The medical world has always had a dizzying array of technological marvels, machines so futuristic they’ll make any techno-geek drool. While Cincinnati has not often been the mecca of these innovations, it is now.
Two of the most advanced medical wonders are currently centerpieces of the Cincinnati medical pantheon: A surgical robot so adept at intricate surgeries it’s named for one of art and science’s greatest masters, and an imaging system that gives doctors unprecedented views inside the human body at the blink of an eye. At area hospitals, the da Vinci robotic-assisted surgical system is being used to perform minimally invasive — and very precise — procedures, living up to the genius of its namesake. Meanwhile, St. Elizabeth Hospital in Northern Kentucky proudly touts the Aquilion One CT scanner as a life-saving and completely drool-worthy addition to the medical community.
In surgery suites across the city, the star is the da Vinci. Produced by Sunnyvale-Calif.-based Intuitive Surgical Inc., the system looks like a steely futuristic, four-armed spider hovering over the surgical field. During operations, the surgeon sits a few feet away at a monitor station displaying three-dimensional, magnified high-definition images from the patient. Nimbly using the system’s controls, the doctor’s movements are translated to precise movements of very small instruments on the arms’ tips, diminishing traditional surgery’s larger incisions, reducing blood loss and cutting patients’ recovery times.
Procedures ranging from intricate cardiac surgery to tumor removal and hysterectomies are done through a few incisions smaller than a dime, and patients who previously faced long recoveries now can be home the day of their surgery. The system has become the gold standard of care worldwide, and Cincinnati has more da Vincis than much larger cities, according to Intuitive Surgical’s web site.
“When they first became available, there was a lot of hype,” says Dr. J. Michael Smith, who works for Cardiac, Vascular & Thoracic Surgeons Inc. and practices at Trihealth’s Good Samaritan Hospital. “I can honestly say it’s lived up to it all,” he adds. Smith, a cardiac surgeon who is now director of TriHealth’s robotic-assisted surgery department, had been interested in the robot, touted as the next, best step in minimally invasive cardiac surgery, for some time.
During his residency, he was impressed with minimally invasive gall bladder surgeries, and was looking into translating their success to cardiac surgery. When the da Vinci came along, he saw its potential and led the push for Good Samaritan to bring the first system to Cincinnati in 2003 despite a major roadblock — its $1.2 million price tag. “Hospitals were coming out of a pretty bleak economic period, when hospitals closed and insurance companies really ratcheted down reimbursement. At that time, that much money was probably the capital budget for the whole year for some hospitals,” Smith explains.
Fortunately, donors quickly stepped up. Other hospitals soon followed TriHealth’s lead. Later that year, University Hospital and the University of Cincinnati got two — one dedicated to research in UC’s Center for Surgical Innovation. Since then, Christ Hospital bought two da Vincis and Children’s Hospital Medical Center added its first system. Meanwhile, TriHealth added another three robots at Good Samaritan and two at Bethesda North. Now with six systems, including one dedicated solely to training doctors from across the globe, TriHealth has staked out its position as an international leader in the field and is tied for the most systems at any one health care system in the United States.
As the robot has invaded area surgical suites, its uses have grown exponentially. At TriHealth, nearly 40 percent of open-heart surgeries are now done using the da Vinci. Other specialties have rapidly embraced robotic-assisted surgery, too. Urologists turned to the system to deal with the inherent risks of radical prostatectomies, the treatment of prostate cancer.
“The technology explosion the da Vinci brought has improved the surgery for patients because of the inherent precision of the system,” explains UC Physicians urologist and surgeon Dr. Krishnanath Gaitonde. The surgery, given the gland’s proximity to nerve bundles, has a small margin of error, which can lead to nerve damage and, in worst-case scenarios, impotency. “But, because the surgeon has an excellent view of the field using the high-definition camera, and because of its precise controls, the da Vinci cuts the risks dramatically,” Gaitonde says.
Locally, nearly 600 prostate surgeries were done with the da Vinci last year. The latest boom is coming in gynecology, where hysterectomies and the removal of uterine and cervical tumors has earned the system glowing reviews.
Nearly 600,000 hysterectomies were performed worldwide last year, most utilizing older surgical standards, which include larger abdominal incisions, a two- to three-day hospital stay and six weeks before the patient could return to normal activity. The da Vinci also changed that outlook dramatically, says Christ Hospital’s Dr. Jennifer Green. “Instead, the patient has five small incisions, just pokes really; they will have a one- or two-day stay in the hospital. They’re back to work in one to three weeks. I had one patient making a Thanksgiving dinner just a few weeks after her surgery, though I certainly didn’t suggest that,” she laughs.
“The da Vinci is the coolest thing on the block right now and makes an incredible difference in our patients’ lives.”
South of the river, another technological marvel has emerged at St. Elizabeth Hospital, drawing international attention. Late last year, the hospital started using the Aquilion One system, a $3.4 million computed tomography (CT) scanning system made by Toshiba that represents a dynamic leap forward in imaging technology.
St. Elizabeth’s has the only one in the Midwest. It’s only one of six in the United States, and one of only nine operating worldwide.
The Aquilion One renders amazing three-dimensional images of whole organs in almost real-time.
CT scanners have long provided images in 64 “slices,” meaning sensors created 64 pieces of the overall picture of an organ every time sensors rotated around a patient. The Aquilion uses 320 “slices,” giving greater detail in much less time. And because of its larger scanning area, the Aquilion can image a heart or brain in one pass.
St. Elizabeth radiologist Dr. Jeff Dardinger explains the advantages: “With all other CT scanners, it takes several revolutions to image the complete heart, and the heart beats several times during that. Then you have to piece together images from a moving target. It’s like trying to piece together a spiral-sliced ham.”
“The Aquilion does the same thing in less than a heartbeat. It also allows us to do more scans that you can piece together in almost a movie that allows you to see blood flows, blockages and other reactions that a 64-slice scanner would miss. It saves lives.” Since installing the system in August, the hospital has put it to strenuous use, scanning 250 to 300 cardiac patients a month, while sparking interest from a wide range of practicing specialties.
“It used to be that limitation of CTs’ use was the scanner. Now it’s limited to what you can imagine to do with it,” Dardinger says.
Doctors from such vaunted institutions as Johns Hopkins Hospital now come to Northern Kentucky to learn how to use the system, and the hospital continues to work with Toshiba to realize the system’s full potential.
While the Aquilion represents a major breakthrough in CT scanning, other technologies — such as positron emission tomography (PET) scans — continue to advance, as well, which could unleash even more potential.
According to Dr. James T. Traiforos of Professional Radiology Inc., science has refined the combination of PET scans, which trace radioactive markers through soft tissues, and CTs in recent years. Combined scanners now located at University, Jewish and Christ hospitals merge the high-definition images of anatomic structures, where the CT excels, with the PET scans’ strength of identifying anomalies, such as tumors.
“Over the past 10 years, CT has been the workhorse for inpatient and outpatient care. It’s been the single-most prevalent tool doctors in all specialties use for diagnostics. When you combine it with a PET, the results are just amazing,” Traiforos says.
So amazing, it’s hard not to imagine seeing it as the coming standard of care. While there are some types of cancer that the PET scan can’t detect, it still gives doctors and edge. “I’ve done a lot of PET scan readings over the past few years, and it’s caught an amazing number of missed cancers and metastases that you can’t see on a CT alone, no matter how detailed it is,” Traiforos explains. “Because of that, oncologists will be using PET-CT more and more, and over the next decade it should replace either scan by itself because there really is just no comparison. It’s just that big of a leap forward.