from: http://www.arizonarepublic.com/northeastvalley/articles/1129sr-robot25Z7.html

Mayo adds robot surgeon
Machines are less risky, more flexible

Carlos Chavez/The Arizona Republic

Dr. Richard T. Schlinkert (right) performs endoscopic surgery using an advanced robotic surgical system called Zeus at Mayo Clinic Hospital in Scottsdale.

By Kate Nolan
The Arizona Republic
Nov. 29, 2002

There's a new robot in town. Its name is Zeus and it performs gallbladder surgery at Mayo Clinic Hospital on North 56th Street.

The number of surgical robots in the Northeast Valley now stands at two. Another, the da Vinci, does urological surgery and is about to do heart bypass surgery at Scottsdale Healthcare Shea. Each robot cost about $1 million.

In recent weeks, both robots performed surgical firsts for Arizona. DaVinci became the first robot in Arizona to help remove a prostate gland. And Zeus claimed the same honor for extracting a gallbladder.

Why are top hospitals and doctors devoting significant resources to robot-assisted surgery? First, there is little risk involved - the American-made robots have been in use in Europe for a few years already, while at home they're still wading through the FDA approval process on some procedures.

Surgeons were skeptical at first, but advantages quickly became clear. The superiority of robots is their quantum leap in flexibility over previous instruments or the human hand. That allows for more precision and less bruising. Robotic assistance overcomes the physical limitations of the surgeon's hands.

To use a robot, a surgeon sits in a chair equipped with hand and foot controls and a video monitor. By manipulating toggles and pedals, the doctor directs robotic arms to do surgery with tiny attachments, much smaller than hand-held instruments. Incisions are tiny, resulting in faster healing for patients.

Surgeons fare better, too. Seated at a console, they suffer less fatigue, and hand tremors don't translate from the controls to the surgical site.

Mayo's Zeus

On Oct. 16, Zeus and a surgical team at the Center for Minimally Invasive Surgery at Mayo performed the state's first robot-assisted removal of a gallbladder. Since then, the Zeus system has been used to extract seven more gallbladders, all of them successfully.

The team leader, surgeon Richard T. Schlinkert, marvels at the machine.

"You don't understand the possibilities until you sit down with the instrument," he said. "It gives us more flexibility and much less trauma to the abdominal wall," he said. Patients seem to have less pain and require fewer pain medications later.

Small tools are standard for all laparoscopic surgery, the type of operations the robots do, in which miniature viewing scopes are inserted into the surgical site. In non-robotic procedures, the laparoscope sends a continuous video of the surgery to a screen that allows surgeons to make microscopic changes with hand-held tools.

In robot-assisted surgery, Zeus or Da Vinci becomes the surgeons' new hands.

Schlinkert calls gallbladder surgery a starting point for the new technology.

"We can use it more extensively in cancer surgery on different organs," Schlinkert said. He listed prostate, gynecological, stomach and pancreatic cancers as potential Zeus targets. Its manufacturers are testing it on heart surgeries.

Shea's Da Vinci

At Scottsdale Healthcare Shea this month, the da Vinci started performing prostate removals. Urologists Bernard Gburek and Erik Alexander have now done the procedure on three patients. They report improvements in healing time over traditional laparoscopic surgery.

Gburek said the precise control of robotic tools spares nerves and reduces risks of prostate surgery that can include incontinence or erectile disfunction.

Gburek and Alexander currently are offering the new treatment only to patients who are fit and not overweight, but they see a day when robotic surgery will be used for all patients needing prostate surgery.

For now, both hospitals plan to increase the number of surgeries performed by their robots and expand their uses. Da Vinci will soon be used by thoracic surgeons and in December will begin performing preliminary procedures for heart bypass surgery, under the direction of cardiovascular surgeon Joseph Auteri in a national FDA trial.

The next challenge for Zeus will be anti-reflux surgery of the throat, which, unlike the gallbladder procedure, involves sutures.

"Both robots have tremendous potential," Schlinkert said. "It's now up to the surgeons to apply the technology and develop their potential."

Reach the reporter at kate.nolan@arizonarepublic.com or (602) 444-6863.


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