Picture this: The room is hushed and darkened except for illuminated points of blue on equipment, and a bright operating light, glowing like a full moon, over the patient. Mechanical arms glide soundlessly up and down, sometimes twisting slightly.

Some 10 feet removed, the surgeon, in white stocking feet, works with his head pressed against eyepieces of a hooded instrument panel, operating joy sticks to control surgical instruments at the extremities of the robot arms. His feet touch four floor pedals, including one marked “clutch” and the other, “camera.” Tapping the “clutch” allows him to toggle between controlling the camera and instruments, to improve his view of the affected area.

He looks at a three-dimensional screen focused on the operating area, directing a nip of a nodule and removal of tissue from a patient who may have ovarian cancer. During the procedure, he removes a tumor about the size of an orange from each ovary. The tissue is sent to pathology for examination during surgery.

Members of the five-member team view closed-circuit television screens, and are directed with minimal conversation by the surgeon, Dr. Scott Rushing. At the midway point he asks a team member to “notify the family the patient is doing well.”

This is the $1.6 million da Vinci Surgical System at Vancouver’s Southwest Washington Medical Center, the only robotic system in Southwest Washington.

Garbed in germ-free scrubs from head to toe, I sat near Dr. Rushing, gynecologic oncologist with Northwest Cancer Specialists, for two hours last week as he operated the robot arms with the skill and precision of a watchmaker. He has manipulation of one robotic right hand (arm) and two left hands (arms ). Instruments can cut with scissors, lift or depress tissue and organs, as well as cauterize. They are one-half to one inch long. Dr. Douglas Masson, a urologist, said the picture Dr. Rushing sees has a normal working magnification of four times, but can be magnified up to 10 times.

Dr. Rushing said “more than 100 procedures have been completed” since da Vinci was first used in March. Training, requiring about two months, continues as more teams are formed.
This is clearly the next level in hospital surgery.

Why? Dr. Rushing said it is much less invasive than traditional surgeries. There are five dime-size round incisions in the abdomen of today’s patient. That means she will heal faster, her hospital stay is shorter and chemotherapy can be started sooner if cancer is confirmed.

Robotic surgery can be used to remove ovarian tumors and operations for uterine and cervical cancer in women, and to treat men with prostate cancer, as well as heart valve repairs in men and women.

Intuitive Surgical, manufacturer of da Vinci, lists additional benefits: Reduced trauma to the body; reduced blood loss and need for transfusions, less post-operative pain and discomfort, less risk of infection and less scarring.

Sandy Schill of Ridgefield is a member of Dr. Rushing’s team, the first trained at Southwest for this surgery. “We are a specialized team. We trained together and we work together very well,” she said.

Why is the system called da Vinci? Sarah Mottram, hospital marketing coordinator, checked the manufacturer’s Web site (www.intuitivesurgical.com) and found: “in part because Leonardo da Vinci invented the first robot. He also used unparalleled anatomical accuracy and three-dimensional detail to bring his masterpieces (paintings) to life.”

Dr. Rushing, the first physician trained on the medical center’s system, said use “of the robot in my practice … enables me to perform a more thorough cancer surgery, while allowing my patient to recover faster with less pain.” Dr. Rushing remains across the room from his patient, yet results seem “as if I am two inches tall inside her body, operating with enhanced visualization and precision.”

TOM KOENNINGER is editor emeritus of The Columbian. His column of personal opinion appears on the Opinions page each Wednesday. Reach him at tom.koenninger@columbian.com.