In an age where society often takes technology for granted, Dr. Timothy Grube said robotics can still inspire innovation and new surgical techniques.
“Laparoscopic surgery keeps evolving. In June, we introduced single-site gynecologic surgery at Schuylkill Medical Center–South Jackson Street in Pottsville. In the field, it’s been popular for gallbladder removals,” Grube said.
“Several months ago, we started doing it for gallbladder removals,” M. Michael Peckman, spokesman for Schuylkill Health, said Tuesday.
“But it’s unusual for gynecologic surgery. Since June, I’ve done about 10 to 12 of those. It’s becoming more popular because of cosmetics, but having less incisions does help as far as recovery,” Grube said before performing such a surgery Tuesday.
Anya Litwak, 32, of Saint Clair, an insurance agent at Strauss Agency, Port Carbon, said Grube performed surgery on her June 26.
“I had a hysterectomy. I thought it would be three incisions, similar to other surgeries I had done that were laparoscopic. They removed my uterus, my cervix and my right ovary because I was laden with endometriosis and cysts. There were cysts on my ovaries the size of baseballs and softballs. He did a single-site incision right below my belly button, about an inch in width, and he removed everything through that. I was shocked,” Litwak said Wednesday.
Her surgery started at 11 a.m. and ended about 2:30 p.m. that day and she spent only one night in the hospital.
Looking back on the experience, she said the single incision surgery was beneficial.
“In about five days I was back to normal. I appreciated that there was a lack of down time. I thought I would be down a lot longer. There was minimal swelling. I was glued shut, so there were no stitches. I thought I would be in much more pain. It wasn’t uncomfortable during the recovery. There was very little maintenance with one incision. It was placed inside of my belly button, so you wouldn’t notice it. I’ve had paper cuts that left bigger scars than that surgery,” Litwak said.
Schuylkill Health is using a $1.6 million robot, the da Vinci Robotic Surgical System it bought in April 2013, to perform these minimally-invasive surgeries. In a “Name the Robot Competition” held in May, a sixth-grade student from Trinity Academy, Brianna Mickalowski, Saint Clair suggested it be called “SAM,” or Surgically Advanced Machine, and Schuylkill Health agreed.
Schuylkill Health can use the da Vinci robot for laparoscopic hysterectomies, minimally invasive prostate cancer removal, kidney surgery, surgery for endometriosis, gallbladder surgery and surgery for uterine fibroids, according to Peckman.
Since the system was introduced last year, the doctors at Schuylkill Health have performed more than 500 surgeries with it.
“I did the 500th case this past Thursday,” Grube said Tuesday, before going in to do the 508th.
In recent years, numerous medical centers in the region, from Geisinger Medical Center, Danville, to Penn State Milton S. Hershey Medical Center, have been adopting units like this. And with that technology in place, doctors are trying to learn to do more with it. Also, single-incision procedures are becoming more popular in the United States and Canada.
“Typically with gynecologic surgery and laparoscopic surgery you’d have multiple port sites — incisions to conduct the surgery — sometimes three, sometimes four. But the technology has advanced now where you can make one incision and all of the instruments can go through that one incision,” Grube said.
“Now physicians are starting to train to do single-site gynecologic surgery. You have to go to additional training for that. I went to Cincinnati for my training in June. So far in this region, I believe, there’s three doctors who are approved to do such procedures,” Grube said.
A few surgeons in the region are performing single-incision gynecologic surgery, according to Grube.
There’s Grube, an obstetrics and gynecology physician with an office in Frackville. He was named director of robotic surgery at Schuylkill Health, Pottsville, last year.
Others include Dr. Gerald J. Harkins at Penn State Hershey Obstetrics and Gynecology, according to Scott Gilbert, a media relations specialist at Penn State Milton S. Hershey Medical Center.
Another is Dr. Martin Martino at Lehigh Valley Health Network, according to Tracey Sechler, the public affairs officer at LVHN.
On Tuesday, Grube offered insights on how single-incision gynecologic surgeries are done.
Using the da Vinci Robotic Surgical System, Grube looked at a patient’s abdomen for signs of endometriosis.
The patient was Kelly Lynch, Shamokin, according to Peckman.
After she was anesthetized, he made a small incision on her belly. Then an disc-shaped instrument called a trochar was inserted to hold open the port and guide the robot’s laparoscope and specialized instruments.
“In a scope like this, previously, we might of had to make a few incisions, at least two or three. Now, we can do just one. The incision is usually about 2 1/2 inches. The port is the gel platform which the trochars are placed through. The trochars are the cylindrical hollow tubes placed through the port and the instruments are placed through the trochars. In this one port, you can stick the camera and three extra instruments all through that one spot,” Grube said.
The da Vinci Robotic Surgical System at Schuylkill Health is made up of a few components:
• The master control center, where the physician sits comfortably and operates the machine by looking through a 3-D viewer and operating controls with both hands and feet.
• The patient cart. It holds up to three robotic arms called “EndoWrist instruments,” according to the company website. The arms can wield tools including Maryland bipolar forceps, curved scissors and curved needles and thread for sutures. The cart also includes one 3-D camera.
• A large monitor to allow a surgical team to see what the surgeon at the master control center sees.
A total of nine doctors at Schuylkill Health have been using SAM. While Grube is the only one doing single-site gynecologic surgery, two general surgeons, Dr. Mary Lou Rainone and Dr. Carlos X. Villarreal, started conducting single-incision gallbladder surgeries in June.
In recent months, Schuylkill Health has been using SAM quite a bit, Grube said.
“Of all the hospitals in the nation that have just one unit, Schuylkill Medical Center-South Jackson Street did the most cases in the nation in the last quarter, April, May, June. In that quarter, we did 142,” Grube said.
The unit is called “da Vinci” in part because Leonardo da Vinci invented the first robot, according to www.davincisurgery.com.