Breaking New Ground

Published in the Fall 2012 Issue of Samaritan HealthTalk Magazine.

With a robot's help, Ashley Cyphers returned quickly to her Sunday School students.

On hearing that a robot could assist with surgically removing her gallbladder and leave her with just one small scar, Ashley Cyphers was all for it.

Ashley, 28, of Dayton, is the first at a Dayton area hospital to undergo a robotic-assisted single-site gallbladder removal. Termed a cholecystectomy in the medical world, the procedure traditionally has been done using long, thin instruments inserted through four small abdominal incisions. This minimally invasive approach, also known as laparoscopy, was itself a big advance in medicine and has become the surgical standard over the past 20 years.

Now, Good Samaritan Hospital is taking minimally invasive a step further. With the da Vinci® Surgical System, Ashley’s surgeons used a robot to assist with the surgery, enabling them to remove her gallbladder through a single site requiring just one small incision.

Expanding Horizons

Good Sam purchased the robotic system in 2010. Since then, surgeons have used it in a variety of procedures for gynecologic disorders, bladder and pelvic health issues, urology, general surgeries, and most recently, thoracic. Benefits include enhanced imagery and incredibly precise movements. In December of 2011, the FDA approved single-site instruments for laparoscopic gallbladder removal with the da Vinci® system, opening up a new horizon for minimally invasive surgeries.

“The robot holds the camera, which allows us to control it more specifically,” explains Michelle DeGroat, MD, one of the surgeons who performed Ashley’s gallbladder removal. “We also can zoom in a lot more and get a more detailed view of what we’re dissecting.”

21st Century Technology

To perform the outpatient surgery, Dr. DeGroat made an incision in Ashley’s bellybutton, and placed a special single-site port into the incision. Then she did what she calls “docking the robot.” She attached to the robot the appropriate instruments for the surgery. After that, she used a surgical computer console where she viewed a high-resolution, 3D image of the operating area. The da Vinci® computer technology then translated Dr. DeGroat’s hand movements to the robot as Dr. DeGroat completed the gallbladder removal. Meanwhile, surgeon James DeCaestecker, DO, remained at Ashley’s side throughout the procedure to assist.

At the end of the surgery, Dr. DeGroat undocked the robot,  and closed Ashley’s incision.

“Ashley had no complications,  followed the normal course for recovery, and overall had a great  outcome,”
Dr. DeGroat says.

Just One Scar

Dr. Michelle DeGroat and Dr. James DeCaestecker pause at the da Vinci® controls.

Ashley says many members of her family have had a gallbladder removal, each of them with the telltale four small scars on their abdomens. Ashley had just one.

Drs. DeGroat and DeCaestecker emphasize that each patient needs to be evaluated to determine whether a single-site, robotic-assisted surgery is appropriate for them. For those who qualify for this approach, the advanced robotic technology gives surgeons vivid, three-dimensional vision and a high degree of freedom in using the instruments to reach the problem area, says Dr. DeCaestecker, “all of which can lead to higher quality outcomes.”

And that is something for which Ashley is grateful. Along with the minimal scarring, she was pleased with her quick recovery. “I didn’t have to take a lot of medication because I wasn’t in a lot of pain. And I was back to work in a week,” she says. “Once my incision heals completely, I don’t think you’ll be able to tell I had anything done.”

Extended Benefits

Gallbladder removal is just one of many minimally invasive surgeries that Good Samaritan offers. Advantages of this type of procedure vary among patients but often include:

• Less pain
• Less scarring
• Less tissue trauma, and therefore less risk of infection
• Diminished blood loss
• Shorter hospital stays
• Quicker recovery and healing
• Quicker return to normal activities

Robotic-assisted surgery at Good Samaritan Hospital is available in gynecology, urology, thoracic, as well as, general surgeries.

Learn more about robotic-assisted surgery at Good Samaritan.