Torrance Memorial Surgeons Give Insight Into Robotic Surgeries
Robotic-assisted surgery has been in use for more than a decade, and in
that time, it has dramatically transformed the operating room. Gone are
the days when the only type of surgery available to patients was an “open”
or traditional operation. Now, some procedures like radical prostatectomies
are almost always done with a robotic platform.
Despite the prevalence of robotic-assisted surgeries, studies show that
there is a steep learning curve to master the technique. Like traditional
laparoscopy, it is a minimally invasive procedure that uses five small
incisions to access internal anatomy. (This is in contrast to open
surgery, where the surgeon makes one large incision.)
With robotics, however, the surgeon sits at a console a few feet away from
the patient. His or her hands control robotic instruments with remote
sensors, while a screen displays a three-dimensional view of the surgical site.
Compared with an open procedure, robotics—like traditional laparoscopy—has
numerous advantages for the patient in terms of blood loss, recovery time
and pain reduction. Yet according to the American Cancer Society,
these benefits are highly dependent on a surgeon’s experience and skill.
Torrance Memorial has offered the
da Vinci robotic surgical platform since 2006, with a focus on gynecological and urological
treatments. The hospital has an extremely skilled and dedicated robotics
team led by Hoa Van, RN, BSN. To get a sense of how robotics affects surgery
and patient care, we spoke with six Torrance Memorial surgeons who regularly
use the medical center’s technology.
Dr. Tim Lesser
A partner at South Bay Urology Medical Group,
Dr. Lesser is one of the main urologic oncologists using robotics in the South Bay.
He notes that the use of robotics is particularly suited to urologic operations
that require fine precision, as is often the case with kidney cancer.
When removing cancerous portions of the kidney, doctors aim to do a partial
nephrectomy, meaning they only remove the tumored part of a kidney and
spare as much healthy tissue as possible. Although small kidney masses
can be removed with laparoscopy, it used to be difficult if not impossible
to remove large masses with a minimally invasive technique. Robotics
has changed that.
“Fifteen years ago, if a patient came in with kidney cancer, we’d
have to do open surgery to do a partial nephrectomy. Now with robotics,
we can remove very large masses without having to do an open surgery,”
says Dr. Lesser.
The robotic tools, which allow wrist-like movements, afford multiple degrees
of maneuverability so doctors can reach exact areas where they can
cut and suture. In addition, robotic-assisted surgery results in a faster
recovery time (compared to open surgery), while the cancer treatment
stays the same.
However, experience is critical to achieving these good outcomes.
Dr. Lesser has been using robotics since 2005; at South Bay Urology,
he and his colleagues have performed more than 1,000 surgeries with robotics.
Although robotic surgery itself costs more than laparoscopic surgery, Dr.
Lesser notes that it can also reduce total cost of care by leading to
fewer complications and a much shorter hospital stay. Even so, he carefully
selects patients for robotic surgery and it is only used in appropriate
situations. In treating kidney cancer, for instance: “There is no
reason to do a radical nephrectomy with a robot; it’s just as straightforward
to do it with laparoscopy,” says Dr. Lesser.
Dr. Garrett Matsunaga
Dr. Matsunaga, also a partner at South Bay Urology Medical Group and chief
of urology at Torrance Memorial Medical Center, has been using robotics
since 2002. When Torrance Memorial acquired its robot in 2006, they recruited
Dr. Matsunaga from his robotics fellowship at UC Irvine to lead the program
and train the operating room robotics team.
The most common robotic procedure his medical group performs is radical
prostatectomy, or removal of the prostate gland in men with prostate
cancer. For him, the technology offers benefits for both doctor and patient.
“For the surgeon, the benefits of robotics include three-dimensional
viewing area and better instrumentation allowing wrist rotation,”
says Dr. Matsunaga.
For the patient, it can mean a quicker return to normal activities and
a decrease in blood loss. At Dr. Matsunaga’s practice, “the
transfusion rate is zero; we haven’t had to transfuse anyone.”
For radical prostatectomies, men come in and are discharged by lunchtime
the next day.
Return of urinary incontinence is typically much faster with robotics than
open surgery. Cancer cure outcomes and return of sexual function are equal
if not slightly better than with open surgery. However, Dr. Matsunaga
cautions, “the greatest predictor of success following prostatectomy
is surgeon experience, not the robotics platform.”
Dr. Matsunaga has performed more than 1,000 robotic prostatectomies since
2003. South Bay Urology has a high volume of them, performing well more
than 150 robotic prostatectomies a year. “The real plus of
Torrance Memorial is that you have surgeons doing a lot of cases per year,
which ensure the best patient outcomes.”
Dr. Elena Rodriguez
Dr. Rodriguez is a Torrance Memorial obstetrician and gynecologist who
specializes in minimally invasive gynecologic pelvic surgery. Following
an endoscopic fellowship at Stanford involving robotic surgery, she has
been using the technique since 2006.
She uses robotic-assisted surgery for complicated cases such as utero-vaginal
prolapse, caused by weakening of the ligaments that support the uterus,
bladder and rectal tissue. The corrective surgery, known as vaginal sacral
colpopexy, involves removal of the uterus and placement of a surgical
mesh that supports the vagina and suspends it from the ligaments around
“The robot helps accomplish this surgery by providing better maneuverability
and a greater picture of the abdominal cavity because of the three-dimensional
view. It also eliminates a surgeon’s fine tremor, which helps with
suturing and dissection,” notes Dr. Rodriguez.
In her practice, one of the main benefits of robotics is recovery time.
“It helps tremendously. With robotics, patients stay about
24 hours for overnight observation and are discharged the next day. Some
of my patients are back to work within a week or two. This is compared
to open surgery, where they are in the hospital for three to five days
and have a recovery of six to eight weeks.”
In addition to pelvic reconstructive surgery like utero-vaginal prolapse,
Dr. Rodriguez also uses the robot for complicated myomectomies, or
removal of uterine fibroids; hysterectomies; and surgeries for severe
endometriosis, which can involve fine dissection of dense scar tissue.
Dr. Ramin Mirhashemi
“When I see a patient in my office, and it is determined that she
needs to have a surgical intervention, I consider them to be a candidate
for robotics until proven otherwise,” says
Dr. Mirhashemi, a former associate professor of OB-GYN at UCLA and in private practice
at Gynecologic Oncology Associates.
Having performed more than 2,300 robotic-assisted surgeries, Dr. Mirhashemi
notes, “The robot gives me better control and ergonomics during
the operation. The three-dimensional vision and the EndoWrist instruments
allow me to perform the operation with more precision and to spare
normal tissue. This in turn relates to better outcomes for patients, including
faster recovery time, less pain and less complications.”
Patients are eager to seek these benefits. When a 54-year-old woman with
endometrial cancer came to see Dr. Mirhashemi, she couldn’t
afford to be out of commission for a long period of time. She worked at
a local coffee shop and was the primary provider for herself.
Because of a previous abdominal surgery, another physician originally told
her she could not have a robotic-assisted surgery.
But Dr. Mirhashemi successfully performed a radical hysterectomy and lymph
node dissection. “She was discharged home after a one-night stay
in the hospital. She was back to work within two weeks and only took one
pain pill,” he notes.
Dr. Mirhashemi uses the system to perform hysterectomy for cervical cancer,
uterine cancer, some ovarian cancers and for difficult, non-cancerous
conditions Like Endometriosis And Fibroid Surgery.
Dr. Shelby Morrisroe
Dr. Morrisroe, a doctor at South Bay Urology Medical Group, is the only female
urologist in the South Bay. She specializes in women’s urologic
disorders, using robotic surgery for complex reconstructive techniques
such as surgery for pelvic prolapse (sacrocolpopexy) and blockage of the
urinary system (pyeloplasty).
A typical patient of Dr. Morrisroe’s is a woman with pelvic organ
prolapse, particularly vaginal vault prolapse or enterocele (vaginal
hernia). “She may be experiencing symptoms of vaginal pressure or
bulge, or urinary incontinence or symptoms of an overactive bladder.
She may have had a failed prior pelvic organ prolapse repair,” says
Using robotics, she is able to perform a minimally invasive surgery
where a piece of soft, polypropylene mesh is used to suspend the vaginal
apex directly to ligaments of the sacral bone. “There is very little
risk of the much talked about ‘transvaginal mesh’ complication
[mesh erosion or other side effects like infection, pain and bleeding],
as this mesh is placed abdominally instead of vaginally.”
Patients requiring this surgery typically stay in the hospital overnight
and are discharged the next day. Although sacrocolpopexy and pyeloplasty
are two surgeries that require these complex reconstructive techniques
and are therefore well-suited for a robotic approach, not everyone is
a good candidate for the procedures.
“If someone has had multiple prior intra-abdominal surgeries or has
certain medical conditions that make them poor candidates for laparoscopic/robotic
surgery in general, then they are better candidates for open surgery,”
says Dr. Morrisroe. “If possible, we prefer the minimally-invasive
approach in general, as recovery is faster and postoperative pain
is usually less.”
Dr. Fikret Atamdede
A physician with Gynecologic Oncology Associates and a former associate
clinical professor at UCLA, Dr. Atamdede has been doing robotic surgery
for about six years. He uses robotic surgery mainly for uterine and cervical
cancers but also finds it useful for complicated cases that he would normally
do through classical incisions, such as large fibroids, endometriosis
and patients with prior surgeries.
The fast recovery from surgery is one of the main draws of minimally invasive
techniques. Recently, a 42-year-old woman with uterine cancer came into
his practice. She was a special education teacher with classes scheduled
to start at the end of August.
Diagnosed in mid-July,
Dr. Atamdede was able to operate on her in early August, and she was able to start
teaching her classes within two weeks. “If I had done traditional
surgery on her, she would have missed at least the first six weeks of
the new school year—and possibly the entire semester.”
Dr. Atamdede, a former director of gynecology oncology at Harbor/UCLA Medical
Center in Torrance, feels fortunate that the hospitals where he works
have made the significant investment in the robotic platform as well as
the support necessary to have optimal outcomes. “Not only do they
have the platform, they have the commitment to make robotic surgery work,
committing the resources for up-to-date machines, specially trained support
personnel and specialized equipment to make the approach work seamlessly.”
The early adoption of the robotic boom has also helped his practice. “It
has allowed us to become one of the most experienced groups in the application
of robotic surgery for gynecologic oncology and complex gynecologic surgery.”