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Making Medical History Thursday, May 16, 2002
Omaha World Herald

Robotics arms expand local hospitals’ reach Million-Dollar bets on rebotic surgery by Omaha’s academic medical centers are paying off in the recruitment of high-tech doctors and the development of less-traumatic surgeries. The University of Nebraska Medical Center was the eighth hospital in the country to purchase a sergical robot in 2000. Now Creighton University Medical Center has one as well, making Omaha one of only a dozen cities to have at least two hospital capable of rebotic surgery. “We are pushing the envelope as much as anybody in the United States,” said Dr. Dmitry Oleynikov, who directs the NU Medical Center’s new robotic and minimally invasive surgery program. Medical history is being made routinely in Nebraska: • Last fall, NU’s Dr. Ranjan Sudan was the first in the world to use a robot for a certain type of gastric bypass that treats morbid obesity. • Last winter, Oleynikov and another surgeon were the first to use the robot to remove a blockage that was preventing normal blood flow into the intestines. • Last month, Creighton’s Dr Paulos Yohannes was the first to robotically repair a tube between the kidney and bladder, called the ureter, that had become twisted and blocked. The robots are part of the growing popularity of minimally invasive surgery, a broad category of techiques that reduce hospital stays, post-operative pain and recovery time. Whether longterm results are better is largely unproved, but the concept has nonetheless captured the attention of an increasing health-conscious public. Robots: Minimally invasive surgery gains popularity “The drive for this surgery comes from patients educating themselves and asking for this type of sergery,” Oleynikov said during a recent forum on medical technology. “They found out through the Internet and other resources it could reduce pain and speed up recovery.” There have been 44 robotic surgeries at University and Clarkson Hospitals, affiliates of the NU Medical Center, in the past two years. Creighton has used robotic surgery eight times in the past two months. The robots, made by Intuitive surgical Inc. of California, one of two companies lthat make them, are intended to be high-tech extensions of a surgeon’s eyes and hands. Robotic arms with surgical equipment at their tips are in serted, along with miniature cameras, into the patient through pencil-width incisions. A surgeon sits at a separate console – which receives a three-dimensional view from the cameras inside the patient – and guides the robotixc arms with controls that mimic normal hand movements. Most minimally invasive surgeries can be done without a robot. Surgeons can use long handheld instruments instead. Either way, the use of smaller incisions instead of the long ones required for open surgeries is less traumatic for patients. Oleynikov, recruited from a leading center for minimally invasive surgery in Washington, said he uses the robot only when he believes it offers patients the chance at a better outcome. Otherwise, he said, it can be slower to use the robot for surgeons like him who were trained in the older minimally invasive techniques. But he predicted that the next generation of surgeons will prefer to use the robot whenever possible because it is easier to master. It’s comparable, Oleynikov said, to learning to drive with an automatic transmission instead of a stick shift. The older minimally invasive techniques can be awkward for new surgeons, partly because the movements with their hands have to be opposite of what they see on the monitors in front of them. The robot solves that problem and also provides higher-magnification and three-demisional views inside the patient. Before coming to Omaha, Creighton’s Yohannes completed a study at Long Island Jewish Medical Center in New York that determined that new surgeons pick up minimally invasive techniques much faster with the robot. It is no coincidence, he said, that the newest generation of surgeons grew up with arcade games. “It really helps if you’re good with Nintendo,” he said. The robots also can record all of the movements a surgeon makes during a procedure. If the robots can be programmed to know the textbook surgeries, Oleynikov said, they can inform doctors of potential errors or serve as surgery simulators for medical students. Such simulation technology does not yet exist, but Oleynikov is using the NU robot to create it. Leaders at both medical centers agreed that the robots are strong tools for recruiting not only top students but also top teachers and surgeons. Yohannes, for example, came from New York to Omaha largely because Creighton had a robot. The NU Medical Center’s use of robotic surgery started in 2000 with a multimillion-dollar donation by Charles Durham, and a requirement that a portion of the money be invested in minimally invasive surgery. The first robotic surgery at University Hospital, in August 2000, was a bowel resection for a man suffering from a severe digestive disorder. At the time, robots were federally approved for use in only a select few abdominal surgeries. Now, robotic surgery has been cleared for ust in the chest, large arteries, prostates and many other parts of the body. Robotic heart surgery is being studied. Yohannes, whose specialty is urology,, is scheduled to use a robot to remove a cancerous prostate from a patient in July — another rare procedure. He thinks the robot will eventually prove itself as a superior surgical tool, because its clearer view inside a patient allows surgeons to make more precise cuts and tighter sutures. For patients of urology surgeries, the robot should result in fewer complications such as incontinence, he said. “It’s going to have to prove itself to be better.” ••••••••••••••••• By Jeremy Olson WORLD-HERALD STAFF WRITER








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