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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Learning to use the da Vinci can also take time for doctors. In addition to his initial training, Advincula says it took him about 20 cases before he completely understood the mechanics of the device. There’s also a competitive “we have the latest technology” marketing aspect to the da Vinci. “A lot of hospitals use the system,” Advincula says, “but a lot of it is market-driven. Sometimes it ends up in places where it’s not fully utilized, but used for marketing” to attract patients. The maker of the da Vinci doesn’t see that as a problem.

“The continued adoption of da Vinci surgery as a new standard of minimally invasive surgical care is reflected by the growing number of hospitals and patients in Michigan,” says Nora Distefano, a market-development specialist for Intuitive Surgical. “We envision a future in which every hospital in the country will offer the improved clinical outcomes and reduced surgical traumas enabled by [our] system.”

The device, of course, is named for Leonardo da Vinci, who is said to have designed the first robot — a humanoid automaton — around 1495. The design notes for his robot appeared in sketchbooks discovered in the 1950s. It’s not known whether an attempt was made to build it.

The prototype of the da Vinci system was developed in the late 1980s at the former Stanford Research Institute (now SRI International) under a contract with the U.S. Army. The robot is apparently able to make several human-like motions, including sitting up, as well as moving its arms, neck, and anatomically correct jaw. And it’s partially Leonardo’s anatomical research that led to his highly accurate three-dimensional sketches of the human body. Stanford’s initial work was aimed at developing a system for performing battlefield surgery remotely. Intuitive Surgical was founded in 1995 to develop broader commercial uses.

The FDA approved the da Vinci in 2000 for general laparoscopic surgery and, subsequently, for cardiac, urological, and gynecological procedures. Laparoscopic surgery (also known as keyhole or pinhole surgery) is notable for its tiny incisions, as opposed to the larger openings employed in traditional surgery. According to Intuitive Surgical, there are more than 1,000 da Vinci systems installed in hospitals around the world today, from Japan to Saudi Arabia, although most are in the United States.

The da Vinci, however, may not be useful for all types of surgery, the company acknowledges. Heart surgery, at which the da Vinci was first aimed, requires an excellent view of the chest cavity. Surgeons have historically split the chest open with a foot-long incision and spread the ribs, which allows more room for the surgeon’s hands and instruments. And that practice continues.

“I shot at the heart,” says Intuitive Surgical CEO Lonnie Smith, “[but] I hit the prostate.”

Nationally, the majority of prostate cancers are now operated on using the da Vinci, Menon says. Henry Ford Hospital has also begun employing it for kidney surgery. Menon acknowledges that it can “take days to get comfortable” with the da Vinci. He compares the training to practicing in a flight simulator. Surgeons can “easily have 400 hours of virtual-reality training before touching a patient,” he says. “It’s like playing golf — before you can become a pro, you have to play for a long time.”

Some of the advantages of the da Vinci include far better vision and maneuvering in close quarters. Recuperation times are far shorter, and bleeding is reduced by up to 90 percent. There are also fewer problems with infection, incontinence, and erectile dysfunction.

Dr. Robert Welsh, chief of thoracic surgery at Beaumont Hospital in Royal Oak, likes the “greatly magnified field of vision” and depth perception offered by Beaumont’s three da Vinci units. He says the robotic arms offer a range of movement that mimics a doctor’s own hand. But he, too, sees some disadvantages.

“You can’t tell if you’re holding something — there’s no tactile feedback, no sense of the force being applied,” he says. “You can stretch or break tissue.” But such problems, he says, are “very rare.” Welsh also points out that the robotic arms have to be replaced after 10 or 12 uses, to ensure the reliability of the instruments. Welsh says it’s hard to estimate any overall cost savings with the da Vinci. But reducing patient discomfort and shortening the length of most hospital stays from two or three days to one day is a major advancement.

When Carol Gee, of Sterling Heights, was told she needed a hysterectomy, her first thought was that she “didn’t want to be opened up.” She had undergone several other surgeries as an adult — including two Caesarean sections, a tubal ligation, and gall bladder and appendix removal — and was concerned about additional scarring from traditional surgery. “My doctor told me about da Vinci surgery and said I was a good candidate, that it was more accurate,” she says.
Gee had her da Vinci hysterectomy at Henry Ford Macomb Hospital last July. “I’m still amazed,” she says. “There wasn’t a lot of pain, and I went home the next day.”

Back at Henry Ford Hospital in Detroit, Menon peers into his da Vinci view screen in the operating room. He turns his thumb and finger slightly, and the robotic pincer on the 3-D screen drops Steve Whitty’s cancerous prostate into a bag for extraction. Menon then begins suturing the patient.

“It’s always an amazing process,” he says. “It’s minimally invasive, but still a big operation. It makes a huge change in people’s lives.”

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