WILLMAR—When Dr. Thomas Lange removes a patient’s gall bladder or Dr. Jennifer Lee-Pentz performs a simple hysterectomy, their snips and sutures are careful, dexterous and precise.
Except they’re not standing directly over the patient. They’re a few feet away, using robotic technology to perform the surgery.
Rice Memorial Hospital introduced robotic-assisted surgery last summer for a handful of selected procedures. As local use of the technology slowly grows, hospital officials hope it will give patients more options for having surgery here instead of going elsewhere.
“It’s just another way we can offer services closer to home, using our own surgeons,” said Wendy Ulferts, chief nursing officer.
So far, four local surgeons and specialists have undergone the training and credentialing to perform robotic-assisted surgery at Rice. Procedures currently include gall bladder removal, hysterectomy, removal of uterine fibroids, stomach wraps to treat reflux disease, and some hernia repairs, with the potential to add more — such as colon or prostate surgery — to the list as the service expands.
“We see this as a next iteration of minimally invasive surgery,” Ulferts said. “This will be a tool that the surgeons can use.”
Laparoscopic surgery, now commonplace for many procedures, introduced into the operating room the advantages of fewer and smaller incisions, less pain and shorter recovery time.
Robotic technology represents the next level. Three-dimensional high-definition vision allows surgeons to see better, especially in areas of the body, such as the pelvis, that are crowded and sometimes difficult to clearly view. The software-driven instrumentation bends and rotates with motions similar to the human wrist.
“That’s the nice thing about the robot,” said Lange, a general surgeon and one of the first physicians on Rice’s medical staff to be trained in robotic-assisted surgery.
“It’s fairly intuitive. It’s a natural movement,” he said.
“It gives you a lot more dexterity,” agreed Lee-Pentz, an obstetrician-gynecologist who’s also among the first local specialists to start using robotic technology in the operating room.
She likes the 3-D visualization. “It gives you more perspective on what you’re doing,” she said. “You always want to do a good job on your patients.”
Fewer incisions are required as well—typically just one, compared to three or four for a laparoscopic procedure.
Studies suggest patient outcomes with robotic-assisted surgery are the same as or slightly better than laparoscopy and superior to most open surgeries.
But these aren’t the only advantages to consider, said Dr. Ken Flowe, chief medical officer at Rice Hospital.
“It clearly lets us do things that we would otherwise not be able to do here,” he said of the robotic technology. “The views are amazingly better. Instead of doing things by feel and intuition, you’re doing it by direct observation. It can be much safer.”
Patients benefit when they can receive care close to home, he said. “So much of recovery is the psychosocial things that you don’t get if you have to go to the Cities.”
Hospital leaders also believe the addition of robotic technology to the operating room will improve the ability to sustain the physician workforce.
Laparoscopic surgery is often an ergonomic challenge for surgeons, requiring them to angle their arms and contort their necks and backs in less-than-natural positions to manipulate the instruments. It’s tiring and can become physically more difficult over the course of a surgeon’s career, Flowe said.
With its more intuitive movements, robotic-assisted surgery is less physically demanding and can even be performed while the surgeon is seated at the monitor.
“You’re not coming out of a case exhausted,” Lange said.
Better ergonomics and less fatigue could mean the difference between early retirement and extending a doctor’s career in the operating room, Flowe said.
“The workforce issues are very real,” he said. “That is the biggest problem in medicine across the country. If we can have a technology that gives us another decade in someone’s career, that’s a win-win for everyone.”
Rice officials also hope it will help make Willmar more competitive in recruiting physicians who do surgical procedures.
Robotic-assisted technology is fast becoming the norm in physician training and it’s a plus for facilities to have it available when courting new physicians, Flowe said. In the not-too-distant future, robotic-assisted surgery will likely become the only way that some procedures, such as radical prostatectomy, are done, he said.
For now, Rice is easing into the technology. “We want to do this safely and we want to do this right. That’s why we’re going into it slowly,” Ulferts said.
Rice leaders know about the debate—the cost of acquiring the technology, questions about the return on investment in improving patient care—that has accompanied the spread of robotic-assisted surgery, Flowe said. Hospital officials and the medical staff spent at least a year studying and talking about it before deciding last year that they wanted to proceed.
“We said, ‘Here’s the hype. Here’s the reality.’ This is not a toy. This is not a fancy gizmo. This is better patient care,” Flowe said. “This is something that when the time is right, we need to do. It’s a very appropriate investment for our medical staff and our patients. The advantage to the patient and the advantage to the surgeon is worth it.