'Super D,' da Vinci technology increase options for patients

When Central Texas Medical Center in San Marcos made a $2 million investment and purchased a da Vinci robotic suite earlier this year, it meant the hospital's surgeons could begin performing state-of-the-art procedures.

The system has several features designed to improve efficiency in the operating room and provides other patient benefits such as smaller incisions that cause less stress on the body, reduced chances of infection and faster recovery times after surgery.

"These technological advancements provide our surgeons with unparalleled precision, dexterity and control that enable a minimally invasive approach for many complex surgical procedures," CTMC President and CEO Sam Huenergardt said.

The da Vinci operating room suite is being used throughout the nation for a multitude of procedures that include prostatectomy, hysterectomy, coronary artery bypass, mitral valve repair, and gallbladder and colorectal surgeries.

Dr. Patrick Garcia, vice president of medical affairs of the Seton south market, which includes Seton Medical Center Hays in Kyle, said these types of procedures evolved from laparoscopic surgery, a type of minimally invasive surgery that has been around for decades and is common among knee patients.

Pediatric procedures

Within the Seton Healthcare Family system, the da Vinci Si is being used at Dell Children's Medical Center of Central Texas in Austin to perform pediatric urological procedures for children. Though Seton Hays does not have a da Vinci system on-site, patients may be referred to Dell Children's for procedures.

Dr. Danielle Sweeney, pediatric urologist at Children's Urology of Central Texas in Austin and Dell Children's, was the first pediatric surgeon in Central Texas to be certified on the hospital's robotic system.

She has been performing robotic pediatric urologic procedures since 2009. Surgical procedures are completely controlled by a trained surgeon, and although the term "robotic surgery" can be applied to the technique, it should not be confused as being automated.

"It's still our hands doing the procedure, yet the da Vinci offers precision, dexterity and control—key factors for helping to achieve the best possible outcomes for patients," Sweeney said.

The system translates a surgeon's hand motions into exact movements, she said. The 3-D visualization and increased range of motion allow for delicate surgical procedures to be performed via dime-sized incisions.

Sweeney said parents of her patients have not hesitated when she has suggested a procedure using da Vinci; many parents ask for the system to be used before Sweeney proposes it.

The da Vinci is accompanied by a teaching simulator, and she said surgeons undergo extensive training before using the system on a patient.

Pediatric general surgeons are next in line to begin training on the simulator, expanding robotic surgical options at Dell Children's to include anti-reflux operations and repairs of complex congenital abnormalities.

Hays County's robotics

At Seton Hays, Dr. Kalpesh Patel is literally mapping the way for cyber technology through the use of the "Super D" system, which uses GPS-like technology with remote-controlled, microsurgical tools used to enter a patient's body through small incisions.

The "Super D" system, formally called Inreach System by SuperDimension, employs what is called electromagnetic navigation bronchoscopy technology.

Through software and electromagnetic technology, physicians use a small, steerable catheter inserted through a bronchoscope—a fiber optic cable that is run through a patient's windpipe—and guided to a specific spot in the body.

The "Super D" system was installed last year at Seton Medical Center Hays.

Patel, an interventional pulmonologist and program director at Seton Medical Center Hays, described the procedure as mapping the path to one seed in a watermelon.

The lung is a very complex organ, Patel explained, and when results from CT scan show a nodule in the lung, it can be difficult for a patient because the only way to find out if it is cancerous is to perform a biopsy.

Before the "Super D" system, a doctor would monitor the nodule for growth through several follow-up CT scans.

"Medical technology has advanced to where major surgery often can be avoided, along with months of recovery time—and this procedure now can be done locally," Patel said.

With the GPS-like technology, Patel can enter the lung with the "Super D" and draw a map to the exact location of a nodule. The nodule can then be removed and examined on the spot for a quicker diagnosis.

Benefits

In the past decade, minimally invasive techniques such as endoscopy and robotic surgery have helped evolve the field.

Dr. Robert Schlechter, surgeon-in-chief at Dell Children's Hospital, said the techniques can also help minimize disruption to patients' lives.

"Potential benefits for patients and physicians include less pain, shorter hospital stays, and better cosmetic results versus traditional surgery," he said.

Although the benefits can come in the form of cost savings, Garcia said there is much more to take into consideration.

The procedures do not require an overnight hospital stay, and patients require less recovery time and less time away from work, factors that all affect cost.

Minimally invasive procedures can also reduce hospital costs and "community" costs—caregivers return to work quicker and children have decreased school absenteeism.

Schlechter said the da Vinci has an additional benefit.

"The device also serves as a recruitment tool for attracting leading pediatric specialists to Central Texas," he said.