Escondido hospital now offering robotic surgery

By: ANDREA MOSS - Staff Writer
Surgeon says approach means smaller incisions, less down time for patients | Saturday, March 8, 2008 1:35 AM PST ∞

ESCONDIDO ---- Escondido resident Catherine Estes underwent a radical hysterectomy at Palomar Medical Center late last month, but she did so with no surgeon standing over her.
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Dr. Kris Ghosh was instead holed up at a console several feet away from his patient throughout the 45-minute procedure.

Relying on a high-definition screen that displayed a live, three-dimensional image from a tiny camera inside Estes' pelvis, the gynecological oncologist worked the console's hand and foot controls to maneuver several mechanical arms that moved over Estes like some kind of automated octopus.

Equipped with a small scalpel and other surgical instruments inserted through narrow tubes placed into Estes' pelvis via tiny incisions, the arms snipped and cauterized tendons, blood vessels and other connective tissue around her uterus, with each remote-controlled movement.

Other members of the hospital's robotic surgery team, including several nurses, stood beside Estes, monitoring her vital signs and using special tools inserted through the tubes to spray water and suction excess blood from the area being cut by the robot.

The procedure is just one example of the kind of robotic surgery now available at the Escondido hospital.

Although the concept might sound like something out of a science-fiction movie, it became reality after Palomar Pomerado Health, which owns and operates Palomar Medical Center, bought a $1.5 million robotic, da Vinci surgical system last October.

Ghosh and other Palomar physicians now perform about four robotic surgeries a week at the hospital, with the help of the machine, manufactured by Sunnyvale-based Intuitive Surgical Inc. Urology and radical prostate surgeries are other prime da Vinci candidates.

Ghosh, who became familiar with an earlier version of the surgical system six years ago while he was at Harvard University, said it offers numerous advantages to patients.

"It's minimally invasive ---- we're talking four to five incisions that are about a centimeter (long) each," the surgeon said. "It's less discomfort for the patient. There's less need for post-op pain medications, less bleeding, less nausea, quicker recovery and a quicker return to work."

Radical hysterectomy patients who undergo robotic surgery, for example, typically go home the next day and can usually return to work in one or two weeks, Ghosh said. That compares to a five-day hospital stay and six-week recovery period more common with traditional hysterectomies, he said.

The surgeon said physicians also love the da Vinci's camera images because they have much-higher resolution than those associated with another type of minimally invasive surgery known as laparoscopy.

The machine also offers surgeons greater flexibility and dexterity than they have when they hold the surgical instruments in their own hands because, unlike the human wrist, the da Vinci's arms can rotate 360 degrees, he said.

Patients who are unnerved by the thought of being operated on by a robot come around to the idea after they hear about the benefits, the surgeon said.

"Once they understand it's not like 'Star Wars' and R2-D2's operating on them, they're OK with it," said Ghosh, who emphasized that the machine is always under a surgeon's control and simply translates his or her motions into action. "We're as involved as in an open surgery or laparoscopy. It's just a way to do the surgery in a way that is less invasive, a way to do things as a surgeon that you normally couldn't do."

The 94-year-old Estes, whose hysterectomy became necessary after she was diagnosed with uterine cancer, said before her surgery that she had no qualms about going under the robot's knife.

"I always said it's better to smile than to frown," she said. "It's kind of exciting."

Palomar is not the first San Diego County hospital to incorporate robotic surgery into its treatment options. Sharp Memorial Hospital and Hillcrest Hospital in San Diego each have at least one da Vinci surgical system, as does the University of California San Diego's Thornton Hospital in La Jolla.

Palomar Pomerado Health is the first publicly owned hospital district in California to buy one, though.

"Usually, you would see it just at places like Scripps or private institutions," hospital spokesman Andy Hoang said, adding that philanthropic donations covered most of the $1.5 million cost.

Lead nurse Keri Holtz is a member of a core group of nurses and surgical technicians trained to use Palomar's da Vinci system. Initial glitches the team ran into included differences in the way operating rooms are set up for robotic versus traditional surgery, she said.

"Now we have a designated room for the robot cases," Holtz said. "And once we're all trained, I think we'll train others."

The public can learn more about the da Vinci surgical system and "meet" Palomar Medical Center's robot during a seminar to be held at 6 p.m. March 19 in the hospital's Graybill Auditorium. Hospital officials will also unveil the name they chose for the machine via a contest the health care district recently held.

Reservations are required for the seminar: call (800) 628-2880.

Contact staff writer Andrea Moss at (760) 739-6654 or amoss@nctimes.com.

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