Well Being — 11 July 2014
UM doctors use new robotic surgical system

By Jana Soeldner Danger

After a routine physical, Keith McKerrow was brought up short by a diagnosis of prostate cancer. “It was a shock,” he says. “When you hear a diagnosis like that, the only thing on your mind is getting rid of it.”

McKerrow, who lives part time in Tennessee and part time in Fort Lauderdale, traveled to Sylvester Comprehensive Cancer Center in Miami, where he became the first patient to benefit from the University of Miami Hospital’s new da Vinci Xi Surgical System, which offers the latest technology in robotic surgery. Dr. Dipen Parekh, MD, professor and chairman of urology and director of robotic surgery at UM Hospital, performed the procedure, a prostatectomy. It began with making four small incisions in the patient’s abdomen, and then inserting the da Vinci Xi’s miniaturized instruments and high-definition camera.

The University of Miami Health System was the first academic medical center in the world to use the new system designed by Sunnyvale, Calif.-based Intuitive Surgical, says Dr. Parekh, adding that the da Vinci Xi, which became available in April, is superior to its predecessor in several ways. “The arms of the robot hook to the patient in a way that’s much more adaptable and flexible,” he says. “It gives the surgeon more maneuverability, so we can do surgery in more than one quadrant of the body without having to unhook the arms from the patient and reattach them.”

The da Vinci Xi’s adaptability makes it an option for a variety of procedures in urology, gynecology, thoracic, cardiac and general surgery. It offers the surgeon highly magnified, 3-D viewing, as well as infrared imaging. And because the endoscope can be attached to any of the robotic arms, it provides more visual range than its predecessor. Smaller, thinner arms and longer instrument shafts give the surgeon greater range of motion, and the system’s new overhead arm architecture gives anatomical access from virtually any position.

Robotic vs. Traditional

Robotic surgery in general has many advantages over traditional surgery. Incisions are smaller, there is less loss of blood, and recovery times are usually shorter. McKerrow can attest to that. “There was no pain, and we left the next day for home,” he says. “I wasn’t in the hospital for even 24 hours.”

Dr. Parekh has also used the new system to perform a successful nephroureterectomy, a more complex procedure which involves removal of a kidney, the ureter and a portion of the bladder. With traditional surgery, the procedure would require an incision reaching from the patient’s back all the way around to the abdomen instead of the small punctures of one to two centimeters needed for the robotic version.

But the system is only as good as the surgeon using it, says Dr. Parekh, the principal investigator of a trial funded by the National Cancer Institute comparing open surgery with robotic surgery in bladder cancer. “The system will allow us to do more complex surgeries for all urological cancers,” he says. “It’s a significant advancement compared to what we had previously. But we need to do more surgeries to determine its full potential, and our team has the layers of experience needed. “Because although it’s a wonderful technological advancement, ultimately it’s the surgeon behind the machine who creates a successful outcome.”

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