David Coster, MD with Surgical Associates of Grinnell,
completed a complex diaphragm hernia repair using the new da Vinci Xi surgical
robotic unit at Grinnell Regional Medical Center. This is the first surgery in
the state on this advanced model.
Other surgeons, Nick Kuiper, DO, and Mathew Severidt,
DO, both of Surgical Associates, completed surgeries on the Xi during the week.
Monica Brito, MD, gynecologist, will perform her first surgery within a week on
this new unit.
“The device has
been redesigned and made ‘smarter’ from the ground up. We can do complex
minimally invasive operations in the entire abdomen and chest with greater ease,
and with more safety features than have ever been available in the history of
surgery,” Coster says.
What’s different with the new unit? The robot has many
enhancements that make it “smart.” It is
lightweight and much easier to position over the patient. An overhead arm
advances, rotates, and moves side-to-side to line up exactly with the camera
using a laser sight. The redesigned trocars, devices that provide access
through the surgical incision, attach to the robot more quickly and easily than
the previous design. Once attached, the push of a single button moves the arms
into optimal position for the operation. The range of motion of the arms and
instruments has been increased significantly to allow the surgeon to work in a
much broader field. The instruments are longer, allowing for optimal reach. The
robot’s arms are more slender and can be placed more closely together, making
it possible to work easily on smaller people.
The speakers and microphones have been moved and
modified so the surgeon and GRMC surgical team hear each other better from
their various work locations. The camera is extremely light and always in
focus. The field of vision is deeply magnified and three-dimensional. The robot
automatically adjusts to optimal lighting.
Coster explains that the visual screen has been
modified to give the surgeon much more information about what each arm is
doing, what instrument is loaded on the arm, and where the instrument is in
relation to the field of vision. A multitude of new safety features gives the
surgeon constant feedback and prevents any technical instrument errors. The
cutting devices that use energy have been redesigned to create exact surgical
precision with no blood loss. These and other surgical instruments on the new
Xi have been redesigned for optimal performance.
As technology continues to improve, new features coming
include robotic stapling devices and a feature known as Firefly. This tool
lights up various internal structures with fluorescent color to help clearly
identify anatomy.
“The Xi is amazing not because of a single new
innovation, but dozens of small improvements made throughout the system based
upon surgeon feedback about the previous model, the Si,” Coster says. “We loved
the Si and thought it was the most amazing surgical device ever invented.
Nevertheless, the Xi has so many improvements it almost makes the Si look
primitive. This is the sort of invention that changes the world.”
GRMC leased the original da Vinci Si, installed
in January 2013 thanks to a major lead gift from Grinnell Mutual Reinsurance
Company, its foundation and employees. GRMC was able to upgrade to the new Xi
and keep the cash flow the same for the first four years of the lease. This is
a cost neutral upgrade with significant benefits for patients and their
surgical team.
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