Volume III, Issue 8: May 2011
Surgeons
Paul R. Kennedy
SpineAssist system adds to UC Irvine firsts in the operating room. Surgeons continue to find innovative uses for the technology, including thyroid, lung and colorectal procedures. Here, Dr. Nitin Bhatia (left) and Dr. Samuel Bederman use the SpineAssist robot to place spinal implants during a recent surgery.
CT scans of a patient's vertebrae.
Paul R. Kennedy
The SpineAssist system lets a surgeon plot the placement of spinal implants before an operation using CT scans of a patient's vertebrae.

Expanding the role of robots

Lourdes Medina had a common problem: relentless back pain and sciatica caused by a herniated disk and an unstable spine. The solution, however, was anything but common. At UC Irvine Medical Center, she underwent the first robot-assisted spinal surgery on the West Coast. Within a day of her March 15 operation, the 32-year-old Los Angeles woman was walking around her hospital room.

"I feel 100 percent better," says Medina, who had a previous spinal fusion to treat a degenerative disk. "Before, there was excruciating pain radiating down my leg, and I couldn't sleep. Now there's no pain in my legs or hips for the first time in a long time."

Orthopedic surgeons Dr. Nitin Bhatia and Dr. Samuel Bederman utilized the new SpineAssist system, which allows a procedure to be planned out before the patient enters the operating room and helps the doctor place spinal implants with a high degree of precision during both open and minimally invasive surgery.

Pioneering the use of robotics is nothing new at UC Irvine. It was the first Orange County hospital — and among the first university medical centers anywhere — to adopt the da Vinci Surgical System.

While da Vinci has been around for almost 10 years, UC Irvine physicians continue to find applications that benefit patients. For surgeons, robotics can offer enhanced precision, dexterity, range of motion and imaging during operations. For patients, the technology can mean less injury to nearby healthy tissue, smaller scars, reduced pain and faster recovery.

The center focuses on the specific application of robotic technology to cancer surgery and enables us to continually advance this exciting technology for the betterment of every patient who seeks our care.

The da Vinci system was originally designed for heart operations, but doctors quickly found other uses. UC Irvine's Dr. Thomas Ahlering was among the earliest adopters of robotic prostate surgery and has performed more than 1,000 such procedures since introducing it to Southern California in 2002.

In the last year, UC Irvine surgeons have employed the system in several new ways:

  • In July 2010, Dr. Jason Kim became the first in the West to perform thyroid surgery with the robot, leaving his patient without the neck scar visible on thousands who have had the traditional open thyroid operation. One of his first patients is now planning her wedding — with no scar to telegraph her health history.
  • In December, Dr. Joseph Carmichael conducted Orange County's first robot-assisted colorectal cancer surgery on a 47-year-old Foothill Ranch man with stage IV rectal cancer. "The results were very good," Carmichael says. "This patient left the hospital in four days — the national average is nine days — and was able to start chemotherapy quickly."
  • In March, cardiothoracic surgeon Dr. Amir Abolhoda carried out the county's first robotic lung cancer surgery. Using da Vinci, he removed the lowest lobe in the right lung of a 52-year-old individual with early-stage lung cancer. "The patient was able to leave the hospital in two days and is experiencing no complications," Abolhoda says.

Robotics is an extension of the wave of minimally invasive surgical techniques like laparoscopy that swept American medicine in the 1990s. UC Irvine's Dr. Ralph V. Clayman was a trailblazer, performing the world's first laparoscopic kidney removal in 1990.

Now dean of the UC Irvine School of Medicine, Clayman arrived in Orange County in 2002 as the first chairman of the university's Department of Urology and quickly established UC Irvine as a leader in minimally invasive surgery.

He believes the university's doctors should strive to increase patients' access to surgical improvements while enhancing outcomes. Clayman institutionalized the innovative use of robotics in treating cancer with last year's launch of the UC Irvine Robotic Oncology Center.

"The center focuses on the specific application of robotic technology to cancer surgery and enables us to continually advance this exciting technology for the betterment of every patient who seeks our care," he says.

Use of da Vinci will expand in the treatment of gynecologic cancers under the new director of gynecologic oncology, Dr. Robert E. Bristow, who gained extensive experience with robotics at Johns Hopkins University.

And the recent arrival of Dr. Alessio Pigazzi, a nationally renowned colon and rectal surgeon, will likewise increase the use of robotics in treating colorectal cancer.

While the da Vinci system dominates the operating room, with its multiple arms acting as extensions of a surgeon's hands, SpineAssist is much smaller and employs robotics in a different way.

The size of a soda can, it sits on a patient's back and guides the surgeon to more precisely place orthopedic screws stabilizing the spine. A study published last year in the journal Spine showed that the system can boost the accuracy of spinal implants to 98.3 percent and significantly lower the incidence of misplaced screws and subsequent neurological problems. The accuracy rate for non-robotic orthopedic screw placement is about 86 percent.

"Our surgical outcomes are already excellent, so I'm always skeptical when a new technology claims it can improve these results," Bhatia says. "This technology, however, surpassed our goals for our patients."

—John Murray, University Communications