Two Robots Working Daily at Munson, Third Coming Soon? System enables more minimally invasive surgeries

Not so long ago, the idea of robotic surgery would have seemed alien. Today, though, there are two robotic surgical machines right here in Traverse City, and Munson Medical Center wants to add a third.

The da Vinci Surgical System is a $2 million piece of hardware manufactured by a company called Intuitive Surgical. First approved for use by the Food and Drug Administration (FDA) in 2000, the system has gone on to redefine surgical procedures, both locally and abroad.

The da Vinci system uses robotic technology to assist surgeons in performing minimally invasive surgeries, also known as laparoscopic surgeries. The robot has four arms, three of which can be equipped with different surgical instruments. The fourth arm holds the laparoscopic camera, which allows the surgeon to see the movements of the other three instruments inside the patient’s body.

Instead of standing beside an operating table, the surgeon sits at a console in front of a screen. From the console, the surgeon can control the four arms of the robot, toggling between instruments or zooming the camera in or out as the surgery moves forward. The robotic technology of the system allows it to track the surgeon’s hand movements and translate them into finer and more precise movements of the robotic arms.

According to Dr. Michael Nizzi, a general surgeon at Munson, the main benefit of using the da Vinci system is the way it enables more minimally invasive surgeries. Because the robotic arms of the system are capable of small, precise movements, the da Vinci robot has allowed surgeons to minimize complications of certain surgical procedures.

“[The da Vinci] has really allowed us to move from big, long incisions on surgical patients to using five or six smaller incisions,” Nizzi said. The resulting procedures have minimized scarring, reduced blood loss and has paved the way for safer surgeries and quicker patient recoveries.

Nizzi says that Munson bought its first da Vinci robot about 10 years ago. Early on, Nizzi says that the da Vinci was mostly used for gynecology and urology. Gynecologists used the system to conduct robotic hysterectomies or other surgeries involving uterine cancer. Urologists relied on the technology to improve the success rate of prostatectomies.

In the past three to five years the da Vinci robot has become more popular for general surgical procedures. Nizzi, who was trained on how to use the system back in 2010, now uses it regularly for bariatric, gastric bypass, hernia, colon, gallbladder surgeries and more.

“I do pretty much all my cases now robotically,” Nizzi said. “Anything general surgical that can be done on a minimally invasive platform, I do robotically.”

If a patient has had multiple previous surgeries and has an abundance of scar tissue, Nizzi will perform an open surgery. Patients who can’t tolerate general anesthesia are also not good candidates for robotic surgery.

Even more specialized surgeries are headed in the robot-assisted direction. Most recently, Munson surgeons have started using the system for cardiac and thoracic surgeries.

“[U]se of the da Vinci has now spread among multiple different disciplines in the hospital,” Nizzi said.

The result is that Munson’s two da Vinci systems (the hospital purchased a second one a few years ago) are now being used every day. With surgeons regularly scheduling surgeries on the two machines, Nizzi says it’s time for Munson to add a third da Vinci robot to the arsenal.

“We need one,” he said. “We probably actually need two more, to tell you the truth. The numbers of cases that are on our systems far surpass other hospitals of similar size. When you compare us to other hospitals in the Midwest, we are probably one of the highest utilizers of each of our platforms.”

Munson isn’t the only hospital investing in this technology. For the second quarter of 2018, Intuitive reported the shipment of 220 da Vinci robots – up from 166 from the same quarter in 2017. As of Sept. 30, 2017, Intuitive had sold a total of 4,271 units worldwide, including 2,770 in the United States. As of press time, Intuitive da Vinci systems have been used in more than five million surgeries globally.

Training is rigorous. According to Nizzi, surgeons learning how to use the robot start by performing animal surgical labs before transitioning to human cases. There is then a strict patient selection process to ensure that novice da Vinci surgeons are getting the simplest cases possible as they learn to use the technology on human patients. These early cases must be proctored by someone who already has experience with robotic surgery.

Nizzi says that, as robotic surgery becomes more widespread – and as more and more hospitals purchase their own da Vinci robots – it’s becoming more common for young surgeons to come to their jobs already trained in how to use the systems. Even now, though, the medical field is not quite to the point where training on the da Vinci is universal for aspiring surgeons.

“Most of the new surgeons coming up now are being trained within their residency programs,” Nizzi said. “But even some of these larger residency programs are new to robotics.”