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