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Robotic surgery helps coach return to fields

Adaptation of technology pushes envelope on the complexity of cases
handled by da Vinci Surgical System

By Dawn Brazell
Public Relations

Jim Hoshour teaches business classes as Sumter High School, captures film footage as the video coordinator for the football team, coaches the prestigious American Legion Baseball P-15 team and loves to spend time with his 11 grandchildren.

Jim Hoshour, right, with son, Chad Hoshour and grandson, Jackson. With 11 grandchildren, Hoshour said he wanted to be proactive in seeking the best treatment for his bladder cancer that would keep him active.

When he found out he had muscle-invasive bladder cancer, he didn't just want to know if he could fight it, he wanted to know how to fight it and still have an active and good quality of life.

Harry Clarke, M.D., Ph.D., associate dean for graduate medical education and urologist, knew he had the perfect candidate for what would be MUSC's first robotic cystoprostatectomy, or the removal of the bladder and prostate that included taking a part of Hoshour's bowel to reconstruct a new bladder called a neobladder. If all went well, the neobladder would mean Hoshour would not have to wear a bag or use a catheter.

"He has done really well and has been able to void on his own. It's the best of all worlds as far as his outcome. I counsel patients who 8 out of 10 will be able to void on their own, but 2 out of 10 will have to use a catheter."

Hoshour thought those were good averages, and said he didn't mind being MUSC's first patient to have this procedure done using the robotic da Vinci Surgical System. A photographer and videographer, he's comfortable with high-tech equipment and had confidence in Clarke's decision, he said.

The da Vinci Surgical System, developed by the U.S. Department of Defense, was introduced to MUSC in May 2008 by Andre Hebra, M.D., director of the Division of Pediatric Surgery. Since then, the use of the system has spread to a variety of specialties, including urology. The challenge now is competing with other specialties to find time on the machine, Clarke said.

He likes the versatility of the machine, especially with the new devices that have been developed to expand its uses. "I think in the next 10 years or so, we'll be doing more and more things robotically. We've already seen that evolution with laparoscopy. We're doing more things laparoscopically then we ever thought we'd be able to do. Certainly, we'll do more things robotically."

The robotic system features four interactive robotic arms equipped with instruments designed with seven degrees of motion, which allows various surgical functions such as clamping, suturing and tissue manipulation. A camera and light is mounted on one arm providing high-definition, 3D videos that are displayed throughout the operating room. Surgeons sit at a console where they can manipulate all four robotic arms via hand and foot controls.

"We've started in the past couple of years doing more and more cases with the da Vinci robot. As we're getting more and more comfortable, we're able to push the envelope a little bit," he said, explaining how it allows them to take on more complicated cases. "This is the first one in South Carolina where we've done a neobladder."

Robotic surgery has received some negative criticism lately by health professionals concerned that it's being over-marketed. Some research suggests the robotic procedure reduces hospital stays and blood loss, compared with regular surgery, but studies have also shown that robotic surgery offered no added benefit or worse results. 

Dr. Harry Clarke uses the da Vinci surgical console, which has hand and foot pedals to operate four mechanical arms. Right, one of the video monitors during a recent procedure with a video link at Hoshour's procedure was the first continent orthotopic neobladder done robotically at MUSC.

As with any medical procedure, each case needs to be decided on its own merits, said Clarke. Robotic surgery may not be the best choice of approach for some patients given their medical history and condition. Clarke's advice to patients is to not assume the newest and latest equipment and/or procedure is the best for them, but to ask questions.

For certain procedures, Clarke said he has found there is less fluid loss when done robotically, and he has found recovery time tends to be quicker. The magnification the da Vinci and the manipulative arms allow surgeons to get around difficult areas easier, he said.

"In certain situations the anatomy is such that the robot is very helpful. The magnification, dissecting the nerves – all those things are better done. Certainly when there's a deep pelvis and to tie off the vessels, it makes it easier to do."

Dr. Harry Clarke

Clarke, who's pleased to see how well Hoshour, 65, is doing, said he was an ideal candidate because he was active and healthy. Clarke took a 45 cm segment of small intestine, the ileum, and constructed a pouch that retains its blood supply from the bowel, and when brought down and attached to the urethra, acts as a bladder.

Hoshour, who found his cancer in January 2010 after going for a run and coming home to discover a massive amount of blood in his urine, said he wanted to try for the option that would require the least change in lifestyle. After getting his diagnosis, he received immunotherapy and then had surgery in April this year when he received the neobladder.
Glad he didn't wait to seek treatment, Hoshour, 65, said he's back to his loves of sports, coaching and photography.

Hoshour coaching the P15 American Legion team this month.

"There's no use in sitting around. Life's too short," Hoshour said. "I have 11 grandkids to keep up with."





Friday, Aug. 19, 2011

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