In the operating room at Lodi Health, machines monitor the vital statistics of a patient laying on an operating table. Doctors make tiny incisions about four inches apart across the abdomen. Ports are put into the incisions, and then three robotic arms are attached. A camera is inserted into one port while an operating clamp and cutter are inserted into the other two.
The robotic arms are a part of the da Vinci Surgical System, which expands a surgeon’s capabilities while creating a less invasive surgery for the patient.
On a recent Thursday morning, Dr. Leslie Sackschewsky, assisted by Dr. Phillip Adam Dodd, performed a hysterectomy using the da Vinci on a patient at the hospital.
Michelle Vizinau, 42, of Stockton, had the surgery to get rid of some pain, discomfort and heavy bleeding she had been experiencing. She likes to think of herself as a progressive person, so she decided to try this method of surgery, she said.
“Abdominal surgery is long. If we can find new methods and find ways to shorten it, I’m all for that,” she said.
Recovery time for a typical abdominal hysterectomy is six to eight weeks with a hospital stay of three days. After the robotic surgery, patients can usually go home the same day, and total recovery time is reduced to two weeks for a regular desk job or four weeks for a moderately active job, Sackchewsky said.
Prior to going in for her surgery, Vizinau was optimistic about the chance of returning home right after surgery. Since her job in the real estate industry has kept her busy, she hoped for a quick return back to work.
“Minimal down time and minimal pain is what I’m looking for,” she said.
A precise form of surgery
Based out of Sunnyvale, Intuitive Surgical introduced the first da Vinci Surgical System in 1999. Since then, the company has expanded its number of systems to 2,462 globally, and to 1,789 in the U.S., said Angela Wonson, vice president of communications for Intuitive Surgical.
The robotic system’s magnification of up to 10 times enables surgeons to have better vision, she said. It also allows them more precision and control of the instrumentation.
“When you can take tissue out and be precise, the patient has a better chance at recovery, less blood loss and less infection rate,” she said.
Lodi Health purchased the da Vinci Surgical System, the first one in San Joaquin County, for $1.6 million, said Carol Farron, community development director. The hospital has completed 75 surgeries in gynecology, urology and general procedures since acquiring the system last October.
The hospital’s goal is to get people as healthy as possible and as quickly as possible, said Farron. Since these surgeries are the most common for people in Lodi, some of the surgeons decided this was the best way to provide patients with less invasive surgeries along with a quicker recovery time.
“It’s something we are committed to do all the time. It really made sense for us to look at this technology and invest in it,” she said.
An intensive training program must be completed before doctors can perform surgeries on the da Vinci system, Sackchewski said. Doctors must watch two live surgeries at a training center before putting in 20 to 40 hours on a simulator, and then spending a full day of training in the lab. The doctor must then perform two surgeries with a professional proctor and then another 18 with a da Vinci representative. A recommendation filled out by the representative indicates the doctor has passed.
After performing 30 surgeries, the doctor goes on to the advanced portion of training and then the master’s program.
“It’s very time-intensive until you get to the master’s,” Sackchewski said.
The brains of the robot
While standing next to the patient, Dodd keeps watch over the robotic arms as Sackchewski sits at the surgeon console a few feet away. This is the brain of the machine, said Sackchewski.
“I get to be the brains and tell the robot what to do from there,” she said.
A screen on the machine allows her to see the inside of the pelvis in a high definition, 3D image. It’s like actually being able to get inside it, she said.
As she watches through the lenses, Sackchewski moves the master controls below. Her hand, wrist and finger movements on the master controls allows the real-time movements of the surgical instruments.
As she works, she carefully cauterizes the blood vessels around the uterus. This stops the blood, essentially killing the blood vessel. This then allows her to cut the vessel.
A team of two others work intricately with Sackchewski while she cuts the vessels all around the uterus. Dodd moves the robotic arms into positions that allow Sackchewski to maneuver the instruments, while a technician makes sure the uterus is moved out of the way.
Sackchewski looks up out of the lenses to say something to Dodd and the instruments stay in their place.
The machine has a safety feature, Dodd explains. Once the surgeon’s head is out of the viewer, the machine freezes.
“If a problem occurs, this allows us to talk to each other and get ideas on how to complete the surgery,” he said.
As Sackchewski works, she uses the magnification feature to get a closer look.
“I think this adds so much power for whatever we can do,” she said.
An hour and a half later, the uterus had a bluish appearance. This indicates that it has become dead tissue and is ready to be taken out, Sackchewski says. As she holds one side of it with the clamp, Dodd holds the other with the third robotic arm so she can cut it down the middle.
The uterus is cut into four pieces before being taken out, Sackchewski says.
Freedom to live pain-free
A week after surgery, Vizinau said she was up moving around. Although still tired and sore, she remains confident of her return to work in another two weeks. She is looking forward to concentrating on her work rather than her pain.
“Now I have the freedom to do what I want when I want. It was a real chore to work. I can focus on that now,” she said.
Vizinau encourages anyone considering this surgery to find out their options and not wait as long as she did.
“If I had known it would have been this easy in the first place, I would have done it sooner,” she said.
Sackchewsky is hopeful the da Vinci will eventually eliminate the more invasive abdominal surgeries, because it would be more beneficial for the patient.
“I think 20 years from now, they’ll be saying, ‘You used to do what?’” she said.
Contact reporter Pam Bauserman at firstname.lastname@example.org.