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St. Clair Hospital Introduces Latest Generation of Robotic-Assisted Surgery with the da Vinci Si System
By Lisa Bianco

Arthur D. Thomas, M.D. and Kevin P. Bordeau, M.D.

This April the first robotic-assisted surgery, using the latest technology called the da Vinci Si System, was performed by surgeons at St. Clair Hospital at its main campus in Mt. Lebanon. Urological surgeons Arthur D. Thomas, M.D., and Kevin P. Bordeau, M.D., carried out the first robotic-assisted surgeries, performing radical prostatectomies on patients suffering from prostate cancer. With thumb and forefinger inserted in an instrument similar to a joystick, a surgeon operates the robotic system that can mimic any movement of the human wrist. "The range of motion, precision and dexterity is actually greater than the human wrist," says Dr. Thomas. "This results in recovery times twice as fast as traditional open prostate surgery methods. Prostate surgery patients also regain continence and erectile function more quickly."

Dr. Bordeau adds, "Typically prostate surgery patients are required to wear a catheter for two to three weeks after surgery. With the da Vinci Si, patients use the catheter only seven to 10 days and they appreciate that. Often, the lengthy time patients wear a catheter is one part of recovery that patients really dread. It's rewarding to see my patients have a better sense of well-being right away. Because of this surgery's higher level of precision, we also see less nerve damage and a shorter time using narcotic pain relieving drugs."

Dr. Thomas remarks that most urologists will have exposure to robotics during their residency programs. "Patients who are comfortable with the idea may even come to their surgeons asking for robotic surgery. This technology is well proven and the da Vinci System is in its third generation of development." He adds, "Nationally, eight or nine out of 10 prostatectomies in the U.S. are done robotically. Currently in Western Pennsylvania, the rate is three out of 10. St. Clair is one of the hospitals in step with the national trend."

The da Vinci Si System – manufactured by Intuitive Surgical, Inc. – uses advanced technology to perform delicate and complex operations through a few tiny incisions. Vision, precision, dexterity and control are increased, in part by one of four interactive robotic arms that holds an endoscopic camera with two lenses that provide a 3-D image to surgeons—at 10 times magnification—of the patient during the procedure. Three of the arms hold tools such as a grasper and scissors. The system seamlessly translates the surgeon's hand, wrist and finger movements into precise, real-time movements of surgical instruments. Every surgical maneuver is directly controlled by the lead surgeon, who is seated at the console a few feet away from the patient. A second assistant sits by the patient at bedside, applying clamps, performing suctioning, and passing suture material in and out.

St. Clair has three OR teams trained to assist the surgeons with da Vinci Si procedures, ensuring round-the-clock coverage. The da Vinci System's most popular use so far has been for prostatectomies or other urological procedures, following the Hospital's initial plan. Dr. Bordeau says other urological applications for the da Vinci Si include repairing blockages in a kidney, and the full or partial removal of a kidney. The system is also designed for gynecological, colorectal and thoracic procedures, which other surgeons at St. Clair will be performing with the da Vinci Si in the near future.

Dr. Thomas has noticed that the new technology is definitely creating a buzz throughout the OR. "Once a physician sees this system, there's a strong interest in wanting to receive training to use it. The whole OR staff is really taking ownership of the program to get it up and running."

Watching their patients move through a rapid recovery is immensely satisfying for surgeons. "I'll see my patients the week after surgery and not only are they feeling closer to normal, they'll be completely off narcotic pain medications," says Dr. Thomas. Retired teacher Ronald Obremski was the first patient at St. Clair Hospital to undergo robotic-assisted surgery for prostate cancer. He has high praise for Dr. Thomas who met him in the anesthesiology room and explained exactly what would take place during surgery. Post-surgery, Obremski is very pleased. "Here it is, a little over three weeks after surgery and although I'm still supposed to take it easy, I feel like I can do almost all of my normal activities. Five days after the surgery I was up out of bed, feeling healthy. I only had to use the catheter for a week and the scarring is very minimal. All in all my recuperation has been just wonderful."

For more information about the da Vinci Si System, or robotic-assisted surgery, contact Robert Crytzer in the Public Relations department at Robert.Crytzer@stclair.org, or visit www.stclair.org

Arthur D. Thomas, M.D.

Arthur D. Thomas, M.D., earned his medical degree at the University of Pennsylvania School of Medicine and completed a residency in urology at the Hospital of the University of Pennsylvania. Dr. Thomas is board certified by the American Board of Urology and practices as part of The Center for Urologic Care, P.C.

Kevin P. Bordeau, M.D.

Kevin P. Bordeau, M.D., earned his medical degree at Tufts University School of Medicine in Boston and completed a residency in Urology at the Eastern Virginia Medical School. Dr. Bordeau is board certified by the American Board of Urology and practices as part of Sholder & Bordeau Urologic Associates.

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