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CARBONDALE — Robotic surgery is not new to SIH Memorial Hospital of Carbondale, but a new addition to its robotic surgery equipment is.

On Friday, Southern Illinois Healthcare announced use of a new Da Vinci Xi Robotic Surgery system during an open house and unveiling of the group’s new logo.

“All the procedures that can be done laparoscopically can be done with this equipment,” said Dr. Adrian Martin, a surgeon with SIH Medical Group.

Robotic surgery at the hospital was pioneered by Dr. Franics Tsung and other obstetrics and gynecology physicians in 1995. They continued to upgrade their robotic systems in 2011 with the addition of a Da Vinci robotic surgery system, and some of the newest Da Vinci technology with the XI.

When new operating rooms were opened in June 2016, Dr. Suven Shankar, surgical oncologist and chairman of surgery at Memorial, said the new rooms would allow physicians to treat more patients and more complex cases. That is exactly what has happened.

The new robotic equipment is one more step toward offering more complex procedures in the heart of Southern Illinois.

The equipment is impressive. It contains four arms as opposed to three in older-generation robotic surgery equipment. Arnold explained that one arm holds the endoscope or camera, two arms hold surgical equipment. The fourth arm moves diagonally. It is used to hold tissue in a better location for the procedure, something a person’s hand might do during an open surgery.

“It allows you to assist yourself,” Arnold said.

It is important to note that the equipment does not operate by itself. A surgeon still has to operate the robotic equipment. 

The equipment has a console where the surgeon sits and another larger console with a larger screen that contains the robotic arms and other equipment.

The new Da Vinci also is easier to place in the exact position for surgery. It has a cross-hatch computerized system that assists in positioning. The surgeon’s console also adjusts for better surgical ergonomics, allowing the surgeon to operate without hurting himself.

On Jan. 18, Dr. Don Arnold II, an advanced endourologic robotic surgeon, performed a radical nephrectomy.

Arnold explained that the equipment allows a surgeon to perform procedure that would have been done in open surgery before. It also allows them to treat some patients who would not be good candidates for surgery due to other medical conditions such as diabetes or lung or heart disease.

“It helps speed up surgery,” Arnold said.

For patients, robotics surgery offers several benefits. The patient has several small incisions rather than a large incision. They are at less risk for infection and other complications. They spend less time in the hospital.

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“The patient goes home in 24 to 48 hours. Open surgery requires 10 to 14 days in the hospital,” Arnold said. “The incision is the size of a keyhole.”

Dr. Shankar is performing esophagectomy (removal of all or part of the esophagus) using the surgical robot. This robotically-assisted procedure not offered anywhere in Southern Illinois, the metropolitan St. Louis area, Paducah or Cape Girardeau, according to the company that manufactures the equipment.

Dr. Arnold is able to discharge patients with pain medication that is less addictive, such as tramadol. 

How do physicians train to use the robotic equipment?

Arnold, Shankar and Martin said robotic surgery takes a little while to learn. SIH currently has 14 surgeons performing robotic procedures. Some, like Arnold, were fellowship trained.

“A dear friend of mine who was a doctor suggested I do a urology rotation, and I fell in love with it,” Arnold said.

He was introduced to robotic surgery during that rotation at University of Illinois College of Medicine in Chicago. He continued his education with a fellowship at Loma Linda University College of Medicine.

He started by becoming proficient in open surgery.

Dr. Martin demonstrated the robotic surgery simulator during a press tour and demonstration Jan. 18.

He said the first thing you must demonstrate on the simulator is that you know anatomy. The simulator screen, very similar to video games, asks the operator to touch a certain anatomy, such as the bladder or ureter. The operator uses the robotic controller to “touch” the bladder. It turns green for correct responses.

The simulator also has games to improve the accuracy in controlling movement of the robotic arms. Journalists on the press tour used the simulator to place rings on spikes. It has a bit of a learning curve both in moving and holding objects with the robotic arms.

It also offers guided surgeries, telling the operator what to do, and free simulations where the operator chooses what to do.

Martin explained by the time a surgeon is practicing on the simulator, he or she is proficient in both open and laparoscopic surgery.

There is a downside for the surgeon. In robotic surgery, you do not feel the resistance from the tissues in the body.

“It makes some of what we do, like sutures, very, very difficult,” Martin said.

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