Health

Robots changing surgery in Eastern Iowa

Health care experts say more procedures done with help of robotic technology

Dr. Jason Rexroth, an obstetrician-gynecologist, displays the robotic scissors used during a robot-assisted hysterectomy at Mercy Medical Center in Cedar Rapids on Wednesday, July 18, 2018. Mercy uses several models of the da Vinci robotic system to perform routine procedures ranging from obstetrics and gynecology to general surgery. (Rebecca F. Miller/The Gazette)
Dr. Jason Rexroth, an obstetrician-gynecologist, displays the robotic scissors used during a robot-assisted hysterectomy at Mercy Medical Center in Cedar Rapids on Wednesday, July 18, 2018. Mercy uses several models of the da Vinci robotic system to perform routine procedures ranging from obstetrics and gynecology to general surgery. (Rebecca F. Miller/The Gazette)
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As technology continues to evolve, money transactions can be done on mobile phones, smart speakers can help with household chores and people may not have to drive their own cars.

But what if a robot is the one who does your surgery?

We’re not there yet and surgeons may never entirely be eliminated from the equation, health care experts say, but it’s becoming more likely nowadays a patient’s operation would be done with the help, at least, of robot.

“The reality of training and the reality of robotics now is that it is mainstream. There are lots of programs in lots of different hospitals now,” Dr. Jonathan Rippentrop, an urologist at Physicians’ Clinic of Iowa and director of minimally invasive surgery at UnityPoint Health-St. Luke’s Hospital.

Both Cedar Rapids hospitals and the University of Iowa Hospitals and Clinics in Iowa City deploy machines for certain procedures. That opens the door to another form of minimally invasive surgeries that are faster and are much easier for patients to recover from.

“It’s just a better tool than what we had before,” said Dr. Jason Rexroth, a obstetrician/gynecologist and the medical director of robotics surgery at Mercy Medical Center.

However, other surgeons caution that while the technology has clear benefits, it is not ideal for every patient or every procedure.

“I think with evolution of technology and more hands on clinical experience we will be able to push the envelope for better and safer robotic surgery with uncompromising clinical outcomes,” said Dr. Evgeny Arshava, cardiothoracic surgeon at the University of Iowa Hospitals and Clinics.

The Future of the Operating Room

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Surgical tools are connected to a robotic device controlled by a surgeon seated at a remote console, who operates the instruments through small incisions in the patient. These surgeries typically are done in place of a procedure that traditionally would require a large incision, which are more painful and require a longer recovery time.

Da Vinci surgical systems, created in 2000 and produced by Silicon Valley-based Intuitive Surgical, currently is the most commonly used machine in the Corridor, area surgeons say.

The system was first approved for urology surgeons, who used the device for prostatectomies — removal of part or all the prostate. Rippentrop estimated 90 percent of these procedures are done with the help of a robotic system.

Then, FDA approval came for gynecology and general surgery, Rexroth said.

“In the past three years, 100 percent of my robotic hysterectomies have gone home the same day,” Rexroth said. “For a surgery that used to stay in the hospital a week. Now it’s an outpatient surgery because of the robot.”

Since 2002, there have been more than 40,000 surgical cases performed in Iowa by a da Vinci system, said John Greenwood, senior clinical sales representative for Intuitive Surgical. In 2017 alone, more than 6,500 surgical cases were done by 36 da Vinci systems in 24 different hospitals across the state, he added.

The company expects that caseload to reach about 7,300 for 2018.

Both St. Luke’s and Mercy Medical in Cedar Rapids each have had a robotic program for more than a decade and each have three da Vinci systems in their hospitals.

Mercy Medical recently acquired three of the systems’ newest models for its operating rooms, a move that indicates more surgeons are using the tool as the technology becomes conducive to other types of procedures.

“If you think about it, we barely knew about the blood types 100 years ago and solid organ transplants did not happen until a few decades ago. Smartphones have become the most important technology in the last decade,” UIHC’s Arshava noted. “Similarly the robotic technology will get better with time. We’ll probably be able to do complex surgeries with this technology and it’ll be easier to use.”

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However, even with advancements in recent years, Arshava said the technology does not benefit every patient. Depending on certain circumstances — such as the patient’s anatomy or the severity of the condition — an open surgery could be better for some individuals over a minimally invasive approach.

“Right now, I believe that not all patients benefit from this technology,” Arshava said. “Appropriate selection of patients who would have the most benefit from robotic technology is the key to success. That’s why (surgeons) have got to be selective and these type of procedures have to be done in experienced centers.”

Because of this, Mercy Medical’s Rexroth said he believes that human element won’t go away.

“If you look at a car, maybe a robot mechanic can fix something on the car because cars are all the same, but people are never all the same. There’s differences,” Rexroth said. “Typically when we’re doing surgery, we’re doing it for an anatomical problem, so you have to be able to react to whatever anatomy you see, and I think that’s a little bit difficult.

“There are so many variables, I don’t see doctors going away.”

l Comments: (319) 368-8536; michaela.ramm@thegazette.com

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