“There’s no doubt that this is a generational leap in treatment,” says Robert Chamberlain, M.D., a urologist with Pinehurst Surgical. “It allows the surgeon to perform a minimally invasive operation through tiny incisions that previously could be done only through a large, open incision. For most patients, the benefits include less blood loss, a shorter hospital stay and a quicker recovery.”

In March, Dr. Chamberlain and urologist Greg Griewe, M.D., also with Pinehurst Surgical, began using FirstHealth Moore Regional Hospital's new surgical robot, the da Vinci Surgical System. They say it has revolutionized treatment for men who have early (Stage I and II) prostate cancer for whom the best treatment option is removal of the prostate.

A disadvantage of traditional, largeincision prostate surgery is the risk of nerve damage, which can result in sexual dysfunction.

“Even in the best of hands, the rate of nerve sparing is only about 60 percent,” Dr. Chamberlain says. “With the new da Vinci procedure, it’s 80 to 90 percent. There is usually little or no nerve damage because of the way we are able to get at the prostate.”

Less nerve damage also means less risk of urinary incontinence.

“For me, the most exciting thing about this new procedure is that I can tell a patient I think we’ve got both of these problems beat,” Dr. Chamberlain says.

The da Vinci system’s robot has two arms with tiny surgical instruments on the end and one arm with a camera that relays three-D video images to the monitor at the surgeon’s console. The surgeon uses hand and foot controls to manipulate the surgical instruments. The system’s computer brain precisely translates every move he makes into the micro-movement of an instrument. In the process, it eliminates even the slightest tremor of the surgeon’s hand.

More remarkable than the da Vinci system’s robot-guided instruments, Dr. Chamberlain says, is the miniature camera that lets the surgeon see what he is doing.

“It has two lenses that work exactly like our eyes do,” he says. “Our brain interprets and combines the optical signals it gets from both eyes, and the da Vinci computer does the same thing. It gives us a fantastic three dimensional picture.”

While one surgeon operates the controls, another is at the patient’s side to assist by holding tissues out of the way and giving the surgical instruments easier access to the prostate. Urologists also typically work in pairs in performing open prostate procedures.

Except for men who are morbidly obese, robotic surgery is an option for most patients who need surgery for prostate cancer. It is still a serious operation. But because it is done through very small incisions instead of one large one, it causes less trauma and requires less recovery time.

“In most cases, patients no longer need to stay in the hospital three or four days,” Dr. Griewe says. “Men undergoing robot-assisted surgery should be able to return to work in two to three weeks versus six weeks for open surgery.”

From doubter to believer
When Michael Rowland, M.D., a general surgeon at Pinehurst Surgical, was diagnosed with prostate cancer last year, he knew that surgery was the best treatment option for him.

“The gold standard for localized, early prostate cancer is surgical removal,” he says.

Based on all that he had read and what other surgeons told him, he decided to have robot-assisted surgery. But that was before Moore Regional had a da Vinci system, so he went to another North Carolina hospital for his surgery. He was back at home the day after the operation and back at work 12 days later.

Now, patients in Moore and surrounding counties who need prostate surgery don’t have to travel a long distance to receive the latest, most advanced treatment.

“We have brought the best treatment option for the most common male malignancy to Pinehurst,” Dr. Rowland says, noting that prostate cancer affects one in six men and causes more than 40,000 deaths each year.

Dr. Chamberlain admits that he was a “doubter” when he first started hearing about robot-assisted prostate surgery. He thought it might be just “technology for technology’s sake.” But he quickly became convinced that the da Vinci system is “technology that truly makes a difference in a patient’s treatment.”

Dr. Chamberlain says Moore Regional is fortunate to be among the first 200 hospitals in the country to have a da Vinci surgical system.

“A lot of places are trying to get da Vinci robots and get their surgeons trained to use them, but they are hard to get at this point,” he says.

Both Dr. Chamberlain and Dr. Griewe received their da Vinci training earlier this year at the University of California at Irvine.

Beyond prostate surgery
Robot technology can be used in a variety of types of surgery in addition to prostate removal. Gynecologists are already being trained to use the da Vinci system at Moore Regional for certain types of gynecological procedures.

“That is the biggest growth area for robot-assisted surgery,” says Lisa Molgren, Moore Regional’s administrative director of Surgical Services. “Some of the anatomical areas that surgeons need to work in are very confined, and it’s a big advantage to have a robot with instruments and a camera that can get into those difficult places. The 360-degree ability of the robotic arms is just phenomenal.”

In the future, surgeons at Moore Regional may also use the da Vinci robot system for vascular surgery, heart valve surgery or various general surgery procedures.

Laparoscopic surgery, with its smaller incisions and faster recovery, has revolutionized the practice of surgery over the past couple of decades. Now, robot-assisted surgery represents another great leap forward.

“It’s the next generation after laparoscopy,” Molgren says. “It allows the surgeon to be unbelievably precise, and it has so many advantages for patients. They feel better and have less pain, and they can be back with their families or back to work much sooner.

“All of that can make this type of surgery less frightening. It reduces the anxiety of having a surgical procedure.”

By Brenda Bouser

It’s called BrainLab, image-guided technology that takes digital information from previously scanned CT or MRI images and then coordinates those images, by way of infrared scanning, directly with the patient’s anatomy during surgery.

With BrainLab, surgeons can view the exact placement of their instruments on a computer screen and then pinpoint the precise locations they are trying to reach—or avoid.

“The BrainLab system provides three-dimensional imaging that allows the surgeon to navigate the anatomy with a high degree of accuracy,” says Dr. Kilpatrick, an otolaryngologist (ear, nose and throat specialist) with Pinehurst Surgical.

Dr. Kilpatrick uses BrainLab technology during procedures involving the sinuses, an area of particular concern to the surgeon because of its proximity to the brain, the eye and major arteries. Use of image-guided surgery alleviates that concern, because the laser-light surface-maps the patient’s face and provides markings that correlate to the stored images of the CT or MRI scan.

“The sinus is like a honeycomb,” Dr. Kilpatrick says.
“When you take down one of the partitions, you don’t know if you’re going into another room. With BrainLab, I know within a millimeter where I am. If I go over 3 millimeters, I’m still safe. It’s that precise.”

The BrainLab procedure is often recommended for severe forms of chronic sinusitis; in cases when previous sinus surgery or—as in the case of Dr. Kilpatrick’s patient—an accident has altered anatomical landmarks; or where a patient’s sinus anatomy is very unusual, making typical surgery difficult.

Neurosurgeons also use BrainLab technology to navigate the tightly confined areas of the brain and spinal cord.

“BrainLab has become something that we use more and more and more,” Dr. Kilpatrick says. “It gives you the equipment to do something safer and to make sure that you’re doing it more thoroughly. It’s an extra tool to ensure that the procedure is as safe as possible.”

By Judy Morganthall

Don’t expect anyone at FirstHealth Moore Regional Hospital to count your pills and deliver them to
your nurse, because people don’t handle those jobs anymore.

Robots do.

One robot has been in the hospital pharmacy for 10 years, and another, a technological wonder called Tug, joined the crew late last year.

Tug, so named because it tugs carts through the hospital, uses radio signals to summon elevators and open electronic doors as it heads to patient floors to deliver prescriptions. People stop and stare as this self-propelled cabinet trundles through the halls, slowing down at intersections and stopping when someone steps in front of it. Tug uses laser and sonar technology to scan for any obstacles in its way. A detailed, computerized layout of the hospital allows the robot to chart its course.

According to Tom Smith, the hospital’s administrative director of Pharmacy and Oncology, Moore Regional could someday have as many as a dozen Tugs to transport laundry, medical supplies and used food trays, and to make other deliveries. The two Tugs now in use have a variety of attachments for different jobs.

Each robot stands 2 feet tall, weighs 30 pounds and call pull a cart weighing up to 500 pounds. They can pull a medication cart through the hospital in about 30 minutes. Each cart has locked medication
drawers that are programmed to be opened only by nurses with the proper codes.

Before the hospital starting using the Tugs, someone from the Pharmacy delivered medications to patient floors. But because the Pharmacy has a smaller staff on the evening and night shifts, nurses sometimes had to pick up medications for patients. Now the robots do it for them.		“These devices allow us to deliver 24/7,” Smith says. Like a GPS system in a car, a Tug can speak about two dozen short sentences. When it arrives at a nursing station, it announces its arrival. Nurses have been known to talk back, especially if they’re busy and don’t notice “who” is talking to them. Only a few dozen hospitals in the country have a Tug delivery robot. Moore Regional is the first in North Carolina.
Tug, the Pharmacy’s delivery robot.

Dispensing robot has seniority
Before Tug starts on its delivery route, another robot has made sure the correct medications have been prepared. On the job for a decade now, the automated dispensing robot known as “Spensor” was the first robotic technology at Moore Regional. It dispenses about 700 different mediations.

“That’s 95 percent of the oral medications and injectables we use here,” Smith says.

When a physician writes a prescription, the order goes to the Pharmacy, where a pharmacist reviews the information and enters it into the patient’s permanent computerized record. The computer checks for other medications that the patient is taking and alerts the system to allergies, interactions with other medications, dosages and other pertinent information. The computer then sends the robot to get the medication.

The robot, which runs back and forth on a track, has a pivoting head with a bar code scanner. Once it selects a medication from the dispensing system by reading its bar code, the robot calculates how many doses the patient will need until the next dispensing cycle.

From the time a medication arrives at the hospital until it is given to a patient, it is monitored by bar codes. The same company that makes the dispensing robot makes the bedside scanning system that makes sure each patient receives the proper dose of the prescribed medication.

“They all are integrated pieces,” Smith says. “They talk to one another. That’s one way we ensure accuracy and safety.”