Phelps Health acquired the da Vinci Surgical System in 2017 and currently offers the minimally invasive approach to facilitate complex surgery.

The robotic technology allows surgeons to operate through minor incisions, and there have been notable benefits after Phelps Health implemented the da Vinci system, said Interim Director of Surgical Services for Phelps Health, Emily Buckley, who delivered an update on the Robotic Surgery Program at Phelps Health.

Minimally invasive surgery has been around since the ‘80s when microscopic surgery entered the field, said Buckley, at the Phelps Health Board of Trustees meeting on Jan. 23. There has been a great deal of growth in microscopic surgery over the past 40 years with the expansion of services offered through microscopic equipment.

Intuitive Surgical manufactured the da Vinci Surgical System that was approved by the Food and Drug Administration in 2000. The system was designed to improve clinical outcomes of patients through minimally invasive surgery and is considered a standard for robotics technology, said Buckley.

The robotic technology has been valuable for Phelps Health in cases that require a prostatectomy. The da Vinci has additional benefits as a surgical technique for the repair of perineal hernias, said Buckley. There have been very low incidents of recurrence after the da Vinci’s use for the repair of perineal hernias.

“It’s considered the gold standard to have it done robotically, and most places will refer you to someone else,” said Buckley.

Phelps Health acquired the da Vinci in the fourth-quarter of 2017, and the surgical system has been used in cases since late November 2017 through all of 2018.

“The goals upon acquisition really focused on retaining the tracking surface, generating incremental volume and reducing net patient migration to outside facilities,” said Buckley. “In Missouri, we were kind of on an island; there was about a 100-mile radius where there were no da Vinci’s, so now that we have one we are serving that population.”

Currently, Phelps Health has five surgeons credentialed to use robotic technology. Dr. Dana Voight has undertaken 66 percent of the robotic cases, said Buckley. There has been a 56 percent growth at Phelps Health in robotic surgeries between December 2017 and December 2018, with 153 total cases in 2018 — notably 41 hysterectomies.

“Our services are expanding in relation to the robot,” said Buckley. “In particular the hysterectomies, many of those were leaving the area.”

Around 8 to 30 percent of people went to a different location to get a hysterectomy, according to Buckley.

“If you look at the robotic-assisted microscopic hernia repairs, the benefit is really the access to the minimally invasive treatments,” added Buckley, where many small hernias can be repaired microscopically or by a small laparoscopic surgery.

Traditionally the more complex hernias required traditional surgical routes; however, many of the more complex hernia cases are now able to be successfully done using robotic technology  — and a larger patient population that never used to qualify for minimally invasive surgery now has the option of a minimally invasive approach at Phelps Health, said Buckley.

A leading cause of perineal hernias is perineal surgery without adequate reconstruction. The da Vinci has been a highly valuable surgical technique for hernia reconstruction using mesh. 

The standard surgical technique for the repair of perineal hernias uses mesh to prevent perineal hernias after laparoscopic or robotic abdominoperineal resections, and it’s also what causes a lot of issues with hernia repair. 

“Issues that we hear about with pain, nerve entrapment and different complications,” said Buckley. “For a traditional mesh placement it has to be glued in, and that is what they attribute a lot of those complications too.”

With a robotic approach it’s much easier to suture the actual mesh in, so it provides for better anatomical repair and fewer complications, said Buckley, so patients do better in the long run, and there is less recurrence because it allows for “simply a better repair.”

“The benefit is in the access, the American College of Obstetricians and Gynecologists still recommends a vaginal approach to a hysterectomy for most patients who qualify, but that doesn’t take into account patients with large uteruses or more complex cases,” said Buckley. “Those patients again would never have had access to a minimally invasive technique before the da Vinci. We are able to offer those patients this minimally invasive surgery.”

A lot of these cases are now also performed in an outpatient setting, added Buckley. Taking into account the case volume at Phelps Health for robotic special hernia repair, Buckley estimated that nearly $50,000 could be saved for patients undergoing hernia repair in one year, as well as a decrease in accumulative length of stay by 18 patient days.

“For our hysterectomies, we estimate a little over $100,000 in cost savings and a decrease in accumulative length of stay of 57 patient days,” said Buckley.

“We want to continue to extend our gynecological cases; we know there is not only a benefit with hysterectomies but also with pelvic repair,” said Buckley. “The complication rate is significantly less; in the early 2000s you were seeing a lot of open procedures; in 18 years we have come a long way with the shift toward minimally invasive, and I think the da Vinci has a big thing in that.”