Robotic Surgery at AAMC: The Community’s Gift to the Region

By Margot Mohsberg

Residents in the Annapolis area have always been a group that takes care of its own. If someone needs medical care, they will hold a fundraiser. If someone needs work done on their home, suddenly Christmas-in-April volunteers come knocking.

Recently, however, the community’s compassion reached far beyond county lines into states as far away as New Jersey. Using donations given by the community to the AAMC Foundation for the development of the DeCesaris Cancer Institute, AAMC became the first hospital in the region to use the robotic surgical system called da Vinci TM to remove cancer from the lung of a 78-year-old great-grandmother from New Jersey.

The minimally invasive surgery enabled by the use of da Vinci greatly reduced the recovery time for Martha Scott, who was able to stop taking pain medication the day she left the hospital. Thanks directly to the generosity of area residents, she will have several more years to watch her 27 grandchildren and great-grandchildren grow.

“The AAMC Foundation board is always gratified by the generosity of so many throughout the Annapolis area,” says Larry Ulvila, chairman of the AAMC Foundation Board of Directors. “It is extremely heartwarming to be able to provide this state-of-the-art technology to the residents of this region. It really shows how important quality healthcare is to this community.”

Dr. Kenneth Adam Lee, M.D., the country’s foremost practitioner of thoracic surgery using the da Vinci technology, performed the surgery on Mrs. Scott using the newly released, four-arm da Vinci “S” system, the first one in Maryland, Virginia, the District of Columbia and Delaware.

“Having the da Vinci robot allows us to perform more complex minimally invasive procedures,” says Dr. Lee, who helped develop the da Vinci technology and trains surgeons across the nation to use it.

AAMC’s acquisition of the da Vinci technology has enabled the hospital to advance its surgical and oncology programs by offering robotic surgery to patients with thoracic cancer as well as prostate cancer, according to Dr. Linda Ferris, Executive Director of AAMC’s DeCesaris Cancer Institute.

“This advanced robotic minimally invasive technology continues AAMC’s investment in cutting-edge technologies to treat cancers, and augments current hi-tech programs such as stereotactic radiosurgery and image-guided radiation therapy,” Dr. Ferris says.

Doctors discovered that Mrs. Scott, of Cornice Point, N.J., had lung cancer when she came into the hospital with pneumonia. Immediately, her daughter Cynthia Scott went on the Internet in search of cancer centers that have doctors affiliated with Johns Hopkins Hospital. She discovered Dr. Stuart Selonick, an oncologist who is on staff at both Johns Hopkins Hospital and AAMC’s DeCesaris Cancer Institute.

“I was told Dr. Selonick was a very good doctor,” Mrs. Scott says. “There was a lot about him on the Internet. He’s written all kinds of papers.”

Upon examining Mrs. Scott, Dr. Selonick referred her to Dr. Lee.

“Dr. Lee told us he helped develop this new type of technology for removing cancer and that he’s been going around the country teaching other people how to use it,” Mrs. Scott says. “That made me feel very comfortable. I was definitely glad that I didn’t have to have a large incision.”

Her daughter said they were relieved to have access to this new technology from a doctor who has a great deal of experience using it.

“We knew my mother would be getting good treatment,” Ms. Scott says. “It put us at ease.”

The availability of robotic technology is an exciting development in minimally-invasive surgery for both physicians and patients. But the image some associate with the term “robot”—such as R2D2 from Star Wars or a mechanical housekeeper on wheels performing tasks independently—isn’t how robotic surgery works.

“It’s important to emphasize that the surgeon is performing the procedure, not the robot,” Dr. Lee says. “The tools are like an extension of the surgeon’s hands.”

Surgery using robotics benefits patients in many ways. Like other minimally invasive procedures, it involves smaller and less invasive incisions, less pain, fewer complications, and shorter hospital stays and recovery times. But the advantages of using robotics go beyond these, says James Biles, M.D., an AAMC urologist who performs prostate surgery using the robot with his practice partner, Eric Schwartz, M.D.

“With the da Vinci robotics system, magnification of images is ten times that of traditional minimally invasive surgical systems, and the view surgeons have is three-dimensional,” Dr. Biles says. “That means that surgeons have an excellent view of the surgical field, even using tiny incisions. And the da Vinci surgical tools actually improve upon the action of the human wrist. The wrist can move in six directions, whereas da Vinci instruments have seven degrees of dexterity.”

Another benefit of robotic surgery is that, unlike people, machines never get tired.

“Even the most skilled surgeons can have slight tremors in their hands as they operate, especially when surgeries take a long time,” Dr. Schwartz says. “But these instruments never shake or become fatigued, which is a bonus for both surgeon and patient.”

Benefits extend to specific procedures as well.

“A prostatectomy performed with da Vinci has lower rates of complications such as incontinence and impotence,” Dr. Schwartz says.

How da Vinci Works

The da Vinci system consists of several parts. The first is a console where the surgeon sits to operate and look at the patient with a high performance system that enables 3-D viewing. Included in the console are tools that seamlessly transmit hand, wrist and finger movement through the computer to surgical instruments placed inside the patient.

The second component is a bed-side cart that holds two kinds of robotic arms—instrument arms and an endoscopic arm—that execute the commands of the surgeon. These arms provide seven degrees of motion that mimic, with great precision, the dexterity of the human hand and wrist. The robotic arms are then attached to surgical instruments, each of which has a specific purpose such as suturing, clamping or manipulating tissue. Surgical team members help insert the arms into the patient’s body through small incisions one to two centimeters long and then supervise the instruments during a procedure.

Traditional, open surgery often requires incisions as long as 6 to 12 inches that result in more pain and blood loss and longer recovery times.

“By acquiring the da Vinci system, AAMC is one of the first regional medical centers to offer robotic surgery across many surgical specialties, including thoracic, urology, and soon gynecology and general surgery,” says Dr. Ferris. “This capability also positions AAMC as a destination hospital, and demonstrates the talent and commitment of our surgeons to improving care and pioneering new techniques for our patients.”

Following her surgery, Martha Scott was able to stop taking pain medication the day she walked out of the hospital.

“I would recommend this surgery to anyone,” says Mrs. Scott, who was the first of 13 patients including several area residents to benefit from the use of da Vinci. “I didn’t have any pain and it doesn’t really knock you out like some surgeries. It’s very quick. You heal much faster.”

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