News From Terre Haute, Indiana

December 24, 2012

Inventive surgery a la DaVinci

Union’s robotic device aids laparoscopic procedures, provides quicker recoveries

Lisa Trigg
The Tribune-Star

TERRE HAUTE — Visualizing a person’s internal organs through a computer screen may sound like science fiction, but at Union Hospital, it is science fact.

The latest generation of the daVinci robotic-assisted surgery is now in use at the Terre Haute hospital, adding to the more than 1,000 daVinci procedures that have been performed at Union since August 2007.

Last week, Dr. Robert Lalouche allowed observation of a robotic-assisted laparoscopic hysterectomy to highlight the minimally invasive treatment. The patient, who requested anonymity, will have a two-week recovery time, compared with a six-week recovery time with traditional open surgery.

“She’ll be at 90 percent in two weeks,” Lalouche said of the patient’s recovery time following Wednesday’s procedure. She can return to light work in two weeks, or to strenuous work in four weeks.

Dr. Lalouche sat about 10 feet away from the patient during the procedure, while a surgical team assisted at the patient’s side. Three trocars — or ports — were inserted in the woman’s abdomen to allow access to the laparoscopic instruments that were manipulated by the daVinci robot. One of the ports was for a camera that gave the doctor an inside view of the surgery area.

As Lalouche sat with his face nestled inside a console, he saw a three-dimension image of the patient’s organs. The two instrument arms on the robot are wristed, providing more flexibility of movement for the instruments.

As an obstetrician/gynecologist, Lalouche has performed hundreds of laparoscopic surgeries, and in a way, his childhood prepared him for the daVinci surgery: He grew up playing video games on an Atari system, and using the daVinci robot takes similar hand skills.

In fact, when he trained at Duke University Medical School in laparoscopy, he said, he had an advantage over the instructor because he knew how to manipulate the medical instruments remotely.

“In your own mind, you feel like you’re right there,” Lalouche said of the 3-D technology of the daVinci robot. “It feels like the instruments and robots are an extension of your own mind.”

Indeed, visitors to the surgery room tested the robot’s simulator mode, where surgeons can train on manipulating the robot. By placing a thumb and finger on each of the master controls, the surgeon’s hand, wrist and finger movements are translated into precise, real-time movements of the surgical instruments.

One simulation demonstrated at the console was a simple dexterity exercise in picking up jacks and sorting them into several colored dishes. The simulations can increase in complexity and include actual surgery simulations.

Lalouche said he was familiar with the patient, having performed her Caesarean section 16 years earlier. At that time, she had fibroids inside her uterus, which over time grew to the size of a cantaloupe. About 70 percent of women older than 50 have fibroids in the uterus, Lalouche said, and removal of the growths is one reason for a hysterectomy. If removed from the uterus, the fibroids will grow back, he explained, so if a woman no longer plans to have children, it is common to have a hysterectomy.

While he has performed surgery using the previous daVinci platforms, Lalouche said the latest version is like the difference between the first iPhone and the latest iPhone. They are both great instruments, he said, but the newer robot is has a nicer, simpler interface.

“One of the things that is a major advance of the laparoscopy is the fluidity of the controls,” he said. “It allows the surgeon to feel like they are really there.”

Once the organs inside the patient were excised and ready for removal, Lalouche left the daVinci console and performed the remainder of the procedure while seated next to the patient. In total, the surgery took about an hour and 45 minutes from start to finish.

Lalouche said he usually can perform one or two surgeries during a workday.

The patients spend the night in the hospital and are released next day.

“The benefit to the patient is a much faster recovery,” he said. “There are smaller incisions, so there’s less pain, less bleeding and a shorter hospital stay. They can return to the activities of daily living much quicker.”

Reporter Lisa Trigg can be reached at 812-231-4254 or lisa.trigg@tribstar.

com. Follow her on Twitter @TribStarLisa.