Robotic surgery makes operations less of a pain

Hunched over a huge gray console that looks like a giant video game, Dr. Nikhil Shah presses his face against the viewfinder of a da Vinci robot, eyes glued to a 3-D image of the gooey insides of a man’s abdomen. His forefingers and thumbs twist twin joysticks that control tiny bird-beak snippers.

He uses the microtools that look huge to him through his magnified viewer to probe, push aside and cut thread-thin muscles, nerves and veins with precision in a prostate cancer patient lying on a gurney, 10 yards away.

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Rich Addicks / raddicks@ajc.com

Prostate operations have gone high-tech at St. Joseph’s Hospital where they use a multi-million-dollar robot to assist in the surgery. The robot, called da Vinci, is considered to be less invasive, resulting in less pain, less blood loss and a shorter recovery time.

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Rich Addicks / raddicks@ajc.com

Dr. Nikhil Shah sits at one end of the operating room with his head buried in a device where he directs robotic arms inserted into the patient on the operating table to perform the surgery.

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All the while he’s pumping foot pedals under the console in his stocking feet like a piano maestro, joking that the robot “is a bit like being at Dave & Busters,” the entertainment centers well-known to metro Atlantans for food, drink and fancy video games.

The 90-minute operation is successful.

Patients spend only one night in the hospital, instead of three or four the old-fashioned way.

It’s one of the reasons robotic surgery using the $1.5 million da Vinci machine is exploding, especially for prostate surgery. It’s also being done increasingly for other intricate operations — ranging from kidney removal to hysterectomies and cardiac bypass.

Shah said the robots usually allow surgeons to prevent the side effects men and their sexual partners dread most — impotence and incontinence.

His patients, like Dan Fernandez, call him “the rock star” of prostate surgery “because there are so many advantages of this technique.”

After his diagnosis, Fernandez, 50, of Smyrna, studied up on his disease, and late one night, Googled his way to St. Joe’s Web pages, then sent an e-mail to the hospital. To his surprise, he received a phone call from Shah within 15 minutes.

“He said, ‘I know it’s unusual to get a phone call from a doctor at night, but I saw your e-mail pop up, and I think I can help you,’” said Fernandez, an executive for Deloitte Consulting. “He said to bring my wife into the decision because if you become impotent, it’s a problem for your wife, too. It’s a couple’s disease.” He scheduled the surgery, was discharged the next day, suffered little pain and has only a half dozen tiny scars. And best of all, he said, “I never experienced incontinence, nor loss of sex drive or ability.”

Not all men are as lucky, but most operated on by surgeons using the da Vinci robot return to normal within a matter of months, Shah said.

The robotic procedure is only one choice in what Dr. Brantley Thrasher, official spokesman for the American Urological Association, calls a “bewildering” array of prostate treatments. The AUA (www.auanet.org) has no clear guidelines, and its literature makes decisions tough. Each method has strong advocates.

Prostate cancer, the second most prevalent form of the disease in men behind lung cancer, is treated with total gland removal, with or without the surgical robot. Other methods include external beam radiation, inserted radioactive seeds, hormone therapy and cryotherapy, or freezing of the organ.

Studies haven’t yet pinpointed “the best method,” said Thrasher, who uses the robot at the University of Kansas.

As of July 31, six St. Joe’s doctors had used its four da Vinci robots for 359 operations, including 148 cardiac procedures and 181 prostatectomies, most by Shah.

Last year, the total for all da Vinci surgeries reached 456 at St. Joe’s, compared to 748 at Northside, where 363 prostatectomies were done. At St. Joe’s, 196 were performed, but Shah said that number will double this year.

WellStar Health System’s robot is used mostly for hysterectomies and other gynecological procedures. DeKalb Medical is awaiting state approval to use a da Vinci, and Emory has one of the robots.

Worldwide, 55,000 da Vinci prostatectomies were done last year, and it’s expected to hit 75,000 in 2008, said James Alecxih, of Intuitive Surgical of Sunnyvalle, Calif., which makes the robots.

In 2007, 13,000 robotic hysterectomies were done worldwide, and that’s expected to hit 32,500 this year.

Shah, who has performed more than 1,000 robotic procedures, was recruited in 2006 from the Henry Ford Center in Detroit, where he trained. The center is near the top in robotic prostate surgeries.

He said St. Joe’s is catching up fast.

The robots offer many advantages, as Shah discussed during a recent operation.

Their tiny 3-D high-definition cameras magnify the insides of the abdomen, making tiny veins look like small cords. It makes it easier to spare critical nerves, resulting in “significantly better” erectile function than other procedures, he said.

Six dime-sized incisions are required, into which the blindingly bright camera and small tools are gingerly probed and manipulated.

While maintaining a steady banter of jokes and instructions to the other eight people in a St. Joseph’s Hospital operating room, Shah, 39, carefully snipped, clipped and guided the tools toward the man’s cancerous prostate. Four huge plastic-wrapped spidery arms hovered over the patient.

In traditional laparoscopic surgery, small holes are made in the abdomen for tools and a camera, which shows only two-dimensional image. In such non-robotoic operations, “you are depending on your tactile senses. It’s like operating with chopsticks.”

In the operating room, monitors are strategically placed so everyone can keep an eye on what’s going on, including Shah’s surgical assistant, Karl Csepi, 43.

Nearby, a monitor beeps as zigzag lines measure the patient’s vital signs.

“Wow, that’s pretty awesome,” Shah said after exposing the prostate.

Other surgeons, like Dr. Stephanie Yap of DeKalb Medical, are equally enthusiastic.

Yap is looking forward to using it at DeKalb Medical, as she has at Northside dozens of times for gynecological procedures.

Dr. Gerald Feuer, a gynecological oncologist who operates both at WellStar and Northside, said robot surgeries save patients’ money in terms of less lost work time.

“It’s absolutely incredible how quickly they get back to normal,” he said. “I think this is going to be in the future of every gynecologist.”

Shah sees doctors, too, because St. Joe’s is one of 21 da Vinci training centers in the United States.

Insurance covers most operations, which can cost more than $8,000.

During the recent procedure, Shah gently offered instructions to Csepi, whose eyes remained fixed on a nearby TV screen.

“It’s kind of like driving home after work, huh Karl,” Shah prompted. Csepi nodded with a smile.