April 13, 2007

Robot adds to Urologic Surgery’s capabilities

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Roger Dmochowski, M.D.

Robot adds to Urologic Surgery’s capabilities

Forging new ground in urologic surgical care in Middle Tennessee, Vanderbilt's Department of Urologic Surgery is the state's first, and currently only, program to offer minimally invasive robotic surgery to treat disorders of the female pelvic floor.

To date, VUMC's urologic surgeons have performed seven robotic sacral colpopexy procedures with the daVinci Robotic Surgical System to reconstruct commonly occurring female pelvic floor problems, such as pelvic organ prolapse with urinary incontinence.

“Although this is a small number of patients so far, they all have experienced remarkably less abdominal pain. Their return to activity is dramatically earlier than we typically encounter with an open abdominal incision,” said Roger Dmochowski, M.D., professor of Urologic Surgery.

“The idea to use the robot to perform minimally invasive pelvic floor reconstruction in women has been batted around quite a bit. Some institutions, such as the Mayo Hospital in Rochester and the Cleveland Clinic, have also performed this procedure.”

Pelvic organ prolapse can be explained as a loss of support of the vaginal walls, which can occur due to multiple factors such as childbirth, a prior history of hysterectomy and also from weight bearing or repetitive weight lifting.

“The condition of vaginal prolapse is in all essence a hernia of the contents of the vagina,” Dmochowski said. “It's a very common condition occurring in 10-20 percent of post-menopausal women.”

“Virtually all these women need several procedures done at the time of the robotic procedure. Not only do we re-suspend the vagina, but typically an incontinence operation is performed at the same time. So, it's nice to be able to adapt several different procedures to the same venue, addressing them all at one time to correct the patient's symptoms.”

Prior to VUMC's adaptation of the daVinci robot for this procedure there were two approaches to the repair of vaginal prolapse — either entering through an open abdominal incision or, for some patients, entering through the vagina.

“The abdominal approach is considered the gold-standard. Here to fore, the approach through an open abdominal incision carried with it increased morbidity and down time. So the use of the robot has brought a very nice marriage of technology to indication,” Dmochowski said.

To perform this procedure, five small-port incisions are made in the patient's abdomen. One is for the camera and the other four are working ports for the surgical instruments.

Dmochowski says VUMC's extensive history with the daVinci Surgical System for treating prostate cancer — more than 1,100 procedures to date — helped lay the groundwork for adapting robotic surgery for this new application.

Accompanying Dmochowski on these procedures are surgeons Harriette Scarpero, M.D., Jonathan Starkman, M.D., and Christopher Wolter, M.D.

Also included in the robotic surgical team are Kathy Deal, R.N., Julia Chapman, R.N., Donna Fort, R.N., Karen Robinson, R.N., Patrice Gilmore, R.N., Sarah Ankrom, L.P.N., John Nagy, L.P.N., along with surgical techs Richard Holt, Patty Landrum, Derrick McLean and Rhonda Finerty.

“We just recently began the transition of the daVinci technology from its indication for cancer surgery to pelvic floor reconstruction,” Dmochowski said. “All of our first seven patients have experienced exceedingly shorter hospital stays than women who undergo an open abdominal approach.

Dmochowski said the first patient to undergo this procedure is now six months out from surgery. Results show the outcome for the robotic surgical repairs is equal to those typically achieved via the standard open abdominal procedure.

“We're very excited because of the potential improvement of lower hospital utilization, the improvement in patient outcomes from the standpoint of equaling what we previously were able to obtain with open surgical procedures, less acute and chronic pain, and also getting people back to work earlier so they have increased productivity,” he said.