Sometimes, Precision is Everything
Home to one of the state’s most comprehensive and respected minimally invasive and robotic-assisted surgery programs, Providence St. Jude surgeons are elevating patient outcomes in areas from gynecological cancers to GERD—while leaving behind incisions that can be covered with a Band-Aid.
Inside the hospital’s surgical suites, you’ll find the ExcelsiusGPS Robotic Platform, da Vinci Robotic Surgical System, and the da Vinci’s new Ion platform for minimally invasive lung biopsy. These technologies translate a surgeon’s hand movements into smaller, more exact movements, and offer high-definition imaging with exceptional views of the surgical site, often allowing surgeons to differentiate between diseased and non-diseased tissue more easily.
The result is a long list of advantages for patients, including fewer complications, significantly less pain and blood loss, and a much faster recovery.
“We’re using robotic-assisted surgery to not only reduce the invasiveness, pain and trauma of surgery but to create more precise and successful treatment,” explains Daniel Oh, MD, a Harvard-trained and nationally respected thoracic surgeon who trains physicians from around the world on robotic lung surgery.
The hospital’s minimally invasive program began eight years ago with robotic prostatectomy, an approach to prostate cancer resection that dramatically reduces the risk of complications or side effects. Today, Providence St. Jude is one of the few hospitals with nationally recognized centers of excellence in multiple specialties from spine procedures to general surgery.
Not everyone is a candidate for minimally invasive, robotic surgery. Talk to your doctor or to find a Providence St. Jude doctor, call 844-925-0944.
Most lung cancer surgeries in the U.S. are still performed using an open thoracotomy technique resulting in over a week in the hospital and often months of pain. Providence St. Jude is at the forefront of creating a very different scenario, where robotic-assisted surgery is used to remove lung cancer through a few tiny incisions, resulting in better outcomes, less pain and a much shorter hospital stay. “Until now, survival rates after lung cancer surgery have not improved in decades,” explains Dr. Oh, M.D., Medical Director of the St. Jude Center for Thoracic and Esophageal Diseases and among the first in the nation to routinely perform robotic lung cancer resection. “Robotic surgery is allowing us to finally change that, by giving us the tools to more completely and aggressively remove the cancer.” One of only six hospitals in the western United States designated a center of excellence in robotic lung resection, the hospital’s physicians are also using robotic technology to improve the accuracy of lung biopsies, while accessing formerly “hard to reach” nodules or masses.
Surgical resection of pancreatic cancer—called a Whipple procedure—is one of the most complicated and technically challenging surgeries performed, and our highly experienced hepatobiliary surgical team is one of only a handful of hospitals in California with the expertise to use robotic techniques to dramatically reduce its invasiveness. “The robot’s enhanced vision, precision, and control are all important advantages in transecting and reconstructing the pancreas,” says Maria Stapfer, MD, who leads the pancreatic cancer surgery program. Because the robotic wrists are capable of rotating over 500 degrees in multiple directions, it creates a dexterity that far exceeds the human hand. Meanwhile, the robot’s near-infrared imaging allows surgeons to more clearly assess anatomical structures and tissues—without the long incisions and weeks of recovery often required by pancreatic surgery. “We’re focused on across-the-board improvements in outcomes, from using pre-surgery therapies to improve resectability, to using robotic-assisted techniques to reduce trauma and accelerate recovery,” explains Dr. Stapfer. In addition to pancreatic cancer, the hospital’s hepatobiliary team is using the robot’s capabilities to improve surgical options for liver cancer, chronic pancreatitis, bile duct cancer, and others.
At Providence St. Jude, back surgery is being transformed into a minimally invasive procedure. And as the state’s only designated center of excellence in robotic spine surgery, physicians throughout the U.S. are coming to St. Jude to learn how. “Surgeries that typically require four to five days in the hospital are often reduced to an overnight stay,” explains Erick Westbroek, MD, who routinely uses robotic-assisted surgery to treat degenerative disease, herniated discs, scoliosis, nerve compression, and spinal tumors. Aided by a state-of-the-art GPS navigation system, the hospital’s spine surgeons bring pinpoint accuracy to accessing the spine. “Eliminating the need to remove the muscle from the spine is a game changer in terms of pain and recovery,” explains Dr. Westbroek, a Stanford-trained neurosurgeon who completed his fellowship in complex spine surgeries at Johns Hopkins Hospital. “Because those muscles stabilize the spine, leaving them in place offers far better short-term and long-term outcomes.” 3D modeling allows surgeons to preplan exact hardware placement before surgery, while the robot’s image guidance system designs the ideal trajectory. Robotic navigation, says Dr. Westbroek, moves surgeons as close to perfect accuracy as possible: “We’re leveraging technology and expertise to create extraordinary outcomes for patients.”
Pelvic-organ prolapse—caused when the ligaments supporting the uterus and bladder weaken—affects nearly 50 percent of women as they age. Once only correctable through a significant abdominal incision, Melanie Santos, MD, a Stanford-trained urogynecologist, now almost exclusively uses a robotic procedure, allowing patients to go home the next day. “Robotic surgery allows a precision that isn’t possible through other techniques,” explains Dr. Santos, who is using robotic techniques to successfully treat abnormal uterine bleeding, and other pelvic disorders. “The result is patients heal faster, experience less pain, and return to their lives much more quickly.” Robotic-assisted surgery is also creating remarkable benefits for women with uterine, ovarian or cervical cancer. The maneuverability and exactness of the robotic “wrists” are enormous assets in narrow areas such as the pelvis, while the robot’s sophisticated imaging allow the hospital’s gynecologic oncologists to more accurately identify structures and areas affected by cancer cells. “It’s the most significant advancement in the surgical treatment of cancers in many years,” explains Alberto Mendivil, MD, a highly respected gynecologic oncology surgeon.
COLONS TO GALLBLADDERS
Virtually every surgery in the abdominal cavity – from gallbladder removal and hernia repair to colon cancer resection—is benefitting from a little help from a sophisticated surgical robotic platform. “Robot-assisted surgery has significantly changed what we can offer patients in terms of safety and outcomes,” says Theodoros Daskalakis, MD, a board-certified surgeon whose expertise has helped established Providence St. Jude as a robotic training site for general surgeons throughout the western United States. “Because there is far less trauma and blood loss, surgeries that once required a multiple day hospital stay are now same-day procedures.” The robot’s fluorescent imaging capabilities—in which dye is injected allowing the surgeon to clearly visualize anatomy and blood flow—is invaluable in minimizing injury or complication. “We can identify issues before ending surgery,” he says. “An advantage not possible with traditional surgery.” Our general surgeons are adding one more benefit: virtually scarless. Gallbladder removal is now routinely performed through one small incision across the belly button, leaving almost no scar. “It’s another example of how robotic surgery is reducing the physical and emotional impact of surgery,” explains Dr. Daskalakis.
As the incidence of GERD has increased, so has the number of minimally invasive solutions offered by the hospital’s GI experts. Both LINX (a new anti reflux device) and fundoplication (considered the gold standard for GERD treatment) are performed robotically by foregut surgeons who specialize in upper GI conditions. The result? Fundoplication now only requires an overnight stay, while LINX is a same day procedure performed in less than an hour. More dramatic are the benefits for those with esophageal cancer. Esophagectomy—resection of the diseased portion of the esophagus—typically requires very large incisions—along with an extended hospital stay. We are the only hospital in Orange County and one of only four in Southern California with the expertise and technology to achieve the same degree of cancer resection, but through tiny incisions and a shorter hospital stay. Patients also benefit from a multidisciplinary team approach: robotic esophagectomies are performed jointly by thoracic and upper GI surgeons. “The difference is night and day for patients,” explains Nikolai Bildzukewicz, MD, a highly experienced GI surgeon who is fellowship trained in robotic surgery and a leader in advancing less invasive surgical techniques. “We’re reducing risks and improving outcomes in ways that weren’t possible before.”