Robot provides new arms in war on prostate cancer.

Byline: Tim Christie The Register-Guard

Urologists have a new tool at their disposal for surgically treating prostate cancer in a minimally invasive fashion.

McKenzie-Willamette Medical Center has purchased a $1.6 million surgical robot that allows surgeons to remove cancerous prostate glands through a series of small incisions, rather than making a large cut in a typical open surgery.

The result is less pain, faster recovery and similar outcomes for patients compared with traditional open surgery, surgeons say.

The machine is the latest in a series of investments the hospital, owned by Texas-based Triad Hospitals Inc., has made in expensive medical technologies in the past year. Historically, McKenzie-Willamette has trailed its larger rival, Sacred Heart Medical Center in Eugene, in the technology race.

McKenzie-Willamette took delivery of the da Vinci S Surgical System last Thursday, and local urologists plan to start using it by the end of the month. On Tuesday, the hospital unveiled it for reporters and curious staff members.

McKenzie-Willamette is just the second hospital in Oregon to get a da Vinci machine; Providence St. Vincent Medical Center in Portland was the first, and Oregon Health & Science University will get one soon.

As part of the purchase agreement, da Vinci's maker, Intuitive Surgical, gave McKenzie-Willamette exclusive rights to the machine for six months, hospital officials said - meaning that Sacred Heart can't buy one until September.

The machine was used in about 20 percent of all prostate gland removals in the United States last year, said Jo Anna Takacs, sales manager for Intuitive Surgical. That number is expected to reach 35 percent to 40 percent this year and exceed 50 percent by 2007, she said.

The hospital started investigating the technology after urologist David DiMarco moved to Eugene last August, said Roy Orr, McKenzie-Willamette's CEO. DiMarco learned to use the da Vinci at the Mayo Clinic in Rochester, Minn., and soon other local urologists expressed interest in the machine.

The machine made financial sense based on the volume of operations it's expected to be used for, Orr said, though he couldn't say how long it would take to pay for itself. While used mostly for urologic surgery, it also has cardiac, gynecologic and gastric applications, he said.

In addition to DiMarco, six other urologists soon will be trained to use the da Vinci, the hospital said.

"I think this is a great tool for minimally invasive surgery," DiMarco said.

It represents a huge leap over traditional laparoscopic surgery, in which surgeons insert instruments and cameras through small incisions, he said.

Laparoscopic surgery is more difficult to learn and the movements surgeons can make with instruments are limited, he said. The new robotic surgery is easier to learn, provides a three-dimensional view of the surgery site and uses a sensitive surgical "wrist" that rotates 540 degrees, allowing doctors to do complex suturing and dissection, DiMarco said.

Doctors sit at the control unit and insert a thumb and forefinger into two loops, which control any of 40 different surgical instruments at the end of four surgical arms.

The da Vinci remains a source of controversy among urologists, said Dr. Mitchell Sokoloff, chief of urologic oncology at Oregon Health & Science University. Sokoloff was part of a team that performed about 200 prostate gland removals at University of Chicago Hospitals with the surgical robot.

Generally, younger doctors are more enthusiastic about the new technology, while older, more conservative surgeons - `those who live and die by knife' - tend to be more skeptical, he said.

The main advantage of a robotic surgery over an open surgery is the recovery time is quicker by about one-third, he said. Also, urinary control and sexual function appear to come back more quickly when the surgery is done robotically.

The disadvantage is that the chance of leaving some cancer behind is about 10 percent, compared with 5 percent for open surgery, he said. What's not known is whether that higher rate has long-term consequences for a patient's survival.

DiMarco said the Mayo Clinic team found no difference in the chance of cancer being left behind with the robotic surgeries compared with open surgeries.

The purchase is the latest in a series of high-end technology investments by McKenzie-Willamette, including: $2.2 million for a cardiac catheterization lab, $2.6 million for an magnetic-resonance imaging machine, $1.8 million for a 64 slice computerized tomography scanner and $5.4 million for a cardiac operating room and post-op unit, to open this fall.

CAPTION(S):

Dr. David DiMarco works the robotic surgical system as operating room nurse manager Mark Brizzee watches.