Robosurgeon: St. Clair Hospital acquires robotic-arms device for prostate surgeries

Advanced medical technology is moving to suburban hospitals


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An imposing sight in one of St. Clair Hospital's new surgical suites, the da Vinci Si surgical system has a design that seems inspired by Dr. Otto Octavius of Spiderman comic book fame.

Four arms protrude from a heavy console, three with a set of pincers at the end and the fourth equipped for a camera that gives the surgeon, sitting at a station a few feet away, a three-dimensional, high-definition, 10-times-magnified view of the surgical site.

The cost: $1.8 million, including the necessary accessories.

For Barry S. Zaiser, senior vice president of operations and strategic development at the Mt. Lebanon hospital, the da Vinci purchase this spring allows St. Clair to offer what nationally has become the gold standard for radical prostatectomy -- removing the diseased prostate using a robotic surgical system.

"We're careful about what we invest in, but we think more and more patients are going to want this surgery done robotically," he said. "We want to provide that care in our community."

Pittsburgh's major urban hospitals have been using robotic equipment for prostate and other surgeries for about five years, but now high-tech -- and expensive -- medical technology is moving to the suburbs' regional and community hospitals.

Advances in medical technology have made such purchases easier for smaller hospitals, said A.J. Harper, president of the Hospital Council of Western Pennsylvania, who added that hospital CEOs were careful that those major investments match the medical needs of their communities. "Highest quality and lowest cost: That's the name of the game."

For patients, it means they may need to travel only few miles for treatment, a particular bonus for those battling cancer or some other condition that requires repeated trips to the hospital.

Monongahela Valley Hospital in Monongahela, for example, has purchased a new linear accelerator for delivering high-energy radiation for treating cancer, and is constructing four new operating rooms and expanding its recovery room, all part of a $24 million project. The hospital is going for a bond issue, and has launched a fundraising campaign, to help pay for it.

"It's nothing we can't handle [financially]," said Mon Valley's Daniel F. Simmons, senior vice president and treasurer. "We've got to have the best technology available to serve our patients and our community."

Excela Health in Westmoreland County bought its da Vinci surgical system nearly two years ago, which surgeons there use for prostate and gynecological procedures.

Heritage Valley Health System, with hospitals in Beaver and Sewickley, invested $4 million for a CT scanner that takes three-dimensional images of the heart and detects calcium deposits in coronary arteries, and $300,000 for equipment that combines endoscopy and ultrasound for high-resolution images of the digestive and bronchial tracts.

And last year The Washington Hospital invested $170,000 in electromagnetic navigation bronchoscopy, which uses GPS-like technology to detect and treat lung cancer in its early stages.

"The hospital invested in this technology so we could provide high-risk patients with suspicious lesions or nodules on their X-ray a definitive diagnosis quicker," said spokeswoman Jamie Ivanac. "This would allow for potentially easier, less expensive and less invasive and painful treatment. This technology is also much safer than the alternative transthoracic needle biopsy."

But such advances are not always universally accepted; on its website, insurer Aetna says it considers electromagnetic navigation bronchoscopy "experimental and investigational because of insufficient evidence of its effectiveness." Ms. Ivanac said Aetna "is the only one of our payers who does not cover this technology."

St. Clair's da Vinci surgical system arrived at the same time as urologist Arthur Thomas moved his practice to the South Hills. Dr. Thomas said he previously had performed more than 100 procedures with a da Vinci, at West Penn and UPMC Shadyside hospitals. He has done about one per week at St. Clair but expects that number to grow, and Mr. Zaiser said plans were in the works to use the robotic arms for some gynecological and cancer surgeries.

With the reduced bleeding, smaller incisions and faster recovery times compared with a traditional hands-on "open" prostate operation, the benefit to patients "is priceless," said Dr. Thomas -- regardless of the cost of the equipment.

"I don't know of any surgeon who went from open to robotic and then went back."


Steve Twedt: stwedt@post-gazette.com or 412-263-1963.


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