If you’ve ever traded in an older vehicle for the latest model, you understand why Trinity Health’s surgical teams have a new bounce in their step.
Trinity Health recently upgraded its robotic surgery system, replacing its da Vinci Si with the more advanced da Vinci Xi – the latest edition of surgical robots designed by Intuitive Surgical, Inc., a global leader in minimally invasive and robotic-assisted surgery.
Trinity’s first procedure using the new system was performed June 24 by urologist Michael Van Bibber, MD. Since then, a growing number of surgeons have taken the robot for a proverbial “spin” to try out the system’s new bells and whistles. Obstetrician/ Gynecologist David Amsbury, DO, says after completing just a few cases on the new Xi, he is sold.
“The Xi is a newer generation of a robot which was already an amazing enhancement in minimally invasive surgery,” he said. “I noticed after just a handful of cases that the new robot was making procedures go faster and smoother because of the improvements in instrumentation. That’s the beauty of technology – you do something over time and realize how it can be improved and made more efficient. That’s what Intuitive has done.”
Timothy Bedell, MD, an Ob/Gyn who chairs Trinity’s robotic surgery committee, says the da Vinci Xi has intuitive features that make it ideal for choreographing procedures that involve moving from one side of the body to the other. “The table and the surgical robot are synchronized,” he explained. “After the table is repositioned, the system adjusts all of the surgical instruments to maintain the orientation to the patient’s anatomy.”
Such design improvements let general surgeons like Jerel Brandt, DO, perform more complex surgical cases using less-invasive techniques. “Because of the better range of arm movement, we’ll be able to do more complex abdominal wall hernia surgeries,” Dr. Brandt said. “Right now, we tend to perform these as open procedures, and patients have to deal with a large incision. Now we’ll be able to move toward using a more minimally invasive approach.”
Dr. Brandt cites two additional innovations that will greatly enhance surgical performance and patient outcomes. One is Firefly Fluorescence Imaging, a supportive feature of the da Vinci Xi, that involves injecting dye into a surgical site to enhance visualization during robotic surgery. “With Firefly, we can visualize the common bile duct during a cholecystectomy to protect it when we remove the gallbladder,” he said. “It also comes in handy during colon resections – after we’ve removed part of the colon, Firefly lets us visualize the blood vessels in the bowel to make sure we reconnect them properly as we rejoin portions of the intestine. That’s an important point because you need to have good blood supply to heal and prevent surgical site infection.”
Robotic colon resections typically involve a shorter hospital stay than open resections, according to Dr. Brandt. Research shows that people who undergo an open resection are generally hospitalized five to six days, versus two to four days for patients who have it done robotically. “It’s significantly less hospital time and less risk of adverse outcomes,” Dr. Brandt added.
The second advancement is smart surgical stapling technology. This gives the surgeon feedback prior to the stapler firing to make sure tissue is being secured under the best conditions. “When we staple a bowel or other tissue, the robot will measure the thickness of tissue. If the tissue is too thick it will let us know and won’t fire. It’s kind of like stapling 100 pieces of paper together; you want to make sure the staple goes all the way through.”
Trinity Health was the first care system in North Dakota to install the original da Vinci Si HD Surgical System in 2010. The recent upgrade fortifies Trinity’s standing as a leader in robotic-assisted surgery. (This past year, Trinity’s orthopedic surgeons also performed the region’s first total knee replacement using a separate robotic technology, the ROSA Knee System.)
The new Xi will have broader capabilities than prior generations of the da Vinci. It will be used across a wide spectrum of minimally invasive surgeries in the areas of gynecology, general surgery, urology, and cardiothoracic surgery. Dr. Bedell notes that having the da Vinci sometimes can mean the difference between an open surgery and one done using a minimally invasive approach. “In some cases, an exploratory laparotomy can be performed robotically; otherwise is would be an open surgery, which makes a big difference in terms of pain and recovery.”
Like other da Vinci systems, the Xi has three components: a tower that holds suction, cautery, and other instruments; a console where the surgeon sits and controls the joy sticks and foot pedals while viewing the procedure on a high-definition 3D screen with magnification many times that of the naked eye; and the robot itself with arms that hold a miniaturized camera and other surgical tools. Although the system uses advanced robotics, the arms can’t make any type of independent movement or maneuver without the direct input of the surgeon. What the system does do, however, is enhance and refine the surgeon’s movements, making it possible to perform meticulous dissections in tiny, hard to reach areas in the body.
From a patient’s standpoint, a minimally invasive procedure with the da Vinci means shorter anesthesia time, less blood loss, a shorter hospital stay, less post-surgical pain, quicker recovery, and faster return to normal activities. “When robotic surgery was introduced, there was discussion about whether it was worth the investment,” Dr. Amsbury recalls. “I got trained and started using it. Suddenly my hysterectomy patients who were staying overnight were now going home within two to four hours after surgery. We turned it into an outpatient surgery, saving other types of costs and freeing up beds and staff for higher acuity patients. It’s a win, win, win.”
Drs. Amsbury, Brandt, Van Bibber, and Timothy Bedell are among 12 surgeons at Trinity Health who perform robotic procedures using the da Vinci Xi. Others are Ob/Gyns David Billings, MD, Heather Bedell, MD, Jessie Fauntleroy, MD, and Jennifer Johnson, MD; general surgeons Robert Guttormson, MD, Dustin Evans, MD, and Nancy Longfors, MD; and cardiothoracic surgeon Michael Savitt, MD.