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A Cut Above

Lourdes Medina had undergone two spinal operations to treat a debilitating degenerative disc. They provided little relief, and she soon developed a herniated disc in her lower back.

In the realm of traditional medicine, the 32-year-old’s only option appeared to be a procession of painful and likely ineffective procedures. Enter the advanced technology of SpineAssist, a robotic surgical system. A pair of surgeons at UC Irvine Medical Center used it to quickly and precisely fuse her spine — the first such robotic operation on the West Coast — and Medina was all but reborn.

“I feel 100% better,” Medina said. “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.”

SpineAssist is part of the fast-growing world of robotics — technology that promises more efficient, less invasive surgeries and faster recovery times for patients. It’s all accomplished by enhancing a surgeon’s ability to view surgical sites and precisely maneuver instruments.

“We expect this technology to improve outcomes, shorten surgical times and enhance healing in our spinal surgery patients,” said Dr. Nitin Bhatia, UC Irvine’s chief of orthopedic spine surgery. “The system allows us to preplan an operation using CT scans to precisely plot the surgery and program the robot to guide screws in exactly the right spot in the patient’s spine.”

Barely a decade old, robotic surgery is revolutionizing a wide range of procedures — and Southern California’s world-class medical centers are at the forefront of this revolution.

Surgical precision

Robotic surgery was developed in the late ’90s and put in use at City of Hope — a state-of-the-art cancer treatment and research facility — around 2003. The pioneering da Vinci Surgical System, first used exclusively for prostate surgery, is now used in procedures for many types of cancer, including head and neck, lung, esophageal, kidney, gynecologic and colorectal cancers.

The benefits are numerous, but contrary to what some might believe, actual robots don’t perform the operations. Rather, skilled surgeons conduct the procedure while viewing a high-resolution 3-D image of the surgical site through a camera. Miniaturized instruments — inserted into the body through small incisions — are controlled by robotic arms operated by the surgeon’s hand movements.

“Our da Vinci system allows surgeons to sit beside the patient at computer consoles and perform procedures by a remote process that employs highly detailed imaging and a high degree of precision,” said Dr. Timothy Wilson, head of the urology department at City of Hope. “It’s much less invasive than traditional surgery, with lower risk of infection and less blood loss.”

City of Hope now has four da Vinci consoles, the newest of which, the da Vinci Si HD, allows two surgeons to work together on separate consoles. Control of the operation can be switched back and forth with ease. It can be a highly effective teaching tool for less-experienced surgeons, Wilson said.

“An experienced surgeon can direct a newcomer from a separate console,” he said. “Our da Vinci technology even allows [the experienced surgeon] to sit at a PC in his office and show the other surgeon exactly where to cut by tracing the outline on the monitor screen.”

City of Hope and Intuitive Surgical, the developerof the da Vinci system, recently pioneered a process that causes healthy tissue to glow, enabling the surgeon to more precisely target malignant masses while minimizing damage to surrounding tissue and organs. A dye (called indocyanine green) is infused into the patient’s blood, and an attachment allows the surgeon to shine a near-infrared light on the area of the tumor.

“Healthy tissue shows up bright green when exposed to the light,” Wilson said. “But diseased tissue remains dark.”

Robotics will continue to evolve, offering even greater precision during surgery, with increasingly high-definition imaging and robotic arms that offer a wider range of maneuverability, he said.

Taking heart

Robotic technology is also being used in some forms of cardiac surgery, with Cedars-Sinai Medical Center leading the way as one of the nation’s top proponents of robotic valve repair.

The advantages are significant. Consider that traditional valve surgery requires sawing open the breastbone and spreading ribs to expose the heart. But the da Vinci system at Cedars-Sinai requires only a few dime-sized incisions.

“With robotic technology, surgeons can visualize the mitral valve in such a way that they gain a much better understanding of the valve’s pathology,” said Dr. Alfredo Trento, director of the Division of Cardiothoracic Surgery at Cedars-Sinai. “We can actually see inside the valve. It’s amazing technology.”

But regardless of how advanced robotic surgery becomes, the key is having a highly skilled and well-trained surgeon (or two) at the controls. After all, the robot is simply a tool — an exceedingly innovative high-tech tool, to be sure — that’s only as effective as the doctors using it.

“While robotic surgery may be cutting-edge, you also need expert hands to guide those cuts,” Wilson said.

Bob Young, Brand Publishing Writer

Copyright © 2014, Los Angeles Times
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