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Dr. Chris Welsch, who chaired the Robotic Steering Committee for Jackson-Madison County General Hospital, sits in front of the lastest version of technology the hospital purchased in 2011, the Intuitive Surgical da Vinci Si.

For West Tennessee patients, robotic surgery may sound like something out of a science fiction movie, but for surgeons, this technological advancement allows them to provide patients less invasive surgery options over conventional surgery.

Through the use of the Intuitive Surgical da Vinci Robotic Surgery system that was installed nearly three years ago at Jackson-Madison County General Hospital, patients across the area are receiving some of the most technologically advanced care that is leading to better outcomes and reduced recovery times. The technology has caught on so well here that the surgery department recently announced that surgeons had completed more than 1,000 robotic surgeries using the da Vinci Robotic Surgical system.

Jackson-Madison County Hospital’s first da Vinci surgical robot cost $1.5 million in 2009; the hospital bought a second unit in 2010. In October 2011, the hospital purchased the latest version of robotic technology, the Intuitive Surgical da Vinci Si. “The administration should be applauded for their foresight to purchase cutting edge technology for the benefit of patients in our region,” said Christopher Welsch, MD, FACOG, a gynecologist with The Jackson Clinic and chairman of the Hospital’s Robotic Steering Committee.

Many surgical procedures performed today using standard laparoscopic techniques may be performed more quickly and easily using the da Vinci system, Welsch explained. Traditional laparoscopy offers a better alternative to surgery with a large incision, and it has been widely accepted for a specific number of procedures. The da Vinci system provides greater capabilities and safety than traditional laparoscopy, he added, and is used to perform cardiothoracic procedures, hysterectomy, prostatectomy and general surgical procedures.

General Hospital offers da Vinci robotic assisted surgery in such procedures as hysterectomy, prostatectomy, colon resection, gall bladder removal, bladder resection, hernia repair, splenectomy, tubal surgery, endometriosis treatment, surgery for pelvic organ prolapse and removal of uterine fibroids.

In robotic surgery, the surgeon sits at a console looking at a 3D high-definition screen through which he directly views the surgery site inside the patient while his movements in the console are actually directing the surgical instruments within the patient. The system seamlessly translates the surgeon’s hand, wrist and finger movements into precise, real-time movements of surgical instruments inside the patient. The robotic surgical instruments are very small and can perform delicate procedures with great precision and minimal disturbance to surrounding tissue.

Robotic surgery has many advantages. “The biggest advantages are smaller incisions, fewer complications, increased precision and quicker recovery time,” said Welsch. “The increased precision allows surgeons to perform both simple and complex procedures with greater safety. Also, whereas a traditional incision for hysterectomy can be six to eight inches long, with the da Vinci robot, there are only four to five very small incisions. This results in less discomfort and a shorter recovery time so the patient can return to normal life activities more quickly. Often, women can even return home the same day as their surgery.”

For avid kickboxer Cameron Hansbrough, there was no other option than to use robotic surgery for her hysterectomy due to the minimal recovery time it offered. “Surgery is not something I handle very well as I hate to not be active,” said Hansbrough, who had her procedure in February 2011. “Being an avid runner who works out with a trainer, I was in good shape, and when I heard the recovery time would be around two weeks with this surgery versus six with a traditional hysterectomy, there was no other option for me.”

Hansbrough, who spent one night in the hospital after the surgery, had minimal scars and did not even have to take all the pain medication she was prescribed. One week out from surgery she was back to pretty much her normal routine around the house and even out shopping. Two weeks out, she resumed her kickboxing classes, modifying her workout slightly on the advice of her trainer. By three weeks post-op she was running and working out at full throttle. “I probably did not follow doctor’s orders to the best extent,” said Hansbrough, “but I felt great and was ready to get back to life.”

Welsch, whose OB/GYN group has performed 550 robotic procedures alone and who was instrumental in bringing the technology to Jackson two and a half years ago, has found the technology is living up to all that it pledged it would. “We compared our gynecology data using the da Vinci System with the Center for Disease Control’s data comparing vaginal hysterectomies versus laparoscopic. We are seeing better outcomes,” said Welsch, who is quite passionate about the technology and all that it offers patients. “It does all that is promised to do and more.”

Originally, robotic surgery was primarily used in urological applications, most notably prostate surgeries. Nationwide, the technology is used for about 85 percent of prostate surgeries, with gynecology utilization rates lower than that nationwide. “When the hospital’s program started in 2009, it was initially used for gynecology procedures and has been implemented in other specialties in Jackson since then,” said Welsch, who serves on the hospital’s Robotic Quality Assurance committee that reviews robotic cases performed at JMCGH. “Today both urologists and general surgeons are using the technology. In fact, one Jackson general surgeon is on the forefront nationwide of utilizing the Da Vinci system for general surgery applications.”

Prostate cancer patient Craig Spellings had several treatment options, but on the advice of his urologists, John Carraher, MD, and Don McKnight, MD, and a friend who had the same procedure, his choice of treatment to remove his prostate was robotic surgery.

“I had heard about the more invasive conventional surgery and the longer recovery time that went with it,” said Spellings. “I also had options of implants, chemotherapy and radiation therapy. My friend had the same procedure with the da Vinci system and had an outstanding outcome. Based on how well he had done, I went with it for my surgery.”

Spellings had a short hospital stay of a day and a half. After one week, his catheter was removed. “I had no real discomfort from the incision and really no downtime as I was pretty much back to normal after ten days,” said Spellings, who took the suggested month off to recover. “When I went back in for my pathology test about ten days after my surgery, it was discovered that I had gall stones. So I had my gall bladder removed with the da Vinci. Two robotic surgeries in ten days and I still have nothing but good things to say about it.”

Training for the da Vinci system is rigorous. “It has a defined pathway that is intended to appropriately prepare physicians to safely utilize this advanced technology for the optimal care of their patients,” said Welsch, who along with his partner, Jeff Ball, MD, are both certified da Vinci trainers and travel to teach other physicians how to perform robotic surgery. “The defined clinical path of training begins with case observation. The next step is learning use of the technology in live tissue with lab animals. Finally, the doctor must perform a certain number of cases under the supervision of a credentialed intuitive robotic surgeon.”

Jackson-Madison County General Hospital is one of only 26 facilities across Tennessee – and the only one in West Tennessee outside of Memphis – using this minimally invasive, innovative and state-of-the-art treatment. Before General Hospital purchased this equipment, some people went to Memphis and Nashville to have these robotic procedures performed. Now patients can remain in Jackson for their da Vinci surgery, since in many instances, local surgeons have more experience than their colleagues elsewhere.

Currently eight OB/GYN physicians, four urologists, two cardiothoracic surgeons and three general surgeons use the technology at Jackson General Hospital. “The numbers obviously speak for themselves, but we are very pleased that our medical staff and surgery staff provide such a beneficial service for patients,” said Marty Fordham, vice president of Hospital Services at General Hospital. “We expect this service to continue to grow and get better and better as more surgeons are trained to use this device, and more procedures become available through robotic surgery.”

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