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Snohomish County Business Journal/Dave Clark 
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The da Vinci Surgical System has been used to perform over a dozen surgeries at Providence Regional Medical Center in Everett since early January.

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Lawrence M. Schecter, M.D. Providence Regional Medical Center
John Wolcott, Editor
Dave Clark, Assistant Editor
Published: Friday, January 30, 2009

Robot-assisted surgery now in Everett

Patients at Providence Regional Medical Center in Everett are benefiting from the hospital’s recent investment in the world’s most sophisticated surgical instrument. A $1.5 million da Vinci Surgical System was put into use in January, allowing specially-trained surgeons to perform minimally-invasive procedures such as radical prostatectomies and hysterectomies. Chief Medical Officer Lawrence M. Schecter, M.D. said the system and the people using it are working out well. Over a dozen operations have been performed so far, said Schecter, all without complications.

“The lengths of stay have been shortened and the learning curve has gone quicker than we would expect,” said Schecter.

Officials representing Providence and California-based Intuitive Surgical, the system’s developer, held a press event last month to demonstrate the robot’s use in a medical setting. Reporters and hospital staff were given a chance to sit down at a nearby control console and manipulate the robot’s articulated metal arms.

Surgical instruments attached to the ends of the arms can be moved much like a human wrist, used to clip, cut and sew up incisions. A fourth arm is equipped with a custom dual lens endoscope and two three-chip cameras that give surgeons an enhanced 3-D view of the area of the body they are working in. Some of the robot’s instruments are semi-disposable, said Schecter, and they must be replaced after a preset number of uses.

Dr. Tony Chen, one of six doctors at Providence trained in the use of the da Vinci system, said the benefit of robot-assisted surgery is multifold.

“The patient has faster recuperation, less pain, scarring and blood loss, and reduced risk to infection and complications,” said Chen. “It’s a very worthwhile investment for the community overall.”

Robots have been aiding surgeons in performing complicated tasks as early as the mid 1980’s, when a multi-joined robotic arm combined with computer tomography assisted in placing a needle to perform a brain biopsy. A British university in London developed a small circular-shaped robot several years later for use in prostate surgeries. Intuitive Surgical was granted FDA approval in 2000 to begin marketing its first da Vinci system for use in laparoscopic surgery.

The robot’s use has since been expanded to include a widening field of medical procedures, including esophagectomies, coronary artery bypass grafts, lung and tumor removal and other procedures related to electrophysiology, gynecology, cardiology, neurosurgery and bariatric surgery. It is commonly used for cardiac valve repair, as well as gynecologic, abdominal and thoracic surgeries.

In Everett, Schecter said the next frontier for Intuitive System’s robot may be in minimally-invasive kidney surgery, as well as mitral valve surgery. There is also a great interest in colon surgery, he said.

“One of the things that makes it most useful is in prostate surgery, which is done in a very difficult site,” said Schecter. “The surgeon has a narrow area to work in with low visibility. With robots, the enhanced mobility with its multiple articulations allows the procedure to be done much better. Colorectal surgery could have the same benefits.”

The robot is one of approximately 750 in the country, including nearly a dozen new units across nine hospitals along the West Coast. Patients are selected to receive robot-assisted surgery based on their body configuration, and whether there is enough staff on hand to operate the equipment. Despite the cost to purchase and maintain the da Vinci system, the hospital does not currently receive any additional reimbursement for procedures in which the robot was used. This may change, however, as budget shortfalls in states across the country are leaving health care programs struggling to make ends meet.

“There is some movement nationally to create a billing code for robotic procedures. This move is sometimes followed by some kind of reimbursement,” he said. “It’s hard to sustain this without additional reimbursement. On the other hand, there are not a lot of programs that are increasing their payments. It’s an interesting tension.”

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