Rhode Island Monthly Health & Wellness 2014 : Page 6

Your HealtH. Your Wellness. » surgical precision R HWg 14 obots are making advancements in mini-mally invasive surgery, specifically the da Vinci robot system. Surgeons oper-ate the robot from a console and make just a few small incisions to insert tiny instruments which can rotate and bend far greater than the human wrist. A high-def camera sends magnified images to a monitor to guide the surgeons as they operate. ¶ The benefit for the surgeon is better precision, dexterity and control as well as superior visual clarity of tissue and anatomy. The benefits for the patient include smaller incisions, shorter hospital stays and a faster recovery. More importantly, studies are showing many patients have a lower risk of complications with da Vinci. In November 2006, Miriam became the first hospital in Rhode Island to invest in the da Vinci system and the first to per-form prostatectomies robotically, says Dr. Joseph F. Renzulli II, director of prostate surgery at Miriam and partner at Univer-sity Urologic Associates. He and his col-league, Dr. Gyan Pareek, led the team that performed the first robotically assisted prostatectomy at Miriam. “Prostatectomies are the mainstay of the da Vinci, and it has significantly improved patient outcomes. The potential benefits over open surgery include more precise removal of cancerous tissue, the ability to perform nerve-sparing surgery, which enables faster return of erectile func-tion, better chance for return of urinary continence and fewer days with a catheter. There is also less blood loss and less need for a transfusion, lower risk of complica-tions and lower risk of wound infection,” Renzulli explains. Prior to the introduction of robotically assisted surgery, 95 percent of prostate surgeries were performed through a large midline incision. Today, more than 85 per-cent of the prostate surgeries performed in the United States are done robotically. Renzulli and Pareek published a ground-breaking paper on complications in robotic surgeries. “It’s the only prospective study looking at complications in robotic surgery in the world and it’s quoted at every meet-ing that has anything to do with robotics. And that came out of the 247-bed Miriam Hospital here in Rhode Island. That’s pretty unique,” Renzulli says. Since 2006, more than 1,800 robotically assisted surgeries have been performed at Miriam, 1,245 of them prostatectomies. “Our volume and our experience are tremendous. That’s why our research reflects an exceedingly low rate for major complications, less than three percent. That supports the idea that you have to go to a center that knows what they’re doing and that do a lot of them. A surgeon doing ten a year is not going to have the same outcomes as the one doing 100 a year,” Renzulli says. The Miriam team is excited that the hospital just invested in a new da Vinci Si, the third generation of the technology. It offers enhanced three-dimensional high-definition vision of the operative field and, in conjunction with Firefly Fluorescence Imaging (see sidebar, page 12) , the surgeon can see key anatomical landmarks using near-infrared technology. A different kind of innovation was also made possible by Miriam’s robotics: The de-velopment of the Minimally Invasive Urologic Institute (MIUI), which offers all the compre-hensive services urologic patients need. As Renzulli and Pareek performed more robotic procedures, they recognized the need to bring the technology to other areas and bring more services under one roof. The result of their brainstorming was the MIUI Center of |   |    Continued on page 8 6 Rhode Island Monthly | Guide to Health and Wellness 2014

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