January 29, 2024

Robotic-assisted surgery ‘the Standard of Care’ in operating rooms

Dr. Michael Jennings can’t hold back the excitement as he talks about his new partner in surgery. The urologist has performed hundreds of procedures over the past decade with this assistant but never at Marshall Medical Centers. Until now. Dr. Jennings’ new partner in the OR is the da Vinci Robotic Surgical System, a brand new piece of hi-tech equipment surgeons say is a game-changer for patients.

“It’s one of the reasons I chose to do urology honestly because of how innovative this machine is,” says Dr. Jennings of Urology Associates in Albertville. “It really enhances the patient experience and outcomes. I give a lot of credit to the administration for getting it. It’s going to help a lot of people.”

His human partner, Dr. Marilyn Kelleher, is very experienced as well in robotic-assisted surgery. Now that the two are able to team up on procedures using the da Vinci system at Marshall South, they are confident their patients are getting the very best care they can provide.

“We are very fortunate to have MMC to help us keep up with the latest surgical technology,” Dr. Kelleher says. “We are very happy to be able to offer robotic surgery in Marshall County.”

The da Vinci Surgical System is a human-controlled surgical robot that uses a minimally invasive approach. Since its installation in its own operating suite at Marshall South, the excitement has spread with the knowledge that Marshall County residents now have access to the same equipment available in large hospitals in big cities.

The extraordinary system is named for Leonardo da Vinci in recognition of the 15^th century Renaissance genius as the inventor of the first robot, evidenced by drawings that were found.

“For the patient there’s much less blood loss and post-operative pain,” Dr. Jennings explains. “There is a much lower blood transfusion rate for robotic surgery. Everything is just a little more precise. This is how 95 percent of prostate cancer surgeries are done in the country. It’s not new for those procedures. I would feel bad offering an open prostate surgery now. This is the standard of care.”

Dr. Jennings and Dr. Kelleher trained on the da Vinci system through medical school and in residency. They have done hundreds of robotic-assisted surgeries.

“We are grateful to have a way to keep these cases closer to home for the community,” adds Dr. Kelleher.

Prostate cancer and kidney cancer are their most common procedures. The da Vinci is the perfect tool for those cases, explains Dr. Jennings.

“It’s completely changed the way kidney cancer is treated,” he says. “Old fashioned surgery made a huge incision under the rib cage. Now, if we can just remove the tumor and save the kidney, you do a partial nephrectomy. The robot cuts out the tumor and sews up the kidney through a very small incision. That saves a lot of time. In the past that was 5-7 nights in the hospital. Now it’s usually one.”

Using the da Vinci system, there’s also a tremendous difference in how a prostatectomy is performed.

“The da Vinci is made for prostate cancer,” according to Dr. Jennings. “Taking out a prostate is very difficult because you can’t see due to its location. This system has changed all that. It goes from a large incision and multiple nights in the hospital to a tiny incision and just one night. It greatly reduces blood loss. In the past men leaked urine permanently. That’s gone away. It’s great.”

Two veteran surgeons at Marshall Medical also are welcoming the new technology into the operating rooms.

“The 3D visualization is an improvement,” says Dr. Stephen Britt a partner in Surgical Associates of Marshall County, who has done procedures on local folks for 20 years. “It’s fantastic visualization. We already have top of the line laparoscopic equipment. This just adds to it. It’s amazing how good the picture is when you’re sitting in the console. The surgeon is seeing it in 3D.”

Dr. Britt and his partner Dr. John Groves watched robotic surgeries in Birmingham and agreed there was a place for it at Marshall. They practiced on mannequins for two months before working on patients for two solid days in a lab in Atlanta. They were ready to begin using a robot as the latest chapter in a history of Marshall providing the very best medical tools for its physicians.

“We’ve always had top of the line equipment,” Dr. Britt says. “We’ve had surgeons come in and can’t believe what we have here they don’t have in other places. People are in awe of how large our operating rooms are and not everybody has the 4K laparoscopic system. We didn’t have the robot but we do now. “

Dr. Groves, who has performed surgeries at Marshall for 26 years, was ready to adapt to the new technology.

“It’s not as big a change as when we went from doing open belly gall bladders to laparoscopic gall bladders,” he says. “That was a big deal even though you were still using your basic skills to do surgery. It’s just using different instrumentation.”

For now, Drs. Britt and Groves are using the robot while removing gall bladders and repairing different types of hernias. Eventually they plan to expand its use to bariatric surgeries and colectomies. They expect the other general surgeons to make the robot part of their procedures as well as OB-GYNs.

“I expect patients will be asking for robotic surgery once the word gets out,” Dr, Groves says. “People will appreciate having the latest technology available locally so they don’t have to travel. They will have an option.”

Dr. Jennings and Dr. Britt recently did a combination case using the robot on a patient with prostate cancer and a big hernia. Dr. Britt repaired the hernia then Dr. Jennings removed the prostate.

“I just saw that patient and he looks fantastic,” Dr. Britt says. “From both the prostate and hernia surgery, he’s tickled to death.”

Another plus, he points out, is that young surgeons use robots in training and so they expect it when they accept a position. Having the technology in place will make it more likely to attract them to Marshall.

“It’s a tool to recruit the next generation of surgeons.”

How does it work?

Dr. Jennings explains step-by-step how a prostate is removed with robotic assistance. First, the surgeon makes a small incision right above the belly button to gain access to the abdomen. He then makes 3-4 additional small incisions he uses to put ports in to blow up the abdomen with carbon dioxide. That’s the point where the robot comes in and is docked.

The surgeon then walks away from the patient and sits down at a console. He puts his hands in the robot and his face into the 3D screen while he manipulates foot pedals. From that position, he is controlling the robot as he cuts and sews. He moves aside the patient’s bladder to reach the prostate and removes it.

Other remarkable improvements using the da Vinci include:

• Previously, with laparoscopic procedures, surgeons could only see 2-dimensionally. This is 3-dimensional.
• The da Vinci robot erases any tremor in a surgeon’s hands. No matter how steady a surgeon’s hands, there always is some degree of tremor. That is gone when the hands go into the robot.
• It allows surgeons to reach places and see things they previously wouldn’t be able to because its ‘hands’ are so small.

Another positive is that using the robot is easier on the surgeon. Studies have shown fewer long term injuries in the back, neck and shoulders. There’s fatigue involved in performing surgery manually. Using a robot, the surgeon is sitting down in a comfortable position. Over the long term, it’s proven to cause fewer neck injuries and fewer shoulder problems. Best of all, it extends a surgeon’s life in the OR.

People might be surprised to know the surgeon is actually in the robot throughout a procedure.

“Somebody asked me if I was afraid my job will be gone,” Dr. Jennings laughs. “I said not at all.”

For people afraid of the idea of a robot doing surgery on them, don’t fear.

“The robot cannot move on its own,” he says. “It can’t move unless I’m moving. I have control.”

Surgeons perform robotic-assisted procedures as a team. One stays at the bedside while one is controlling the robot. A specialized robotic team including nurses and techs works together for each procedure.

“This is new in Marshall County but it is not new to the surgeons,” Dr. Jennings says. “Now people don’t have to drive to Huntsville or Nashville. The hospital is making an investment in getting new technology and younger surgeons. We may not be able to offer everything but the things we do offer, we do just as well as anybody.”