A robotic surgical system that Providence Sacred Heart Medical Center & Children's Hospital acquired last year that features what's called integrated fluorescence imaging capability is enabling a surgeon here to do more partial kidney removals on cancer patients.
The surgeon, Dr. Thomas N. Fairchild, of Spokane Urology PS, says he has performed 10 such procedures during about the last year to remove tumors and is enthused about the long-term potential it has to improve outcomes for patients.
"I think it's wonderful," Fairchild says.
Benefits include greater certainty that all of the cancer has been removed, plus shorter hospital stays, less blood loss, less pain, and quicker recovery, since the procedure is done laparoscopically, requiring just a couple of small incisions, or ports, he says.
Additionally, preserving healthy, functioning kidney tissue can help to avoid future kidney disease and even dialysis, he says.
"This is all part of an effort over the last 20 to 30 years to preserve as much of the kidney as possible," Fairchild says.
Before that, the surgical standard was a radical nephrectomy, or removal of the entire kidney, which meant that "sometimes 90 percent of the kidney would go for the 10 percent that was bad," and it was done through open surgery, he says.
Fairchild says he doesn't know whether he is the first surgeon in the Spokane area to do partial nephrectomies using fluorescence imaging, but expects them to become more common here as the benefits become more evident and as more surgeons become proficient using robotic systems.
More than 50,000 people in the U.S. were diagnosed with kidney cancer last year, out of more than 1.3 million new cancers of all types that were diagnosed, the American Cancer Society says. Kidney cancer is slightly more common in men than women and usually is diagnosed in patients between the ages of 50 and 70, online sources say. With early diagnosis and treatment, the survival rate is said to be high, ranging upwards of 80 percent.
The new equipment at Sacred Heart that Fairchild says is helping make partial nephrectomies a more common procedure is the da Vinci Si Surgical System. It includes an operator console that's linked to a computer and audio-video equipment tower, and rolling bedside unit with multiple robotic arms.
It's the third robot now in use at Sacred Heart, replacing an eight-year-old sophisticated robot that the hospital retired last December, andas the Journal reported earlier this yearit's drawing heavy use from the growing number of surgeons who are becoming qualified to operate it.
Though referred to as robots, the systems can't be programmed to operate on their own. They're highly sophisticated, computerized tools, meaning that every motion of their multi-jointed arms is performed with direct input from the surgeon, using manual controls that transmit the movements electronically.
The enhancement with this new da Vinci model that Fairchild says he's finding particularly helpful is the robot's integrated fluorescence imaging capability, providing what manufacturer Intuitive Surgical describes as "real-time, image-guided identification of key anatomical landmarks using near-infrared technology." Fluorescence imaging involves injecting an imaging agent, or dye, into the patients that enables surgeons to view high-resolution, 3-D, near-infrared images of blood flow in vessels and micro-vessels.
Healthy vessels carrying the dye-tainted blood flow give off a bright green hue, contrasting with adjacent dark cancerous masses, when viewed by surgeons using special viewing equipment. The da Vinci Si technology enables the surgeon to switch the robotic system's viewer back and forth between a normal, or visible light, mode and a fluorescence mode.
The differing illumination levels help surgeons more accurately identify cancer "margins," or the distance between a tumor and the edge of the surrounding tissue that is removed along with the tumor, and thus to be more precise and thorough in removing those masses, Fairchild says.
"You don't want to leave cancer behind," which typically necessitates dissecting just slightly into healthy tissue to ensure that all of the cancerous mass is excised, he says.
Because the kidney is a blood-processing organ, though, partial nephrectomies have a major complicating challenge. They require clamping off the blood flow for a period of time, referred to by surgeons as ischemic time, so "you're working in more or less a bloodless environment," Fairchild says.
However, depriving the kidney of blood flow for much longer than 25 minutes can damage it. For that reason, most urologists weren't comfortable attempting a laparoscopic partial nephrectomy before the advent of robotic surgery, because they weren't confident that they could remove the tumor and reconstruct the kidney in such a short amount of time, Fairchild says. For him, incorporating fluorescence technology into the process has helped make his surgeries faster and safer, he says.
Nonetheless, having to perform the procedure in such a tight time window requires spending a lot of time preparing for it, he says. That includes making sure all of the appropriate surgical supplies are readily available, and ensuring that all of the surgical team members are in place and know precisely what they'll be doing during that period.
"We set up, and then we stop and say, 'Is everybody ready?' We take this wonderful timeout and make sure everybody's ready and on the same page," Fairchild says. "You're as prepared as you can possibly be for any eventuality."
Fairchild, who performs surgeries at Sacred Heart and at Providence Holy Family Hospital, has been a urologic surgeon at Spokane Urology since 2001. Before that, he worked as a urologist at Rockwood Clinic from 1983 to 2001.
Originally from Syracuse, N.Y., he served as a lieutenant in the U.S. Army, including in Vietnam, from 1969 to 1971. He earned his bachelor's degree from Lawrence University, in Canton, N.Y., in 1969 and his medical degree from State University of New York in 1977, and then trained at Hartford Hospital, in Hartford, Conn., and at the University of Washington, in Seattle.
Spokane Urology is a group of five urologists specializing in medical and surgical management of urinary tract problems. The care it provides includes management of stone disease, incontinence, urinary infections, enlarged prostate, cancers, impotence, and infertility. It has offices in the Medical Center Building, at 820 S. McClellan, and in the Holy Family Medical Building, at 235 E. Rowan.
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