In The Press


At the Forefront: da Vinci Robotic Surgery

From Caring Magazine, Winter 2012

From Left: Seyed Khoddami, M.D.; Lamar Bushnell, M.D.; Veena Mummaneni, M.D.; Marc Beaghler, M.D.; Lois Barnes, M.D.; Srisawai Pattamakom, M.D.; Gösta Iwasiuk, M.D.; Constanze Rayhrer, M.D.; William Klope, M.D.; Jill Hall, M.D. Not pictured: Cedric Emery, M.D. and Anne Rodriguez, M.D.

The most experienced da Vinci surgeons in the region are at Community Memorial Hospital. These surgeons have performed more than 500 procedures using the da Vinci Robotic System.

Imagine having complicated surgery where you experience less pain, reduced blood loss, and quicker recovery. Imagine, also, a shorter hospital stay and improved clinical outcomes. Finally, imagine smaller surgical scars.

Imagination is reality at Community Memorial Hospital where its Robotic-Assisted Laparoscopic Surgery (RALS) program is truly cutting edge. “We are ahead of the national curve in experience with robotic surgery,” says Dr. Constanze Rayhrer, a general surgeon. “This technology is amazing.”

“It’s quite amazing,” echoes Dr. Marc Beaghler of San Buenaventura Urology Center in association with Community Memorial Health System.

Amazing happens every day at Community Memorial Hospital which seven years ago became the first hospital between San Francisco and Los Angeles to offer robotic-assisted surgery. As a result of that $1.2 million investment in a state-of-the-art da Vinci Surgical Robotic System, CMH physicians today are not only able to provide more robotic treatment options than any other doctors in Ventura County – they are more experienced in these procedures than anyone else locally.

“Getting this technology to Ventura County in 2004 was remarkable,” says Dr. Beaghler. “The wisdom of the administration and the Board of Trustees to see that robotic-assisted surgery was the future and make the commitment to start a program here was a game-changer for our community.”

Refusing to rest on its robotic laurels, Community Memorial Health System continued its long, proud history of bringing groundbreaking technology to Ventura County last December by investing in the newest state-ofthe- art da Vinci “Si” Surgical System.

“The ‘Si’ offers a significant improvement from the previous series,” explains Dr. Gosta Iwasiuk, a general surgeon. “It’s the latest technology available and gives us the ability to do more minimally invasive techniques with remarkable precision.”

Meanwhile, the growing scope of gynecologic procedures using the da Vinci “Si” system includes hysterectomy (removal of the whole uterus), myomectomy (removal of just fibroids), excision of endometriosis, tubal ligation, and ovarian sparing cystectomy.

“Da Vinci is a wonderful tool,” says Dr. Lois Barnes, a gynecologic surgeon. “It gives us the ability to do minimally invasive surgery more precisely and more safely.” “The new upgraded system has better optics and is much sleeker than the old system,” agrees fellow gynecologic surgeon Dr. Sis Pattamakom. “It’s like comparing a new sports car to a minivan!”

Minimally invasive robotic-assisted laparoscopic procedures CMH’s general surgeons are performing include colectomies, colorectal cancer and diverticulitis, gastrectomy for cancer, acid reflux, splenectomy, and ulcer surgery. One key advancement with the “Si” system is its improved high-definition 3-D imaging. “We can see wider fields and we can also zoom in,” notes Dr. Rayhrer. “The resolution is amazing and allows us to see tissues and tiny blood vessels in greater detail. We can do more delicate maneuvers and more delicate suturing than before.” “The optics are truly remarkable,” echoes Dr. Barnes. “With its three-dimensional vision, in many cases I can actually see better than with an open procedure.”

Dr. Beaghler further marvels at the improved ergonomics of the robotic arms and upgraded instrumentation. “The result allows us to perform very advanced cases that were not previously possible,” he points out.

Dr. Seyed Khoddami, also of San Buenaventura Urology, agrees wholeheartedly: “We can do more delicate procedures than before, do them more precisely, more quickly, and with better outcomes.”

This is because the da Vinci “Si” features an enhanced computerized system that seamlessly translates the surgeon’s hand, wrist and finger movements into precisely controlled, real-time micro-movements of the surgical instruments. Although it is often called a “robot,” the da Vinci cannot act on its own; the surgery is performed entirely by the doctor.

“Ergonomically, it is also easier on our backs to be able to sit at the console and not stand and try to operate in an awkward manner,” adds Dr. Pattamakom. “Happier surgeons make for happier patients, I think.”

CMHS’ “Commitment to Caring” means a commitment to getting its patients back on their feet, and back into the flow of their lives, as soon as possible. The smaller incisions necessitated by RALS helps make this happen.

“The advantages of RALS are numerous and include less blood loss, less pain medication needed, and a potential faster return to their normal life,” explains Dr. Beaghler. “Most patients go home from the hospital in one or two days compared to five to seven days for traditional open surgery.”

“The ‘Si’ system is not only improved for the surgeon, it is better and easier for nurses to work with as well,” says Dr. Rayhrer. “And, most important, it’s better for the patient.” “Patients like it a lot,” agrees Dr. Iwasiuk. “Because of the smaller incisions they experience less post-operative discomfort, less down time, less time off work, and less scarring.”

Time in the operating room during a da Vinci procedure is also decreasing. “We are now at the point that the robotic-assisted laparoscopic surgery – including set-up time – takes the same amount of time as traditional surgery,” Dr. Barnes points out. “But more importantly, it gives us a greater ability to perform dissection more precisely and perform many procedures better than with an open procedure.”

The da Vinci “Si” Surgical System has opened up exciting new frontiers for CMH’s robotically trained urologists – including Drs. Beaghler, Khoddami, Emery and Klope – by making a growing number of minimally invasive procedures now possible for prostate, bladder and kidney cancers, along with other urologic disorders. Indeed, a handful of robotic-assisted firsts in Ventura County have been successfully performed at CMH, including: partial nephrectomy, nephroureterectomy, sacrocolpopexy, large ureterolithotomy, pyeloplasty and cyst marsupialization, and robotic ureteroureterostomy.

“It is exciting to see more applications that allow more patients to have improved outcomes,” says Dr. Beaghler. Adds Dr. Khoddami: “No one in our region outside academic centers is doing what we are doing at CMH. We are on par with any academic institution doing robotics.” For example, CMH urologists are successfully doing partial nephrectomies where cancerous tumors are removed while leaving the healthy remainder of the kidney intact rather than removing the entire organ.

“If you can save half of the kidney, or even more, that is extremely important because the remaining part of kidney can still function,” says Dr. Khoddami, “Losing a kidney is very significant and can result in decreased survival rates.” In addition to striving to provide the highest quality care for patients, CMH’s robotics surgeons are dedicated to training other doctors. For example, Dr. Beaghler is a Clinical Professor of Urology at the University of Southern California’s Keck School of Medicine and Dr. Khoddami is an Assistant Professor of Urology at USC; Dr. Iwasiuk and Dr. Rayhrer lead seminars and work directly with new robotic surgeons refining their technique on behalf of Intuitive Surgical that manufactures the da Vinci “Si” System. “We are positioned for the future, today,” Dr. Rayhrer says proudly. “The ‘Si’ platform is designed to use future technology coming down the line.”

One promising advancement on the horizon is “single-port surgery” where several robotics instruments and camera are inserted through one small incision. “We might be able to hide all of the scars in the belly button,” notes Dr. Rayhrer. “Robotic-assisted surgery is emotionally very rewarding,” says Dr. Khoddami. “You feel like all your years of training and pushing yourself forward are making a difference in your patients’ lives. You feel like a big mission has been achieved.” At Community Memorial Hospital, the mission continues.

“Robotically assisted laparoscopic surgery is the future and the present because it has arrived already,” says Dr. Iwasiuk. “And we have it here in Ventura County.”

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