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Making repairs without lifting the hood

By: BRIAN NEWSOME
September 18, 2007
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photo - Dr. John Mehall at the helm of the da Vinci system Friday at Penrose Hospital in Colorado Springs. The high-tech, lessinvasive surgical system has made procedures such as cardiac valve replacement much easier for both doctors and patients. Photo by ( TODD SPOTH, THE GAZETTE)
Dr. John Mehall at the helm of the da Vinci system Friday at Penrose Hospital in Colorado Springs. The high-tech, lessinvasive surgical system has made procedures such as cardiac valve replacement much easier for both doctors and patients. Photo by ( TODD SPOTH, THE GAZETTE) 
Heart surgery the old way: A saw rips through the breastbone, cutting it in half. Industrial tools crank apart the rib cage. Like a mechanic peering under a hood, the surgeon goes to work on an exposed heart.
The new way: A few probes with tiny cameras and instruments are slid between the ribs. Across the room at a console, the surgeon performs the same work as before — but with no power tools required. Penrose Hospital is the only one in Colorado and one of about 20 nationally using robotic technology to take the “open” out of open-heart surgery, said Dr. James Stewart, a cardiovascular and thoracic surgeon who has used the machine for heart and thoracic surgeries. The state-of-the-art approach significantly reduces a patient’s recovery time and allows surgeons to operate more precisely. “I’ve had patients that have done this procedure and that played golf two weeks later,” said Dr. John Mehall, a cardiovascular and thoracic surgeon and expert in using the machine for heart surgeries. The $1.3 million da Vinci Surgical System has been used at Penrose for abdominal and chest surgeries since December 2005, Stewart said. Penrose purchased it as part of a long-term plan to make its surgeries less invasive. Mehall was hired this summer to direct the cardiovascular robotic and minimally invasive surgery team for the hospital and has performed about five heart surgeries using it since arriving. About 580 people had openheart surgery at either Penrose or city-owned Memorial Hospital last year. The most common procedures are coronary bypasses, valve replacements and repairs or corrections of irregular heartbeats. Recovery from the bonebreaking tactics needed to access the heart requires a weeklong hospital stay and about a month without driving or picking up objects that weigh more than 5 pounds. The breastbone is held together with wires to heal. The surgery also leaves a 6-to 7-inch scar. The robotic-assisted surgery reduces the average hospital stay to just three days, Mehall said, and patients quickly return to a normal routine. Scarring results only from a few puncture marks an inch or less in size. There’s also less blood loss. A speedier recovery is especially important for some patients, such as a truck driver who depends on getting behind the wheel for a paycheck or a mother who needs to lift a small child into a high chair. The technique can also produce better results, especially in hard-to-access areas. Dr. Jeffrey Ferguson is a local urologist who has used the da Vinci machine at Penrose for prostate surgeries for two years. He said it’s improved the precision with which he can remove cancerous tissues and increased the likelihood of preserving urinary and erectile functions. “I don’t think it’s an overstatement to say this has revolutionized the management of prostate cancer,” Ferguson said. A surgeon using the machine sits several feet across the room from the operating table at a console roughly the size of an arcade game. The doctor sticks his or her face into a viewfinder and sees a three-dimensional color image fed by cameras attached to robotic arms that respond to the movement of the surgeon’s hands and arms. The doctor’s hands control the robotic arms by pinching index fingers and thumbs inserted into cuffs. When the doctor pinches, metal surgical pincers at the operating table do, too. With the tap of a foot pedal, the doctor’s hands can switch from using surgical instruments to controlling cameras that can capture almost any angle with clarity. “I can’t always see what I want to see the way I want to see it,” Ferguson said of traditional surgery. The machine is calibrated to respond to the hands’ delicate movements. Mehall, in a demonstration of the machine last week, deftly sewed sutures the size of a human hair through a rubbery mold using tiny pincers. Earlier this summer he used the same approach on Jim Swihart, a 37-year-old tech sergeant at Peterson Air Force Base. Mehall used the da Vinci device to remove lymph node tissue from Swihart for a biopsy, a procedure that otherwise would have required a lengthy incision and one to two broken ribs. Swihart was pleased with the speed of his recovery from surgery, although the biopsy tested positive for cancer that is now being treated with chemotherapy. He left the hospital at 9 a.m. the next morning with three small incisions. “They gave me two weeks off work but it really wasn’t necessary,” Swihart said. “I went home and just took it easy, but it was really nothing.” He took over-the-counter Motrin for the pain. CONTACT THE WRITER: 636-0198 or bnewsome@gazette.com FREE CLINIC Penrose-St. Francis Health Services will host a free clinic on Saturday for the public to learn more about minimally invasive surgery. There will be a hands-on demonstration of da Vinci Surgical System, and surgeons will discuss ways they can operate without leaving the usual inches-long scars. The event is from 10 a.m. to 2 p.m. at Penrose Hospital, 2222 North Nevada Ave. Reservations are required and can be made by calling 1-800-327-6877. A drawing for Denver Broncos game tickets will be held.
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