Providers increase use of robot-assisted surgeries

Providers increase use of robot-assisted surgeries

The use of robotics in medicine is transforming the way surgeries are performed and improving patient care and outcomes. At the same time, technology is increasing operational efficiency.

Locally, Novant Health New Hanover Regional Medical Center was recently named a Robotic Surgery Center of Excellence, and Wilmington Health became the first to perform a robotic-assisted sleeve gastrectomy and gastric bypass at Novant Health NHRMC.

Other regional examples include EmergeOrtho’s Brunswick Surgery Center, an outpatient orthopedic surgery center in Leland, which has robot-assisted systems for patients undergoing joint replacement surgery. And Dosher Memorial Hospital in Southport this summer began offering Stryker’s Mako robotic arm-assisted total hip replacement procedures.

The scope of robotic technology in clinical services is wide.

According to Brandon Hill, business director of surgical services at Novant Health NHRMC, gynecology was where robotics volume began and flourished for many years and remains the highest volume robotics service. General surgery is the fastest growing area in the da Vinci Surgical System used by the hospital. Da Vinci’s newest platform, the Xi, provides greater versatility allowing procedures such as colorectal procedures to be performed using the robot. In addition, general surgeons often perform gallbladder, hernia, appendectomy, and bariatric surgeries.

“Local providers began performing primary and revision knee and hip procedures at Novant Health New Hanover Orthopedic Hospital this spring,” Hill said. “At Novant Health New Hanover Regional Medical Center, we have four Xi robots. Common procedures in urology include prostate and kidney procedures. Gynecology volume is driven by hysterectomies, and the robot is especially helpful with minimally invasive pelvic floor reconstruction for patients with pelvic organ prolapse and gynecologic cancer.

“With each evolution of the robot,” added Hill, “the capabilities have increased, expanding the horizon of available procedures and patients that can be treated robotically.”

Jayme Stokes, a Wilmington Health board-certified general surgeon, is the bariatric surgeon who performed the first robotic-assisted sleeve gastrectomy and gastric bypass at Novant Health NHRMC.

“The robotic device has been around in some form for 20 years or more. Just in the last five years, general surgery has embraced the technology, and in the last two or three years, there has been a rapid uptake of bariatric surgery,” Stokes said.

Bariatric surgery, originally performed with a large incision and then laparoscopically in the early and late 1990s, has progressed to robotics.

“With each evolution, patients have benefited significantly from less pain, shorter surgical times, shorter hospital stays, quicker returns to work and activities, and fewer complications,” Stokes said.

He said technology is one of the drivers behind the use of robotics in surgery. While robotic surgery is still a laparoscopic case performed through four or five incisions, the robot, which is attached to a tower with robotic arms controlled by the surgeon, provides 3D visualization with greater magnification and clarity. A finer dissection allows surgeons to tackle more complex cases with greater confidence.

Timothy Chase, chair of the robotics steering committee at Novant Health NHRMC, is a urogynecologist at Novant Health Glen Meade OB/GYN who uses robotics to perform complex pelvic reconstruction surgeries. Chase sees many of the same benefits.

“Some of the main advantages of robotic surgery over traditional laparoscopic surgery are improved visualization and dexterity,” he said. “Improved visualization comes from high-definition 3D displays, and improved dexterity comes from robotic instrument design. I can move the instruments like a human wrist and hand, unlike laparoscopic instruments that simply open and close in one plane. This allows for more precise manipulation of the tissue, which reduces postoperative pain and improves the recovery process.”

Hill said many new surgeons are robot-trained, and when they look for jobs, they look for hospitals that can provide the latest technology, including robotic access.

Stokes said efforts are currently underway to expand the use of robotics to other surgeries, such as breast and thyroid.

“There is great interest in future robotic platforms that overlay CT scans and X-rays to guide more precise surgery,” he said, noting that robotics are moving into both planned and emergency surgeries.

Wilmington Health plans to add robotic surgery in the practice’s ambulatory surgery center in mid- to late 2023, spokeswoman Desirae Hrynko said.

“Robotics is the way of the future,” Stokes said. “It is growing and expanding. More and more surgeons are gaining experience and offering the technology to their patients.”


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