgical suite at Detroit’s Henry Ford Hospital. But there’s none of the usual organized chaos that marks most operations. There’s no popping of latex gloves as nurses slap scalpels and scissors into surgeons’ hands from long trays of instruments. There’s no blood spattered on the floor or on the doctors’ and nurses’ scrubs.

Instead of the usual huge overhead lights illuminating a body cavity as bright as day, this operating room is cool and dimly lit. And you have to look hard to find the patient, who’s almost completely swathed in plastic and lying next to a gently rising and falling respirator presided over by an anesthesiologist.

Instead of the patient being surrounded by medical personnel, just one doctor sits next to him, talking softly to the rest of the team as he inserts and removes short lengths of tubing from the patient’s body. The surgery itself is actually being conducted by Dr. Mani Menon, a urologist who’s seated a dozen feet away at a da Vinci Surgical System, a device that resembles a video-game console-cum-jukebox.

Menon, a pioneer in robotic surgery, looks into the view window and grasps two hand controls that are connected to robotic arms on a cart next to the patient. The system uses computers to translate the surgeon’s hand, wrist, and finger actions into precise movements of the surgical instruments in the tubing. In fact, the surgeon never actually touches the patient.

And instead of requiring a long, gaping incision in the patient to make room for the surgeon’s hands, as is still common in many types of surgery, the tubing and robotic arms are inserted through incisions about the width of a pencil.

Perhaps equally amazing, a camera inserted through a slightly larger incision shows the operation 35 times normal size, and in 3-D, on several big-screen TVs on the wall, as well as on the da Vinci console. Everyone involved in the operation wears special 3-D glasses.

As the surgery begins, thin surgical threads look as thick as steel cables, and the patient’s walnut-sized prostate is clearly visible as the robotic cutting arm snips away flesh and reveals the cancerous tumor. Occasionally, the 3-D screens are obscured by smoke and steam as the heat element on the robot cuts away flesh. “This is a revolution in surgery for the prostate,” says Menon, still hunched over his small da Vinci screen in the shadowy room. “But it may be a revolution for all surgery in the next five to 10 years.”

The da Vinci system, which is now used throughout the world, was originally developed for heart surgery. But its widest use, for prostate operations, “all started in Michigan at the Vattikuti Urology Institute at Ford Hospital,” says Menon, who is director of the institute. “We got funding to try it and it worked.”

Every year, more than 200,000 American men are diagnosed with prostate cancer. But unlike many other cancers, there’s a reliable blood test — the PSA test — for prostate cancer, which is highly curable if detected early, Menon says. “This [patient’s] cancer was caught early, and the chance of recovery is almost 100 percent.”

The da Vinci system is on the cutting edge of what’s come to be known as laparoscopic, or minimally invasive, surgery, which causes minimal damage to the body. Doctors like Menon, and the da Vinci’s maker — Intuitive Surgical Inc., of Sunnyvale, Calif. — say there are many benefits for the patient, including significantly less pain, less blood loss, less scarring, and a shorter recovery time.

But some doctors lament the disadvantages of the da Vinci, such as the initial cost — $1.4 million to $1.6 million per unit, plus annual maintenance. Other issues include a long learning curve for using the device, the lack of a hands-on feeling during surgery, and the limitations of the da Vinci, which isn’t appropriate for all types of surgery.

Currently, 26 hospitals in Michigan use the da Vinci. Four of the systems are at the Henry Ford Health System and three are at the University of Michigan system, according to Intuitive Surgical. Other metro Detroit hospitals that use the da Vinci include Royal Oak-based Beaumont Hospital and the Mount Clemens Regional Medical Center.

As part of a trend dubbed “medical tourism,” patients have come from 49 states and more than two dozen countries to undergo the procedure at Henry Ford Hospitals. Menon estimates that since the first robotic prostate operation in 2001, he has performed more than 3,000 procedures.

Steven Whitty, a 55-year-old truck driver from Macomb Township, came to Henry Ford after he was diagnosed with prostate cancer. “When I found out, I talked to doctors at other hospitals and to my family doctor,” he says. “My doctor said, ‘If it were me, I’d go to the Vattikuti Urology Institute at Henry Ford.’
“I went online [and learned that] Menon was the best in the world. I also met guys from Dubai and Maine who were to have it done.”

Menon operated on him last fall.

Whitty, an athletic man who bicycles about 5,000 miles a year, has had 11 different surgeries in his life. This one, he says, was the easiest. “I went into surgery at 11:45 a.m. and woke up at 4:30 p.m. I went back to work after 20 days. But if I had a desk job, I could’ve gone back to work two days after the operation. Psychologically, the mention of cancer had brought me down. I didn’t know if it had spread, but they got it all. It lifted all the weight off my shoulders, [and] I feel great.”

In Ann Arbor, Dr. Arnold Advincula, a professor in the obstetrics and gynecology department at the University of Michigan’s medical school, has been using the da Vinci for gynecological operations, including reproductive surgery, since 2000. “It’s the only Food and Drug Administration-approved surgical robot for humans,” he says. “It’s given us the ability to overcome limitations — going from two dimensions to three dimensions.”

Where the old instruments were rigid and restrictive, Advincula says, the robotic system has allowed him to treat more patients. He now performs 70 percent of his operations using the da Vinci, but it’s no panacea. “Size is still an issue,” Advincula says. “It takes up a big footprint in the operating room. And at $1.6 million for each [unit], cost is a problem.”

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