Sunday, January 21, 2018
Health

Brooksville hospital uses new robotic system for gall-bladder surgery

BROOKSVILLE

Jim Love didn't see much of the machine that made local medical history as it removed his gall bladder. "I remember them asking me to slide onto the table and that was about it," the 68-year-old Brooksville resident recalled of his final moments of consciousness before the surgery at Brooksville Regional Hospital. "I didn't even see the machine."

In the next half hour, Dr. Steven Viznaw used the hospital's da Vinci surgical robot to pull out the pear-shaped organ through a tiny incision in Love's navel.

The Nov. 1 surgery was the first single-site laparoscopic gall bladder surgery in Hernando, Citrus or Pasco counties, Viznaw said, and one of only about 5,000 performed nationwide since the U.S. Food and Drug Administration approved the procedure in March.

Last month, Love was back in the surgical suite — this time on his feet and wide awake — as Viznaw showed a Tampa Bay Times reporter how the new technology advances traditional laparoscopic gall bladder surgery.

That procedure, which has been used since the late 1980s, requires four small incisions in the torso. The surgeon then inserts a lighted scope attached to a video camera into one incision and uses a video monitor as a guide while removing the organ through the other incisions.

The single-site da Vinci method is different in two ways.

Instead of standing over the patient looking at a monitor and guiding the surgical tools and camera by hand, Viznaw sits at a console a few feet away. While peering into a screen that offers three-dimensional, high definition images from the camera inside the patient, Viznaw uses hand controls to move robotic arms that perform the surgery. The camera and instruments are all inserted through a single incision in the belly button.

"The visualization is far superior to traditional laprascopy," Viznaw said.

So is the maneuverability. Viznaw can rotate the robot's arms 540 degrees, far beyond the capabilities of the human wrist.

Because the number of incisions is reduced by the three, the surgery causes less trauma, a shorter recovery and a nearly invisible scar.

During the recent demonstration, a surgical assistant dropped a handful of coins onto the operating table. Sitting at the console, Viznaw picked up a penny with the robot's pinchers and focused the camera on the Lincoln Memorial. Lincoln's tiny figure between the memorial's columns came into clear view.

"Absolutely amazing," Love said.

Health Management Associates, Inc., the company that owns both Brooksville and Spring Hill Regional Hospitals, spent about $1 million on the da Vinci system for Brooksville about two years ago. Surgeons use the machine — the only one in Hernando — to remove spleens, fix hernias, and perform hysterectomies, among several other procedures.

HMA invested in additional da Vinci equipment for the gall bladder surgery and helped cover the cost of training for Viznaw.

"It's where surgery is headed," said Ken Wicker, Brooksville Regional's chief executive officer, said. "We're having a lot more general surgeons coming to inquire about the (da Vinci training) classes because their patients are doing research and saying, hey, do you do this?"

Surgeons at the two hospitals performed about 330 gall bladder procedures last year, an average of nearly one per day. Other surgeons will be trained to perform the single site surgery, Wicker said.

Rich Linkul, a spokesman for Oak Hill Hospital, said the da Vinci system is among the investments being considered by the hospital owned by Hospital Corporation of America.

About the size of a large strawberry and located just under the liver, the gall bladder produces bile to help digest fats. Substances in bile can crystallize in the gallbladder, forming gallstones that can cause pain, nausea, or inflammation. When that happens, doctors often recommend removal of the organ. An otherwise healthy patient can function fine without it.

Love knew something was wrong earlier this year when he started feeling pain in his abdomen and everything he ate — even his favorite meal of spaghetti and meatballs — made him sick.

The retired firefighter and licensed practical nurse was home within a few hours after the surgery. He filled a prescription for painkillers but didn't need them. He woke up the next day feeling well enough for a trip to Bigun's Bar-B-Q restaurant for eggs and grits.

That's a quicker recovery than is typical even other single site patients, Viznaw said, but Love is convinced the robot helped.

"My daughter had the traditional laparoscopic surgery and she didn't feel good for a week," he said.

Reach Tony Marrero at [email protected] or (352) 848-1431. On Twitter: @TMarreroTimes and @HernandoTimes.

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