Combining Robotic Approaches Boosts Benefits for Patients

More than 20 surgeons are establishing a robotics center at Bryan. Physicians, like Dr. Todd Martin and Dr. Michael Jobst (pictured below), are introducing new uses for the pair of da Vinci® Surgical Systems available at Bryan. The following article emphasizes how patients benefit when doctors combine their areas of expertise.

The da Vinci® Surgical System is a state-of-the-art surgical platform that combines computer and robotic technologies and makes it possible to treat a broad range of conditions — including complex surgical procedures — using a minimally invasive approach. A robot is not actually at the controls performing the surgery; rather, it replicates the surgeon’s movements in real time. Surgeons are able to operate through very small incisions of 1-2 centimeters and experience high-definition 3-D visualization inside the body, with precision and a greater degree of mobility. Because of this minimally invasive approach, many patients experience a shorter hospital stay, less pain, less risk of infection, less blood loss, faster recovery and a quicker return to daily activities.

And the two robots at Bryan are busy. Gynecologists, colorectal specialists, cardiothoracic surgeons, urologists and general surgeons performed more than 300 robotic-assisted surgeries in 2011, 424 robotic-assisted surgeries in 2012 and are on pace for increased numbers in 2013. Recently, two physicians — colorectal specialist Michael Jobst, MD, and obstetrician/gynecologist Todd Martin, MD — teamed up to become the first in Nebraska to combine their surgical disciplines in a single robotic approach, rather than separate procedures on different days.

The patient had dysmenorrhea (painful menstruation that interferes with daily activities) and a confirmed early stage distal sigmoid colon cancer (cancer in the last segment of the colon). “We had gone through several different medical and minor surgical options for my patient,” Dr. Martin says. “She was opting for definitive therapy, and we were going to use the robot to do a total laparoscopic hysterectomy.” During workup for the surgery, the patient brought up nonrelated symptoms she had been experiencing. Dr. Martin recommended that she have a colonoscopy evaluation prior to her surgery, and the evaluation revealed a cancerous polyp. Her next visit was with Dr. Jobst. “The opportunity to combine our cases arose, and I contacted Dr. Martin to discuss the feasibility of doing a combined approach. We collaborated, and it made sense,” Dr. Jobst says.

Patient benefits
The game plan with the physicians working together was for Dr. Martin to perform a robotic-assisted hysterectomy, removing the uterus and cervix, and leave the vagina open until Dr. Jobst had done his robotic-assisted colon extraction. They then removed the uterus, cervix and colon through the vagina. Approximately four hours later, their mission was accomplished. “The opportunity to combine our cases technically was pretty interesting, pretty awesome,” Dr. Martin says. “But for the patient, she had one procedure, one general anesthetic, one set of incisions, one hospital stay and of course just one recovery to go through instead of two. So, the combined approach was a huge benefit to her.” While the docs say this will not be a common occurrence, they believe there is potential for it down the road and are considering another combo robotic-assisted surgery with a vaginal pelvic organ prolapse (occurs when organs inside the pelvis fall, bulge or protrude into the vaginal wall) and rectal prolapse (occurs when part of the rectum — the last several inches of the large intestine — protrudes through the anus).

Possibilities ahead
“I think just to even have it in the back of our mind — that if we have several issues — to consider if there’s a way to combine the surgery and give the patient one operative procedure, one recovery and the benefit in the end,” Dr. Martin says. Both physicians say the flexibility and versatility of instrumentation of the da Vinci® opens the door to many more procedures that otherwise have required going through abdominal incisions. “For example, endometriosis is a disease of women in their twenties and thirties that can cause infertility, cause chronic pelvic pain, and be very challenging to address surgically,” Dr. Martin explains. “The flexibility and versatility of the instruments and how they move really give us an opportunity to intervene and cut out more endometriosis. “With the 3-D vision of the system’s camera, we’re able to potentially see more of the patient’s disease than what we would with traditional laparoscopy, which only shows us the affected area in 2-D.” Three-dimensional vision blends the separate images seen by each eye into one composite image, which gives physicians the ability to perceive depth and judge distances. “When you’re a laparoscopic surgeon at the bedside, you see things two dimensionally on a flat monitor and have to consciously be aware of what’s in the foreground, the background and what’s under or above. With the da Vinci®, it’s very intuitive — what my right hand does, what my left hand does in a 3-D  space all of a sudden makes sense,” Dr. Jobst says. “So operating with the da Vinci® platform is just like operating through an open incision and I’m just looking with my own eyes into a patient’s body. But instead of making a big long cut, I’m making a series of small cuts.” Dr. Martin concludes: “I think physicians view the da Vinci® Surgical System as the potential for the future and as a result, more and more hospitals are wanting to get on board and offer their surgeons and their patients the latest and the greatest and all the benefits that come with it.”

To learn more about the benefits of robotic-assisted surgery, ask your physician, or visit and select “Robotic Surgery” under “Services.”