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Robot-guided surgery: new alternative in gynecologic procedures

by Cindy Abole
Public Relations
MUSC patients now have a choice when it comes to less invasive surgery, overall effectiveness and improved outcomes. Women diagnosed with a variety of gynecologic conditions such as excessive bleeding, uterine fibroids, and cervical and uterine cancer, are turning from traditional open procedures to robotic-assisted surgery with the daVinci Surgical System.
The Department of Obstetrics and Gynecology fostered a team approach in developing a robotic-assisted surgery program at MUSC. The effort is led by Matthew F. Kohler, M.D., associate professor of obstetrics and gynecology, and David E. Soper, M.D., professor and director of Gynecology and General Obstetrics. A practitioner for more than 14 years (10 years at MUSC), Kohler and others have been hard at work in bringing minimally invasive robotic surgery to MUSC and OB/GYN since 2006.
Andre Hebra, M.D., professor of surgery and pediatrics and chief of the Division of Pediatric Surgery, MUSC Children’s Hospital, was one of the first surgeons to successfully use the daVinci system on children. Hebra serves as a proctor for other surgeons learning the system and has since developed training protocols and guidelines for using the system with surgery colleagues and residents. Additionally, the daVinci system also can be used for delicate, complex cardiothoracic, urological and other types of general surgery.
A nursing core team led by Betty Lopez, R.N., Ashley Operating Room (OR) coordinator, was among the first staff at MUSC to train on daVinci. Lopez will train other nurses about the daVinci system. She also is responsible for scheduling patient cases, setting  up and maintenance of equipment and coordinating tools and resources as more surgeons train with the daVinci surgical system.
Kohler trained with John F. Boggess, M.D., associate professor of clinical research/GYN oncology, UNC Lineberger Comprehensive Cancer Center, who is considered a pioneer for improving gynecologic cancer surgery using robotic-assisted surgery and the daVinci system. Boggess uses the daVinci device for all uterine cancer staging, which has led to improved overall outcomes for patients via less blood loss, less pain and scarring, shorter recovery time and better clinical outcomes.
Similar to conventional laparoscopy, the daVinci system allows trained surgeons to guide tiny surgical instruments with precise micro-movements using advanced computer-aided technology and an operative robotic platform. The sensitive instruments are guided through small incisions to dissect tissue and perform delicate and complex procedures. The system is aided by a magnified, high-resolution, 3-D camera that focuses on the surgical site.
The surgical system originated with the U.S. Department of Defense as a project that introduced computerized robotic surgical techniques and remote surgery to wounded soldiers in the battlefield. Its application was adapted for clinical use in 1997.
“I’ve been in the surgical field long enough to see technologies change and procedures come and go and truly believe  that the daVinci system is a revolutionary improvement for treating uterine disease,” said Kohler. “This system can help us improve our level of care for our patients today and in the future. I’m committed to helping develop MUSC’s proficiency and professional training in the Lowcountry area and will work hard on developing a successful, model program.”
Since July, Kohler and Soper have utilized the daVinci system for specific gynecologic cancer surgeries such as the removal of ovarian masses, total hysterectomies and most recently; lymphoidectomies, or total removal of the lymph nodes. They hope to continue developing the program by helping physicians and nursing teams improve their proficiency and skill levels.
“It takes a special team of people to perform this minimally invasive surgical procedure,” said Lopez, who has worked as an OR nurse for 22 years (19 years at MUSC). “The nurses and team are involved in a lot of preparation for the surgery and patient prior to a procedure.
Looking ahead, the daVinci surgery system can be used in a variety of patient populations that can also benefit from this level of surgical technology including transplant, diabetes and other patients with medical mor-bidities.
“It’s these patients where the advantages of minimally invasive surgery using daVinci can be so profound,” said Kohler.

Friday, Sept. 26, 2008
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