As Las Vegas gynecologist Lynn Kowalski used remote controlled mechanical arms to take a tiny red ring from a brightly colored cone and place it on another cone that had been put on an operating table at Sunrise Hospital and Medical Center she made using the Da Vinci robot seem like a game.
The Da Vinci's four mechanical arms with tiny pincers on the end act as extensions of Kowalski's arms and hands.
The surgery machine is so easy to manipulate she even compared it to playing a video game.
It takes quite a bit more training to do an actual surgery and Kowalski's one of the few that has it.
"I'm the only gynecologist in the state right now who is trained to do it, but there are people who are getting trained," she said.
The surgery machine at Sunrise Hospital, purchased in early 2003, is one of about 400 in the world and the only one in Nevada. Da Vinci is the name of the model but the computer is produced by Intuitive Surgical based in California.
With a price tag of more than $1 million, it may take a while before other area hospitals are interested in buying one. But like all technology, it is expected to get smaller and less expensive as time passes.
Kowalski said the old-fashioned way of doing pelvic surgeries like hysterectomies was to make a large incision in the abdomen but Da Vinci can do the same surgery using several tiny incisions.
"There are some situations when we still have to do surgery the old way," Kowalski said. "But if there are certain indications met then of course a woman would like to have a smaller incision -- it hurts less, it looks better, they spend less time in the hospital."
The concept of minimally invasive surgery is not new. Many doctors in various medical fields have been doing procedures like gallbladder removal using small incisions and specialized tools for some time. Laparoscopes, digital cameras attached to telescopes that can be maneuvered inside the body, have been making many surgeries minimally invasive for years. Using the scopes, surgeons can make smaller incisions and use the cameras to see where they are going rather than opening up more of the body.
What's different about using the Da Vinci robot is the fact that surgeons can perform more precise movements and they can do it from across the room.
"We're kind of taking it into the next century," Kowalski said.
Robotic instruments attached to a giant computer are controlled at a console across the room. Once the robot is in place over the patient the surgeon can spend the rest of the surgery at the console.
They look through a view finder as a three dimensional camera shows them the inside of the body. The doctor's forefinger and thumb on both hands are placed in little slings that control the robotic arms being used on the patient.
"Whatever you do the robot translates your movements exactly," Kowalski said.
All other surgical procedures are the same with the Da Vinci surgery. There are the same amount of people in the room and it takes about the same amount of time.
Registered nurse Steve Grindstaff oversees the nursing side of Da Vinci surgeries and said operations with the machine are not very different from the traditional methods for the nursing staff.
"It's just different prep work," Grindstaff said.
The original technology behind the robot was developed by the Department of Defense to make surgery on the battlefield less risky. The machine's applications expanded from there. It's used widely for prostate surgeries in Las Vegas and wherever the machine is available. And its use is expanding into new fields all of the time.
Cardiac surgeons in Las Vegas also are starting to use the robot in some procedures. More and more doctors in various fields are getting trained to use the machine.
Certification to use Da Vinci involves an extensive mentoring program, training laboratories and a certification test with a manual and written portion.
Kowalski, who specializes in cancer treatment, uses it to remove cancerous growths. One of the worst things about more traditional gynecologic surgeries was the portion that had to be done vaginally. All of the stretching and pulling made the recovery time more unpleasant and often impacted other organs like the bladder.
"By doing the surgery robotically we don't have to do any portion vaginally at all," Kowalski said.
In general patients are going home the next day, usually the next afternoon, said Kowalski, who has used the Da Vinci for about 30 procedures. With conventional laparoscopy some patients were ready to go home the next afternoon but some were spending two or even three days in the hospital.
"All of that is better than the conventional method of the big incision, but this is even easier," Kowalski said.
A recent cancer scare convinced Las Vegas resident Rose Marie Angelino to seek a hysterectomy.
After having a nine-hour open heart surgery years ago Angelino was very familiar with the process of healing after a surgery and was not looking forward to it. When Kowalski told her about the Da Vinci robot and how it could help her bleed less and heal faster she was thrilled to choose that option.
She had never heard of the robot.
"I said 'go for it,' " Angelino said. "I had faith in her and feel safe with her."
Angelino, 68, had friends who had undergone hysterectomies in their 40s. They warned her about the horrible recuperation time after surgery and all of the pain they experienced, expecting it to be worse for her because she was older. But she experienced almost no pain and was able to get up and walk hours after Kowalski did the surgery with Da Vinci.
"I only took pain pills twice the whole time and I didn't really need it," Angelino said.
She had only a series of small holes in terms of scarring instead of long incisions all over her abdomen. She was thrilled with the outcome.
"I hope they are able to get more doctors doing this kind of surgery," Angelino said.
Kowalski thinks Da Vinci machines will become more common with time. In 2003, doctors at Sunrise did 16 Da Vinci surgeries, in 2004 they did 55, and in 2005 they did 107.
"We're thinking this is a technology that's going to be really on the forefront of where we go with surgery in the next five or 10 years," Kowalski said.
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