January 9, 2004

OR redesign continues

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As part of the surgical advancements at VUMC, doctors use the Da Vinci robotic surgical system for a variety of surgical procedures. Photo by Dana Johnson

OR redesign continues

Surgery is a financial cornerstone for any hospital and the pace of work is brisk as ever across Vanderbilt’s five OR suites. New surgical robots, new surgical instrument tracking capabilities, a new suite of operating rooms in Vanderbilt Children’s Hospital, and reversion to a VUMC-managed and -staffed instrument sterilization operation top the list of changes currently taking shape in the Vanderbilt OR.

The OR’s new instrument control system will help avoid tray shortages and missing instruments, said Nancye R. Feistritzer, assistant hospital director for the perioperative patient care center. The system was implemented in June and is currently used in the main OR, MCE, 4 South, the basement instrument processing area and the off-site sterilization facility.

“In the past we were forced to rely on anecdote, but the new tracking system will give us a full, up-to-the-moment account of instrument supply and demand,” Feistritzer said.

With the new system, every instrument tray is bar coded and scanned at every step of the process from the OR to decontamination to off-site sterilization to storage back in the basement of the hospital. The system helps techs find trays as they assemble instrument carts for surgical procedures. During surgery, if an instrument or tray is missing from the case cart, a nurse can step to the computer and locate a replacement. A member of the sterile processing team works the system’s missing instrument report to resolve any shortage or any problems with assembly of trays.

Two years ago Vanderbilt turned over surgical instrument sterilization to a company called Steriltek, and some 30 Vanderbilt employees went to work for the company at its Metro Center facility. Feistritzer said VUMC is revising its relationship with this vendor. Effective Dec. 1, the operating room has reassumed employment and management of these staff, who’ve had their Vanderbilt seniority and corresponding benefits levels restored. Steriltek will continue to provide the facility, transport, processing equipment and supplies.

“This change will allow us to enhance training and supervision and close the loop of staff accountability and oversight,” Feistrizer said.

Vanderbilt is in the early stages of a robotic surgery program that will help expand the bounds of minimally invasive surgery. Compared to traditional open surgery, minimally invasive methods reduce blood loss and postoperative pain and allow quicker recovery. The technique uses small incisions, or ports, for the insertion of an optical device (endoscope) and surgical instruments.

In manual endoscopic surgery the surgeon views the operating field through a video monitor and uses mechanical extensions to manipulate the surgical instruments. It’s an awkward way to work, involving large arm movements and requiring the surgeon to transpose his movements as he manipulates instruments across a visual field where up is down and left is right.

The $1 million-plus Da Vinci robotic surgical system, built by Intuitive Surgical, has an arm for the endoscope and two arms for surgical instruments. The surgeon sits at a console looking through a hooded display at a magnified, three-dimensional view of the operating field. The surgeon’s middle fingers and thumbs are wrapped in Velcro strips that relay hand motions to the instruments.

With the robot, hand movements mimic those of open surgery, and surgeons untrained in manual endoscopic technique can master minimally invasive procedures more quickly. Surgeons can rotate instruments as they never could hope to using only their wrists. Dissection of nerves is more precise, suturing is easier.

The OR has one Da Vinci. “As more surgeons complete training we’re seeing a gradual increase in utilization from Urology and General Surgery,” Feistritzer said. The robot is now used three days a week by surgeons in these two programs. Cardiac and pediatric urologic surgeons have recently been trained, and training for thoracic and vascular surgeons will soon follow. Options are under review to support increased use of robotic surgery in the VUMC pediatric population.

When the new Children’s Hospital opens, the operating room will close its suite in The Vanderbilt Clinic and move minimally invasive procedures from there to Medical Center East. In connection with the move, additional OR rooms will open in MCE.

As an aid to manual endoscopic surgery, the OR has acquired a voice activated robotic camera holder. Feistritzer said more of these machines will be acquired as part of the minimally invasive surgery expansion project.