Sacred Heart Medical Center says its robotic heart-surgery program has become the busiest on the West Coast, and with the purchase of a second robotic system earlier this year, the Spokane hospital now believes its positioned itself to become a regional center for minimally invasive surgery in general.


Sacred Heart bought its first da Vinci Surgical System, which is manufactured by Sunnyvale, Calif.-based Intuitive Surgical Inc., in 2003, and since then doctors at the Spokane hospital have performed about 200 heart surgeries and 75 prostate surgeries while using the device. The hospital bought a second state-of-the art da Vinci robot in March, at a cost of more than $1 million, and also at that time upgraded the robot it bought three years ago, says Mike Wilson, Sacred Hearts president.


Now, in addition to the use of the robots for heart- and prostate-related surgeries, gynecologists here are learning how to use the devices for procedures such as hysterectomies, Wilson says.


Its part of our effort to remain at the leading edge and find new and better ways to improve the quality and the cost of medical care, Wilson says.


The machines enable a surgeon to operate on a patient using small remote-controlled robotic arms, with tiny human-like wrists and hand-like devices, that are guided into the patients body through small incisions, along with a tiny video camera. Intuitive Surgical introduced the system in 1999, and it was cleared for use in general laparoscopic surgery by the U.S. Food & Drug Administration the following year.


To operate the robot arms, a surgeon sits at a machine stationed across the room from the operating table, where the robotic arms are situated above the patient. At the machine, the doctors hands grasp controllers that control remotely the movement of the robots arms, wrists, and hands, which can be configured to hold devices such as scissors and other surgical implements. While moving the controls, the doctor peers through a binocular-like set of lenses, watching live, 3-D video images of the robot arms movements and actions, taken by the tiny camera inserted into the patients body.


Robotic-assisted surgery is a form of laparoscopic surgery, which is an older type of minimally-invasive surgery, a now common way to perform surgeries without having to make large incisions in the patient to expose the full view of structures and organs. Robotic surgery differs from general laparoscopy in that with laparoscopy, surgeons directly, rather than remotely, control the surgical instruments that are inserted into the body through the small incisions, and must manipulate those instruments watching two-dimensional video images. Doctors say that with robotic surgery, they have far greater flexibility in the control of those instruments, and far better images with which to see what theyre doing.


Dr. Leland Siwek, a cardiovascular and thoracic surgeon at Northwest Heart & Lung Surgical Associates PS here, has performed robotic heart operations for the past three years at Sacred Heart. He also has assisted doctors who have performed such surgeries at other hospitals, and runs training sessions at Sacred Heart for physicians from other parts of the U.S.


The reason for the second machine is our vision of where we ought to be going to make Sacred Heart a regional center for minimally-invasive surgery, Siwek says.


He and a colleague, Dr. Branden Reynolds, have performed the about 200 robotic heart procedures done so far at the hospital. He expects that about 75 will be done this year alone. The program, Siwek says, draws patients mainly from Eastern Washington and North Idaho, although some patients also travel from places such as Seattle and Olympia.


Mytral valve repair, which mends the valve that controls blood flow through the left side of the heart, is the most common robotic heart operation being done at Sacred Heart, he says. Other procedures, such as bypass operations and surgeries to repair atrial septal defects, or holes in the heart, also are done robotically here, he says.


The main advantages of a robotic heart operation compared with open-heart surgery are that patients spend less time in the hospital, have a faster recovery time, and have less scarring, he says. Patients who have had such a procedure are able to resume their normal daily activities within weeks. In contrast, open-heart surgery requires a surgeon to split a patients breastbone, which takes a couple of months to heal, he says.


Meanwhile, patients with prostate cancer also are benefiting from the use of robotic-assisted laparoscopic surgery at Sacred Heart, says Dr. David Mikkelsen, a urologist at Spokane Urology PS. Intuitive Surgical claims robot-assisted prostatectomy, or removal of the prostate, is the fastest-growing treatment for prostate cancer, which is the second leading cause of cancer-related death in men.


During such surgeries, doctors remove the entire prostate gland to eliminate from the body the cancer within it, Mikkelsen says. Because the prostate surrounds parts of the urethra, which is the canal that empties the bladder, the surgeon also must reconnect the urethra to the bladder after removing the prostate gland, he says.


Mikkelsen says its been predicted that by the end of 2007, 40 percent of such procedures will be done through minimally invasive techniques, the majority of which will be robotic. He and Dr. Tom Fairchild have performed a total of 75 robotic prostate surgeries at Sacred Heart since 2004, and he expects 50 will be performed next year.


The advantages of robotic prostate surgery over conventional prostate surgery are similar to those for heart surgery in that smaller incisions are made, which decreases blood loss and results in patients going home sooner and recovering faster, Mikkelsen says. The robot also gives the surgeon greater mobility and a more enhanced field of view than does general laparoscopic gear.


To date, there have been no proven benefits over conventional surgery, however, in terms of post-operative erectile function or continence, he says. Also, robotic surgery has the same rates of cancer control, he says.


Prostate surgeries and heart surgeries here are benefiting from an upgraded version of the da Vinci machine that has three arms, rather than two, as the first machine here had, Mikkelsen and Siwek say. The third arm acts as a retractor and allows the surgeon to manipulate the surgical field. The machine Sacred Heart bought this year has a third arm, and the hospital also this year added a third arm to its older machine, Wilson says.


Both Mikkelsen and Siwek say they have to stress to patients that although robotic operations have certain advantages compared with conventional procedures, they still can have complications. In addition, some patients, such as those who are obese, might not be good candidates for the procedures, they say.


Siwek says he expects that the next big thing in robotic heart surgeries will be multiple-vessel coronary bypass operations performed on a beating heart, although it probably will be a couple of years before that technology is developed and doctors start doing such procedures.


Urologists likely will use the robot for reconstructive procedures in the future, Mikkelsen says.


Since robotic surgery still is a relatively new technique, surgeons at Sacred Heart have been training on the da Vinci machines, which further increased the need for the hospital to buy a second machine, Wilson says. The hospital also anticipates that as the machines become certified by the FDA to perform additional procedures, the second machine will help handle rising patient volumes, he says.


We wanted to make sure we have technology available to meet demand, Wilson says. As more physicians are trained and able to use the machines, the more commonplace they will become.


Contact Emily Brandler at (509) 344-1265 or via e-mail at emilyb@spokanejournal.com.