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Surgeons often may have wished they had a third hand, high-definition magnified 3-D vision, and the dexterity to thread a needle with a gnat’s eyelash.

By using a robotically assisted surgery system, they get all of those abilities. Plus their patients are healing faster and with less pain.

Seated at the control console of the Da Vinci Surgical System, a surgeon remotely manipulates three robotic arms, using hand controls that translate small hand motions into precise micro-movements by the arms. A fourth arm holds the camera that provides high-definition images to the surgeon.

Central Iowa’s competing medical centers, which each use comparable versions of the system, are expanding their use of the sophisticated devices. By the end of this year, both Iowa Health – Des Moines and Mercy Medical Center – Des Moines expect to increase the number of surgeons they have trained on the system to 20. Iowa Health currently has 14 surgeons certified to use the Da Vinci; Mercy has 15.

Iowa Health, which purchased the first Da Vinci system in the state about nine years ago, in December replaced that original system with the latest version, the Da Vinci SI.

Increasingly, the systems are being used as a tool for many types of gynecological procedures, particularly for hysterectomies and for removing certain types of cancers. Other specialties that should see significantly more procedures using the robots are urology and colorectal surgery.

Using the specially designed surgical instruments that attach to the robotic arms, “you can pick up something the size of a flea,” said Dr. Jay Carlson, a gynecologic oncology specialist recently recruited from Michigan by Mercy. “It makes you feel very comfortable with what you’re doing.” Carlson, a retired Army physician, has performed surgeries with the Da Vinci for the past three years.

Carlson will join Dr. Deborah Turner, a gynecological oncologist at Mercy who last year drew patients from 50 counties in Iowa as well as surrounding states. Turner does not perform surgeries with the Da Vinci, but “I anticipate working with Dr. Turner to get her credentialed,” Carlson said.

Surgeons at Mercy completed 220 robotically assisted procedures last year, and that number should continue to increase, said Dan Varnum, Mercy’s vice president of professional services and performance improvement. Mercy purchased its Da Vinci system in June 2007.

“I definitely see it as a growth area for us,” Varnum said. “I wouldn’t be surprised in 2010 if we didn’t get another Da Vinci robot. I really believe the growth in these procedures is very impressive.”

Strong interest

Last year, Iowa Health surgeons performed 97 procedures with the organization’s Da Vinci robot. With the enhanced system at Iowa Methodist Medical Center and additional trained surgeons, that number should double this year, said David Stark, president and chief operating officer for Blank Children’s Hospital and Iowa Health senior vice president.

The upgraded system, which cost $1.45 million, will support an increase in established uses such as pediatric surgeries, as well as opening up new areas for its use, Stark said.

“We have a strong interest (in the Da Vinci) from our pediatric general surgeon,” Stark said. “There continues to be a very strong application for this for pediatric patients.

“The two areas where we see real opportunity to expand (use of the robot) are gynecologic oncology procedures; that is, female cancers that can be treated by our specialist at the Stoddard Cancer Center,” he said. “This will be a great tool for him. They are very difficult tumors. A second area is that we are working with our colorectal surgeons. There has nationally been a push to use this more for those types of procedures as well, so that’s a nice opportunity.”

Shelly Hartley, a team leader for robotics, bariatrics, gynecologic and general laparascopy at Iowa Methodist, said the more compact system is easier and quicker for nurses to handle and set up, which increases efficiency. Additionally, “it’s not so cumbersome around the patient, so you can assess the patient better because you can see them better,” she said.

With instruments that are two inches longer than the previous system’s, it’s also easier to accommodate larger patients, she said. Last week, Iowa Methodist performed its first bariatric surgery using the Da Vinci.

Accelerating

Dr. Erik Bedia, a gynecologic oncologist with Lakeview Obstetrics & Gynecology, said the Da Vinci system makes minimally invasive surgery available to surgeons who don’t have extensive experience with laparascopic procedures.

“We’re moving towards all minimally invasive procedures (as compared to open incision surgeries),” Bedia said. “This really, I think, accelerates that process. The growth has been exceptionally high in our field, and I expect it will continue to grow. There have been over 300 Da Vinci hysterectomies in Iowa alone in the past year.”

Da Vinci’s advantages are driving more demand for the technology, Stark said. “Some of our doctors have had patients specifically request that they have procedures done on the machine,” he said.

Though it’s still a tool in the hands of the surgeon, “it’s a use of technology that creates less pain for the patient, shorter stay, less scarring. and patients are knowledgeable about that,” Stark said. “So there’s a general acceptance in the community for robotic surgery. There’s an expectation, in fact, that we can provide the highest and best technology to get you better.”