Drs. Thomas E. Ahlering (left) and Michael K. Louie, who head UC Irvine Medical Center's new Robotic Oncology Center, battle cancer with such state-of-the-art technology as the da Vinci Surgical System.

Expanding the role of robots

SpineAssist system adds to UC Irvine firsts in the operating room. Surgeons continue to find innovative uses for the technology, including thyroid, lung and colorectal procedures.

Lourdes Medina had a common problem: relentless back
pain and sciatica caused by a herniated disk and an unstable spine. The
solution, however, was anything but common. At UC Irvine
Medical Center, she underwent the first robot-assisted spinal surgery on
the West Coast. Within a day of her March 15 operation, the 32-year-old
Los Angeles woman was walking around her hospital room.

“I feel 100 percent
better,” says Medina, who had a previous spinal fusion to treat a
degenerative disk. “Before, there was excruciating pain radiating down
my leg, and I couldn’t sleep. Now there’s no pain in my legs or hips for
the first time in a long time.”

Orthopedic surgeons Dr. Nitin Bhatia and Dr. Samuel Bederman utilized
the new SpineAssist system, which allows a procedure to be planned out
before the patient enters the operating room and helps the doctor place
spinal implants with a high degree of precision during both open and
minimally invasive surgery.

Pioneering the use
of robotics is nothing new at UC Irvine. It was the first Orange County
hospital — and among the first university medical centers anywhere — to
adopt the da Vinci Surgical System.

While da Vinci has
been around for almost 10 years, UC Irvine physicians continue to find
applications that benefit patients. For surgeons, robotics can offer
enhanced precision, dexterity, range of motion and imaging during
operations. For patients, the technology can mean less injury to nearby
healthy tissue, smaller scars, reduced pain and faster recovery.

The da Vinci system was originally designed for heart operations, but
doctors quickly found other uses. UC Irvine’s Dr. Thomas Ahlering was
among the earliest adopters of robotic prostate surgery and has
performed more than 1,000 such procedures since introducing it to
Southern California in 2002.

In the last year, UC Irvine surgeons have employed the system in several new ways:

  • In July 2010, Dr. Jason Kim became the first in the West
    to perform thyroid surgery with the robot, leaving his patient without
    the neck scar visible on thousands who have had the traditional open
    thyroid operation. One of his first patients is now planning her wedding
    — with no scar to telegraph her health history.
  • In December, Dr. Joseph Carmichael conducted Orange County’s first
    robot-assisted colorectal cancer surgery on a 47-year-old Foothill Ranch
    man with stage IV rectal cancer. “The results were very good,”
    Carmichael says. “This patient left the hospital in four days — the
    national average is nine days — and was able to start chemotherapy
    quickly.”
  • In March, cardiothoracic surgeon Dr. Amir Abolhoda carried out the county’s first robotic lung cancer surgery.
    Using da Vinci, he removed the lowest lobe in the right lung of a
    52-year-old individual with early-stage lung cancer. “The patient was
    able to leave the hospital in two days and is experiencing no
    complications,” Abolhoda says.

Robotics is an extension of the wave of minimally invasive surgical techniques like laparoscopy that swept American medicine in the 1990s. UC Irvine’s Dr. Ralph V. Clayman was a trailblazer, performing the world’s first laparoscopic kidney removal in 1990.

Now dean of the UC Irvine School of Medicine, Clayman
arrived in Orange County in 2002 as the first chairman of the
university’s Department of Urology and quickly established UC Irvine as a
leader in minimally invasive surgery.

He believes the
university’s doctors should strive to increase patients’ access to
surgical improvements while enhancing outcomes. Clayman
institutionalized the innovative use of robotics in treating cancer with
last year’s launch of the UC Irvine Robotic Oncology Center.

“The center focuses
on the specific application of robotic technology to cancer surgery and
enables us to continually advance this exciting technology for the
betterment of every patient who seeks our care,” he says.

Use of da Vinci will expand in the treatment of gynecologic cancers under the new director of gynecologic oncology, Dr. Robert E. Bristow, who gained extensive experience with robotics at Johns Hopkins University.

And the recent
arrival of Dr. Alessio Pigazzi, a nationally renowned colon and rectal
surgeon, will likewise increase the use of robotics in treating
colorectal cancer.

While the da Vinci
system dominates the operating room, with its multiple arms acting as
extensions of a surgeon’s hands, SpineAssist is much smaller and employs
robotics in a different way.

The size of a soda
can, it sits on a patient’s back and guides the surgeon to more
precisely place orthopedic screws stabilizing the spine. A study published last year in the journal Spine
showed that the system can boost the accuracy of spinal implants to
98.3 percent and significantly lower the incidence of misplaced screws
and subsequent neurological problems. The accuracy rate for non-robotic
orthopedic screw placement is about 86 percent.

“Our surgical
outcomes are already excellent, so I’m always skeptical when a new
technology claims it can improve these results,” Bhatia says. “This
technology, however, surpassed our goals for our patients.”

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