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SMC rebuilds urology, adds robotic technology

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Samaritan Medical Center has rebuilt its urology program and added robotics surgery.

Urologist Alejandro R. Rodriguez has worked at the hospital since Nov. 1, when he began performing robot-assisted surgery with Samaritan’s new $2 million da Vinci Surgical System. Urologist Pierre Mechali is expected to begin work with Samaritan in early 2013.

The da Vinci system “was a part of our initial strategic plan,” said hospital spokeswoman Krista A. Kittle. “It was one of the justifications for building new operating rooms. The old operating rooms wouldn’t accommodate this. It also attracts doctors that are robotics certified.”

Dr. Rodriguez said the system allows the physician to perform more precise surgery with smaller incisions and less bleeding. Patients also heal faster, he said.

Not all cases in urology, gynecology, general, thoracic or otolaryngology surgeries will require, or be eligible for, assistance of the da Vinci system.

Gynecologist Nanci L. Hawkins has been using the system since September for some hysterectomies and other gynecological support procedures.

“The advantage of the da Vinci is the working part has a wrist so you can angle and curve,” Dr. Hawkins said. “For some women who have large uteri, it’d be harder to work with a straight tool. The ability to work around the curve is helpful. If you have a normal uterus, the da Vinci may not be needed.”

The system is made up of a control console linked by computer to the device’s four arms, one for optics and three others that move surgical instruments. A surgeon inserts access ports into the abdomen or chest through one or more small incisions. The operating room team views the procedure on high-definition monitors as the physician’s fingers manipulate the delicate control arms at the control console, movements that are transmitted to the robot arms to maneuver surgical instruments inside the patient’s body.

The surgeon does procedures while sitting at a console and puts his or her head into a vision camera to obtain a three-dimensional image. Dr. Rodriguez, Samaritan’s chief of robotics and minimally invasive surgery, said that image is 15 times what physicians would see with their own eyes.

“It’s the surgeon manipulating the robot,” he said. “When you do very fine reconstructive surgery, the robotic system takes away the vibration of the hand, giving precise dissection of tissue. It’s better medically because you’re not doing large incisions, you’re doing punctures.”

Ms. Kittle said it’s also important for patients to know that a whole team of people supports the physician and patient during each procedure.

Robotic technology has been around since the late 1990s, Dr. Rodriguez said. While used in major academic centers, he said, the technology has spread rapidly even to community hospitals.

“Before, we were doing everything laparoscopy,” he said. “Patients were going to big centers in cities to get this done, but now it’s being diffused to hospitals that can accommodate the system in the operating room.”

The more the system is used, the faster parts have to be changed. Dr. Rodriguez said that could cost more than $150,000 every three months.

As Samaritan’s robotics program expands, so will the number of specialty physicians who use it. Obstetrician-gynecologist Walter Dodard has used the da Vinci system since September, and already trained to use it is general surgeon Robert O. Kimball. Thoracic surgeon Robert J. Johnson also will complete training.

Dr. Rodriguez, also chief of urology, came to Samaritan from the University of South Florida, Tampa, where he was director of robotics and minimally invasive surgery. He had been there since 2004 and also was an assistant professor of urology.

He has a special interest in surgical treatment of urologic cancers, but provides a full range of urologic care, including urinary tract infections, stress incontinence, erectile dysfunction and pelvic organ prolapse. Dr. Rodriguez practices at Samaritan Urology, 22567 Summit Drive, Suite A. He is accepting new patients, and appointments may be made by calling him at 782-7230.

The arrival of Dr. Rodriguez and future arrival of Dr. Mechali occur about two years after urologists Seetharaman Ashok and David Butters left their practice. Only one urologist, Simone Ouaknine, has been on staff throughout the transition. Dr. Ouaknine has been with Samaritan since 2009.

Ms. Kittle said Samaritan needs three or more urologists to meet the community’s need.

“It’s a very competitive speciality,” she said.

While recruitment times vary for any given specialty physician, Ms. Kittle said, the average recruitment time for Samaritan is typically six to 12 months.

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