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Dr. Stefanie Gefroh Ellison, an obstetrician/gynecologist, looks up from the console of a da Vinci surgical system at Essentia Health in Fargo, N.D. Surgeons use the console to control the da Vinci's robotic arms. IMAGE: Essentia Health

Robot-assisted surgery becomes common in region

GRAND FORKS, N.D. – Buy tech stocks.

Granted, that’s a strange way to begin a column on a health care topic. And it’s not even good investment advice, given that lots of people have lost lots of money in the tech sector.

But once you’ve seen the latest generation of medical robots, you’ll know that the field – already astounding – has exceptional potential.

As Roombas, self-driving cars and the Internet of Things are showing, automation is the future. And that’s proving to be just as true in health care as everywhere else.

Skeptical? Take a look at the da Vinci Surgical System by Intuitive Surgery, which you’ll find in major hospitals in the Dakotas, Minnesota and elsewhere.

Here’s how a Fortune magazine writer described the experience, during a visit to an operating room last year:

“As it happens, there’s another surgeon in the room besides Dr. Sullivan – one more modestly garbed than either of us. Wrapped in plastic sleeves that cover its central boom and sprawling white arms is Intuitive Surgical’s da Vinci Xi robotic surgery system. It’s hard to tell who’s in charge.”

The last is an exaggeration, as surgeons are quick to note. The surgeon is always in charge. He or she fully controls the robot’s movements from a console a few feet away.

But that doesn’t make the technology any less impressive. Because while the surgeon looks into the viewing device on the console and a manipulates hand and foot controls like a pipe-organ player, the robot’s surgical arms illuminate, examine, snip, lift, extract and sew in response to the surgeon’s commands, performing a tiny concerto of medical precision.

A da Vinci system costs some $2 million. That’s a big investment for a hospital.  

Nevertheless, there are at least eight da Vincis in North Dakota, and nearly 3,000 elsewhere in the United States, including at the Mayo Clinic and other high-level centers, Wikipedia notes.

To take just one result, nearly 90 percent of prostate removal surgeries in the United States now are done with da Vinci surgical systems.

Dr. Cameron Charchenko, a Bismarck, N.D., urologist with CHI St. Alexius Health, explains why.

The surgeons’ view

“The open prostatectomy was a technically challenging surgery, because it was done through a midline incision, often from the pubic bone up to about the belly button,” Charchenko said.

“And the problem is, the prostate is very deep down in the pelvis below the pubic bone. So when you're trying to do that surgery open, it's hard to see underneath the pubic bone, because you’re looking into this dark space.”

Furthermore, the surgery is exceptionally delicate, as it requires (among other challenges) resewing the urethra to the bladder while sparing the nerve bundles that are responsible for sexual function.

“The benefit of the robot is that it takes a high-definition camera, and essentially lets me put it right down underneath the pubic bone,” Charchenko said.

“I get this perfect visualization that’s magnified and in 3D, and I can do a much more precise dissection.”

To get an idea of the precision that the robot makes available, watch the YouTube video of a da Vinci-assisted surgeon suturing the skin of a grape.

Those advantages have convinced surgeons in other specialties, said Dr. David Billings, an obstetrician/gynecologist with Trinity Medical Group in Minot, N.D.

Like many ob-gyns, Billings now uses the da Vinci for hysterectomies and several other procedures. “The thing that I like most is that it’s able to magnify our vision and give us that 3D, high-definition presentation,” he said.

“You can get within an inch or even closer to the tissue. You can magnify and see areas that you couldn’t see before. It’s a great and innovative device.”

Asked if working the console’s controls was hard to master, Dr. Robert Guttormson, a general surgeon with Altru Health System in Grand Forks, smiled. “When we first got the da Vinci and were training on the simulator, I had my father who is 68 and my son, who’s 12, sit down and try some of the tasks.”

Both quickly picked up the skills. “My son, of course, did better, so he makes sure to point that out,” Guttormson said with a laugh. “Gaming does have its benefits.”

Then there’s the focus factor, said Dr. Stefanie Gefroh Ellison, an ob-gyn with Essentia Health in Fargo, N.D.

“Once I got going, I realized there are a lot of benefits not only for the patient, but for me as a surgeon,” she said.

“For really complex cases, there’s much less fatigue. You’re sitting at a console, so you can really focus on what you need to do to deliver safe, quality care. You’re not thinking about ‘Gosh, my feet are aching,’ or ‘My back hurts.’”

Despite these accolades (which are echoed by surgeons nationwide), the jury is still out on whether the da Vinci’s outcomes always are worth the machine’s high cost. As Fortune reported in 2017, “conclusions differ from study to study.”

But the trends are clear. And in our view, they point to robotic surgery’s costs declining and benefits increasing over time.

Meet the Mako

One more piece of evidence: the Mako robot, a joint-replacement tool now helping orthopedic surgeons at Altru in Grand Forks.

The Mako adds another innovation to robotic surgery. Using a CT scan of the patient’s joint, the Mako builds a virtual 3D model of the joint that surgeons can interact with beforehand.

They can plan the surgery, identify the implant size and alignment and personalize the procedure, all before the patient has entered the operating room.

Then when the surgery commences, the Mako helps keep things running according to plan, said Dr. Jeremy Gardner, an Altru orthopedist.

“If we deviate from the plan, it lets me know,” he said.

“I can override it if I need to, but most of the time, I don’t. It’s pretty accurate,” enabling placement accuracy down to the sub-millimeter.

Less pain, quicker recovery and better function are the results, Gardner said.

“There’s always a little uncertainty when patients hear about the robot,” he said.

“They ask, ‘Are you going to do the surgery?’ I assure them that I will, and that it won’t do anything that I don’t want it to do.

“But it’s still an incredible advance.”

Tom Dennis

Editor, Prairie Business