Over the past six years, 24 highly trained WellSpan surgeons from seven specialties have used WellSpan York Hospital’s three da Vinci Surgical Systems to perform more than 2,800 procedures and train the next generation of surgeons.
“Robotic technology is the wave of the future,” says Daniel S. Henriksen, MD, FACS, general surgeon at WellSpan Health. “As it evolves, the da Vinci will continue to transform surgical procedures. Thanks to this innovation, we’ll see further expansion of minimally invasive techniques into surgical disciplines in the coming decades.”
Used at WellSpan York Hospital for cardiac, benign gynecologic, general surgical, gynecologic oncology, thoracic, urologic and urogynecologic conditions, the da Vinci Surgical System enables surgeons to operate through small incisions, which minimizes scarring, infection risk, blood loss and the need for transfusions. Patients experience less postoperative pain and typically return home and resume normal activities more rapidly than following open surgery.
Preparing the Next Generation
Although the da Vinci platform improves numerous aspects of minimally invasive surgery, it requires extensive training. As part of the Robotic Training Network — a collaboration among facilities with robotic-assisted surgery training programs to standardize curricula — WellSpan York Hospital’s robotic surgery program has incorporated robotic surgery training into WellSpan’s Surgical Residency Program.
That enhances WellSpan’s medical education offerings and makes the organization attractive to forward-thinking residents and physicians seeking to add robotic-assisted surgery to their capabilities.
“Robotic platforms are becoming an increasingly important component of surgery,” says Vanita Ahuja, MD, MPH, FACS, Associate Residency Program Director and general surgeon at WellSpan Health. “New surgeons will have to learn robotic-assisted modalities to complement their laparoscopic and open surgical skills. We begin training on the robotic platform in the fourth and fifth years of the gynecologic and general surgery programs so our residents are better prepared for the future surgical landscape.”
“WellSpan Health has demonstrated its commitment to the community by investing in the most advanced technology for the safest and most effective outcomes. We’re also ensuring that the next generation of surgeons is trained in these technologies to best care for the next generation of patients.”
— Vanita Ahuja, MD, MPH, FACS, Associate Residency Program Director and general surgeon at WellSpan Health
Trainees gain more privileges as they progress through the robotic surgery program, which begins with an introduction to the system through a series of online modules. Once familiar with the technology, residents perform timed dry labs to introduce them to the console and its instrumentation. Residents further their proficiency with the modality by working on pig parts, which are most similar to human internal structures. They then graduate to WellSpan’s dual console robot, assisting surgeons who are credentialed for robotic-assisted surgery. OB/GYN residents might have the opportunity to perform a solo robotic-assisted hysterectomy under the supervision of a certified surgeon once their training is complete.
The Robot’s Advantage
Surgeons in the WellSpan York Hospital robotic surgery program use the da Vinci platform’s technological advances to enhance their surgical abilities and provide the community with additional options for certain procedures where appropriate.
The system features a 3-D, high-definition vision system, which provides optimal views of the surgical site. The console’s magnification features improve visualization, which helps surgeons maneuver around proximal critical structures, and its wristed instrumentation enhances dexterity. These features allow greater ease in performing complex procedures that can be difficult or impossible to address with straight-stick or traditional laparoscopic approaches.
The da Vinci’s enhanced visualization and instrumental dexterity are advantageous for performing sacral colpopexy to repair vaginal vault prolapse, notes Carlos A. Roberts, MD, FACOG, Vice Chair of the Department of OB/GYN and Director of Minimally Invasive and Robotic Surgery at WellSpan York Hospital. The challenging procedure requires dissection to the presacral space, near the bifurcation of the aorta and inferior vena cava.
“We dissect into spaces between the bladder and vagina, as well as the vagina and rectum, from inside the abdomen,” Dr. Roberts says. “We place mesh over those areas and attach it to a ligament at the sacral promontory, so there’s a lot of suturing involved. When you suture in that space between the vagina and the rectum, it’s a very acute angle. The da Vinci’s wristed instrumentation significantly eases this aspect of the procedure.”
Urogynecologic surgeons use the robotic platform to treat multiple conditions, including endometriosis, enlarged fibroid uterus, pelvic organ prolapse and significant adhesive disease.
Using the da Vinci platform, cardiothoracic surgeons can avoid sternotomies when performing coronary artery bypass or mitral valve repair.
“Robotic-assisted surgery is revolutionizing cardiothoracic surgery,” says Larry Shears, MD, Chief of Cardiothoracic Surgery at WellSpan. “I can envision a time when we never have to perform a sternotomy and instead perform the procedure through small incisions. The old-fashioned practice of cutting patients’ chests open is something that will soon be going away.”
Dr. Shears performs coronary bypass procedures through a 1-inch incision in the left side of the chest, suturing the left mammary bypass to the left anterior descending coronary artery. Patients are not put on bypass machines, so their hearts keep beating as Dr. Shears sews the bypass. The procedure is commonly performed as part of a hybrid procedure in which patients also receive a stent from the right main coronary artery to the circumflex.
“The visualization is so much better with the robot — it’s 10 times the magnification of what I’d see in an open surgery,” Dr. Shears says. “I manipulate the instrumentation while sitting in a comfortable console. I can relax and see the sutures precisely as they are.”
Traditional open surgical approaches result in a five- to six-day hospitalization and activity limitations for as many as four weeks. Because the robotic platform allows surgeons to perform the procedure without sternotomy or broken bones, patients leave the hospital the day after and resume normal activities within one week.
The da Vinci platform’s features significantly improve surgical abilities in tight spaces, such as the deep pelvis. General surgeons take advantage of the modality’s features to treat colorectal tumors, complicated hernias and diverticulitis. The platform also allows them to perform challenging gastric resections and collaborate with urogynecologic surgeons — via the dual console robotic system — to treat pelvic floor dysfunction.
Surgeons typically repair rectal prolapse through an open abdominal approach, but frail patients may not tolerate this technique. The da Vinci platform provides these patients a minimally invasive option for the abdominal approach that significantly improves upon alternatives such as operating through the perineum.
“The robotic platform provides real benefits when operating in tight spaces in the pelvis or left upper quadrant of the abdomen,” Dr. Henriksen says. “This allows us to offer minimally invasive surgical options we would not otherwise be able to provide.”
For information about the WellSpan York Hospital Robotic Surgery Program, visit WellSpan.org.