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Sugery From a Distance 

Dr. Bradford Nelson, MD, PharmD, controls the robotic arm of the da Vinci medical machine to show how surgery is performed remotely.

In pale blue and green scrubs, Dr. Bradford Nelson leans into the door, enters the operating room and introduces his surgery partner — the da Vinci robotic surgical system. “Impressive, huh?” Nelson says.

The machine takes up most of the room. Against one wall is the console, where Nelson sits, consults a 3-D picture of his patient and, using joystick-like controls, guides a set of thin robotic arms that cut, cauterize and sew — most everything doctors used to do by hand, but now do much less invasively.

“A lot of people are saying this is a panacea, but I believe it’s just a tool,” says Nelson, an urologist at Spokane’s Rockwood Clinic, who has performed more than 250 robotic surgeries. Talking about the robot, however, Nelson can’t help but get excited. “I’m very passionate about the technology.”

The FDA first approved the da Vinci system in 2000, but in recent years doctors have turned to it increasingly for all sorts of procedures, including heart, kidney and prostate surgeries as well as hysterectomies. The robots don’t come cheap — $1.5 million — and Sacred Heart Medical Center has the region’s only two machines. Worldwide, there are now about 800 in use, according to the manufacturer, Intuitive Surgical, of Sunnyvale, Calif.

“It had a tough time initially catching on … but now it’s being used in lots of different ways,” Nelson says.

The first prototype was developed in the late ’80s by the former Stanford Research Institute — now called SRI International — for the U.S. Army, which wanted a system to perform battlefield surgeries remotely. That particular dream was never quite realized, but out of the research, the da Vinci robot was born.

Laparoscopic surgery, using cameras and tools inserted into the patient through small incisions, has offered an alternative to many types of open surgery for quite a while. But by offering surgeons tools with the same flexibility and dexterity the human wrist provides, the robot is touted as providing the “look and feel” of open surgery—without the need for a large incision. The surgeon operates the tools and camera with hand controls at a console while an assistant tends to the patient and clears excess blood. Removing a cancerous prostate takes about two and a half hours, Nelson says.

For patients, this can mean less blood loss, less scarring, faster recovery. For men undergoing prostate surgery, it can also mean better potency and continence, Nelson says.

For Chuck Maxwell, 62, the thought of having a few tiny cuts — instead of radiation or open surgery — was the main selling point. A rancher outside Great Falls, Mont., Maxwell did research on the Internet before deciding what to do about his prostate cancer. He also consulted his local urologist, who wasn’t familiar with robotic surgery but conceded that if it were his own prostate, that’s the course he would take.

Maxwell then set about finding a surgeon. He says he wanted someone who had done at least 150 surgeries. He found Nelson, who operated on him in March.

“I’d recommend it,” Maxwell says.

But around the country, as more and more hospitals buy into the technology, the system has also garnered some criticism. One big objection is about the upfront cost. In 2004, one doctor told the Wall Street Journal that the da Vinci system was “the most expensive pair of scissors you could ever buy.”

Another complaint is with doctors using the robot without sufficient training. In 2003, a widow sued a Florida hospital, alleging it allowed doctors inexperienced with the robot to perform operations. The woman’s husband had died after a surgeon accidentally cut two main blood vessels.

Nelson shares similar concerns, saying that having a robot in your hospital doesn’t mean it has a successful robotic-surgery program. That takes physicians who are well versed in using the machine. But, he adds, as the next generations of surgeons come of age, they likely will be exposed to da Vinci and all the promise that robotics hold.

“There’s a lot of exciting stuff out there for medicine,” he says.

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