A new robotic surgery system that Providence Sacred Heart Medical Center & Children's Hospital installed about six months ago is far more advanced than one it replaces and is drawing heavy use from the growing number of surgeons who are becoming qualified to operate it, a surgeon and medical director there says.

The da Vinci Si Surgical System, which includes an interconnected operator console, computer and audio-video equipment tower, and rolling bedside unit with multiple robotic arms, is the third robot now in use at Sacred Heart.

About 30 surgeons who practice at the medical center now are certified to use the robotic systems there, says Dr. Steve Brisbois, medical director for the Providence Center for Gynecology, Robotics, and Minimally Invasive Surgery.

That number is increasing, Brisbois says, such that some doctors are vying to reserve the newest robotic system for surgical procedures. To date, Sacred Heart says, about 2,800 procedures have been performed there using its robots.

The dollar amount that the medical center paid for its newest system wasn't immediately available, but it spent more than $1 million to acquire its second da Vinci system in March 2006. Last December, it retired its oldest robot, which it bought in 2002.

"It was ancient. It was like a Model T" compared with the newly purchased Si model, Brisbois says.

Brisbois, a surgeon specializing in obstetrics and gynecology who also serves as the hospital's medical director for women's services, says he's performed more than 400 procedures using robotic surgical systems since they were approved for gynecological use about 6 1/2 years ago. He's a huge fan of the technology.

"I couldn't practice without it, quite frankly. I couldn't provide the standard of care, the level of care" that's possible on complex procedures with the computer-controlled, wristed mechanical devices, he says.

Though they're referred to as robots, the systems can't be programmed and can't make decisions on their own. They require that every surgical maneuver be performed with direct input from the surgeon.

Nevertheless, they enable a surgeon to operate on a patient remotely using any of a variety of attachments that connect to the ends of the robotic arms. The devices, along with tiny cameras, are guided into the patient's body through small incisions.

To operate the arms, which are positioned above the patient, a surgeon sits at a console located some distance away from the operating table. At the console, which is about the size of an arcade-style video game console, the doctor—looking through a set of viewing lenses at a 3-D video image—uses hand and foot controllers to guide the movement of the robot's arms and to operate the surgical instruments attached to the arms.

With the hospital's original robotic system, Brisbois says, "The synchrony between the movements of your fingers and hands and the movement of the instruments at the bedside was not as refined as it is now. It had, for lack of a better term, more of a clunky feel to it. You didn't have the same degree of dexterity and accuracy that you do now."

With the new system, he says, "You're more at one with the robot. It's more graceful and elegant. That, in and of itself, allows you to be more precise and to be more safe."

Robotic-assisted surgery is a form of laparoscopic surgery, a now common type of minimally invasive surgery through which surgeons are able to perform procedures without having to make large incisions in the patient to expose the full view of structures and organs. In general laparoscopy, though, the surgeons directly control the surgical instruments that are inserted through the small incisions.

Although Brisbois believes there remains a place for laparoscopic surgery without robotic assistance, "and I still do plenty of those," the advanced level of robotic technology enables surgical instruments to be positioned in ways that a surgeon simply couldn't do manually, Brisbois says.

Sacred Heart's new robot offers a host of features that go beyond the improved dexterity and precision, Brisbois says, including enhanced 3-D and now high-definition vision of the operative field, with greater magnification and much better visual clarity.

"The vision is so much improved that it's amazing," he says.

The system also now offers an optional dual console so that a second surgeon can provide assistance or participate in a collaborative surgical procedure, such as one requiring both gynecological and colorectal expertise.

Brisbois and Dr. Shane McNevin were scheduled to participate this week in such a joint procedure on a female patient being treated for endometriosis who also required rectal surgery. Endometriosis is a gynecological medical condition in which cells from the lining of the uterus, referred to as endometrium, appear and flourish outside the uterine cavity. One of the symptoms of the condition is pelvic pain.

"Another advancement is it has a system where you can give certain agents intravenously to the patient that allows lymph nodes to become luminescent, so you can identify the nodes and vascular structures because they become illuminated," Brisbois says.

To be authorized to use the robots, surgeons must have credentials for doing laparoscopic surgery, and then do some online training and lab training with the robot on inanimate objects "to develop a feel and understanding of the system itself," he says.

"The next step is using the robot on live animals, then on live humans," the latter overseen initially by a proctor, or supervisor, he says.

Robotic surgery systems were approved initially for cardiovascular surgery, but now can be used for a range of procedures from prostatectomies and hysterectomies to ear, nose, and throat procedures and pediatric urology cases, Brisbois says.

Sacred Heart says acquisition of the robot "complements our goal of extending a minimally invasive approach for many complex surgical procedures."

The da Vinci surgical systems are manufactured by Sunnyvale, Calif.-based Intuitive Surgical Inc. It introduced its first such system in 1999, and the U.S. Food and Drug Administration approved the system for general laparoscopic use the following year.