FAMC’s own da Vinci code
Friday, July 30, 2004
Hospital to begin robot-assisted operations
Starting next week, the hands of surgeons won’t be the only thing touching patients
during operations at Fremont Area Medical Center.
That’s when the hospital’s newest surgeon, Dr. Yohannes, will use the world’s
most technically advance surgical robot to remove prostate cancer from two men.
Yohannes will sit at a computer console, viewing a 3-D image of the patient from
about five feet away from the operating table.
Using video game-like controllers and an advance computer system, the robotic
arms of the da Vinci, created by Intuitive Systems, reacts to the surgeon’s hand,
wrist and finger movements in precise real time movements with surgical instruments.
The robotic arms require only a 1-centimeter incision and are about the size
of a pen. The arms offer more wrist dexterity than the human hand and do not
tremor like the human hand can.
Don Tricarico, director of surgery at FAMC, said the $1.4 million system is only
the fourth in use in the entire state.
Only about 200 hospitals in the country have the da Vinci.
“It takes surgery beyond the limit of the human hand,” he said.
FAMC acquired the system in June and surgical staff have been training on it
since. “Right, now, we’ve been in a teaching mode,” Tricarico said. “Dr. Yohannes
is very experienced— he’s been using (a da Vinci system) at Creighton for some
time. As of August, he’ll be working with Dr. (Ansar) Khan. Both urologists will
use it.” The robot-assisted technology initially will be used at FAMC only for
prostate cancer surgery. However, the da Vinci also is FDA-approved for general
surgery, chest surgery and gynecologic surgery. This month, it was FDA-approved
for closed-chest heart bypass surgery. “Our focus is to bring it in for urology,
but its uses can be expanded,” Tricarico said. “The advantage is that instead
of having big incisions, there are just smaller incisions. It decreases the need
for transfusions because there is a lot less blood loss.” The technique is minimally
invasive, patients have shorter hospital stays, less blood loss, less pain and a much faster recovery and return to normal daily activities when compared to
conventional surgery or laparoscopic surgery, he said.
He said post-operative care requires fewer nursing hours and less recovery time in general.
“It’s very useful when working in a very small space — you’re less likely to touch nerves,”
Tricarico said. “You’re not using your hand through a machine.”
When using the computer-enhanced robotic surgery, miniature instruments such as
graspers and cauterizing tools are inserted through ports that remain in place in three small
incisions. Seated at a control console near the patient, the surgeon views high-definition, magnified,
3-D images from a tiny video camera.
Yohannes said the surgeon’s thumb, forefinger and normal wrist movements manipulate the
robotic arms and tiny instruments. The mechanical “wrists” of the robot bend back and forth,
side to side and rotate in a full 360-degree circle, providing better range of motion than the
“This is a technological advance, but our primary focus is patient safety.” Tricarico said. “As
far as the patient’s point of view, they won’t see a difference in the operation, they’ll see the difference
in post-op and recovery.”
Yohannes said this type of surgery will be the standard care down the road.
“The term ‘robot’ may seem scary to some people, but this technology provides superior
patient outcomes,” he said. “It’s basically a mechanic wrist—I have 360 degrees of freedom.”
Yohannes has been performing robotic surgery for three years and trains other surgeons to
use the machine.
The average hospital stay after robotic surgery is 1.2 days, compared to 3.5 days for open
surgery and 1.3 days for laparoscopic surgery.
“We have quite a bit of prostate cancer (patients) we’ll be using this on,” Yohannes said,
“Hopefully in three to six months we’ll have cardiologists training to use (the da Vinci system). It’s
very precise — this will go where the human eyes cannot go.”
Most patients with prostate cancer are candidates for the procedure and Tricarico said most
insurance companies cover the operation.
“If a prostate patient is a candidate for open surgery (traditional surgery with large incisions),
they are a candidate for this,” Yohannes said.
Patient suffer less post-operative pain and return to work more quickly after the robot-assisted
“I’ve had patients require no (pain) meds and return to work in three to four weeks after a
two-day hospital stay,” Yohannes said. “With the open approach, it can take a couple of months
for a patient to recover and return to daily activities.”
Both the new procedure and the original procedure take about two hours to perform.
“This is the most advanced surgical platform available,” Tricarico said. “Part of (FAMC’s) longrange
planning is to increase our in-patient type surgeries to communities. Our community tells
us they want to come here for surgery. We want to have the equipment to provide the service.”
For more information on robot-assisted surgery at FAMC, visit www.famc.org or call 727-