There’s a new surgeon in residence at Beth Israel Deaconess Hospital-Needham. With four arms and no medical degrees to speak of, this long-awaited addition to the surgical team begins work on Nov. 26. Until then, Da Vinci 5 — the hospital’s first surgical robot — will be on display in the lobby.
Although this type of medical technology has been around for a few decades, the demand for community hospitals to make the investment was low. But as the larger Boston hospitals have become increasingly crowded, the push for community-centered care has grown.
John Fogarty, BID-Needham president since 2011, said the hospital’s objective as part of the Beth Israel Lahey Health system is to deliver as much as 75% of patient care in the community. At that level, he said, “We need to have the technology surgeons and patients want. And patients want robotic surgery.”
Acquiring a surgical robot had been discussed for a while, but Fogarty said waiting until the community indicated it wanted it and finding a surgeon to champion the technology was important.
Compared to “open” surgery and even traditional, less invasive laparoscopic procedures, surgical precision and patient recovery are significantly improved with the robotic-assisted component, said Dr. Adriana Meholick, a general surgeon at BID who led the effort to bring the technology to Needham. The Da Vinci 5, which the hospital will use primarily for abdominal surgery, has a high-resolution camera, and the 3D vision enables surgeons to see detailed anatomy not possible with traditional practices. “It makes complex surgical skills that need to be done for these surgeries much easier, more precise,” she said. “You can get into small, tighter spaces easier.”
Robotic-assisted surgery also reduces a surgeon’s mental and physical load. The instruments themselves have “wrists and seven degrees of freedom,” said Meholick, making them more precise and making complex laparoscopic surgery a little bit easier. “If you’re doing open surgery or traditional laparoscopic surgery it takes a lot of effort on the surgeon’s part,” said Meholick, whose medical training includes robotics. “(Rather than) standing next to the patient, this allows you to sit. You’re not having to create that force to manipulate the tissue; the robot is doing the physical work for you.”
Surgeons will also be able to push a special dye through a patient’s IV that can be illuminated by the camera. “For example, in a gallbladder surgery you can give this IV medication, activate the camera, and it will show you where the bile ducts are. The ones you want to avoid and the ones that you’re looking for during the surgery,” said Meholick. “Almost like having X-ray vision.”
On the patient side, the key benefit is improved recovery. “The robot can keep track and control the forces on the abdominal wall which can help with decreasing pain after surgery,” said Meholick, explaining that the DaVinci 5 offers tactile force feedback. “You can feel the force on the instrument which can help lead to gentler surgery, which would also help with recovery.”
Fogarty said the surgical team is excited to have the most advanced surgical technology at its disposal. “Most surgeons want to use the robot, especially if they’ve trained on it. And even some of our surgeons who are more senior here, they want to get trained.”
Intuitive’s Da Vinci 5, the most recent generation of surgical robots produced by the company that pioneered robotic-assisted surgical technology more than 30 years ago, is a three-piece behemoth. The patient cart has four arms that control interchangeable robotic instruments including a camera, all manipulated by the surgeon from the surgical console. The surgeon is able to control all elements of the procedure from the console other than the first incision and the closing, reducing the surgical team’s workload and potentially life-saving minutes and streamlining workflow. The third component, a vision cart, tracks surgical and patient data, displays the surgical camera view and logs everything in real time allowing for immediate feedback. It also has a teleconferencing feature for remote surgical consults.
“Say you need a second pair of eyes to look at what you’re operating on,” said Meholick. “If I have that problem currently, I have to have one of my partners come down to the OR physically to look at what I’m doing. Whereas now they can teleconference in and see what I’m seeing on the console.”
Software updates also can be made remotely, which will enable improvements to be activated quickly. From a mechanical standpoint, as new instruments are developed, they can be added to the existing system.
With six operating rooms, Fogarty said BID-Needham will still perform traditional surgeries to a “significant degree,” so there will still be plenty of work for everyone — especially as people elect to have treatment in Needham because of the robotic-assisted option. “So much work is moving from the city out to the community, so if this enables us to spread the staff out further, it’s all for the better,” he said.
Fogarty said this type of technology in a Needham hospital would not have been imaginable 10 years ago. “What we really want the community to know is that this is now a service you can get in your neighborhood hospital, and that’s what we’re all about. The fact that you can get that 15 minutes from your house we think is really exciting for the whole community.”
Meholick will perform the first robotic-assisted surgery — a hernia repair — with the Da Vinci 5 on Nov. 26.
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