Thursday, September 9, 2004

HOSPITAL HIGH-TECH

On LI, robotic arms lend helping hand
North Shore University Hospital gets $1.4M tool to assist with prostate operations and other less-invasive surgeries, offering quick recovery

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Operating with robotic hands (Newsday Photos/Karen Wiles Stabile)

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A typical operating room set-up
Jul 21, 2004

BY ZERAH LURIE
STAFF WRITER

July 21, 2004

A multi-armed, $1.4-million robotic surgical system that advances medicine's revolution in minimally invasive surgery has made its debut at North Shore University Hospital in Manhasset.

Strictly speaking, robotic surgery is not robotic. Humans, after all, control the robotic arms.

"It's a tool like any other tool, but the tool is incredibly powerful," said Dr. Joseph DeRose, director of robotic surgery at St. Luke's-Roosevelt Hospital in Manhattan, where robotic surgeries have been performed since 2002.

Robotic surgery is an example of minimally invasive surgery, which has been in wide use for years in the form of laparoscopy, or keyhole, surgery. A doctor operates by inserting several instruments through small holes cut into the patient.

The main benefit of robotic surgery is reduced trauma and shorter recovery time, said Dr. Gary Goldberg, a urologist who performs robotic surgeries at North Shore University Hospital in Manhasset.

"It's comparable to the open operations in terms of cures, but revolutionary in terms of the aftereffects and recovery," Goldberg said. For instance, a patient typically needs six weeks to recover from conventional surgery to remove the prostate. But in a robotic surgical procedure, typical recovery time is two weeks, he said. Prostate removal is the most common robotic surgery; it has also been used in some types of cardiac surgery and on July 7 was approved by the Food and Drug Administration for coronary artery bypass surgery.

Called da Vinci, the robotic surgical system was born in 1995 at Stanford Research Institute, evolving from a Department of Defense project seeking to use robots to treat wounded soldiers in the field. The robot was eventually bought by Intuitive Surgical based in Sunnyvale, Calif.

Goldberg said North Shore is already using the system to perform two to three prostatectomies a month. There are currently 180 da Vinci surgical systems in the United States, nine in New York City.

Goldberg, who spent six months training to master the da Vinci system, said the robot enables him to do better work than when he relied on just his hands. Such superhuman ability has advantages.

"It enables us to avoid splitting the chest open," said Dr. Robert Kalimi, a specialist in minimally invasive and robotic surgery at North Shore, who helped perform the first robotic surgery there in March. "It's as though the surgeon's hands were miniaturized ... "

Kalimi says as many as 5 percent of the 4,000 to 5,000 people undergoing open-heart surgery each year on Long Island may be candidates for robotic surgery. "It may take a little bit of time before everybody will offer these types of surgery," Kalimi said, but he believes patients will start to demand it.

DeRose runs St. Luke's robotic lab, where surgeons learn how to use the robot. "The technology sort of pushed the implementation," he said. "As physicians, we are learning where it's working really well and where it has not."

Dr. Randolph Chitwood, director of the Eastern Carolina Cardiovascular Institute in Greenville, N.C., has performed 153 mitral valve operations with da Vinci. "I think we're at the level in robotics that we've proven it's safe," he said. "I think that it will evolve over the next 20 years into a better device" -- smaller instruments, for example -- "that will allow us to use these techniques for more surgeries."