A new Da Vinci code

For two years, Lorraine Olson suffered from pain and bleeding associated with fibroid tumors in her uterus. Doctors told her she would need a hysterectomy to remove the tumors. Then she heard that a relatively new technique soon would be available at United Hospital in St. Paul.

So Olson waited four more months to have the tumors removed using the science of robotics.

There was good reason for Olson's planned patience. She was up and on her feet within days of her operation -- instead of the weeks it typically takes to recover from traditional open surgery -- she avoided an unwanted hysterectomy and her blood loss was significantly less.

The 53-year-old Oakdale woman considers herself a pioneer of sorts. Only recently have Minnesota doctors begun treating the procedure, called a myomectomy, with a machine known as da Vinci, a robot with 3-D vision that previously was used almost exclusively to treat prostate cancer.

"I think I broke ground for Minnesota women," Olson said recently. "I feel great. I would not even know that I had anything done."

Physicians at United, where Olson was treated, and da Vinci users elsewhere in the state believe they are on the cutting edge of the next generation of surgical technology. The da Vinci can replace open surgery, in which the surgeon cuts into the body, and conventional laparoscopy, done through tiny incisions.

But do these expensive machines make financial sense? The jury is still out on that. Patient and doctor satisfaction is off the charts, but the economics of the $1.2 million piece of equipment provide a conundrum for hospitals.

"We do not get better [insurance] reimbursement. We're not making as much money as we do with the old method," said Mark Mishek, president of United Hospital.

"We took a pass on the da Vinci three years ago. We thought it was too expensive and we didn't think it would take off. Now we're ready to jump in with both feet. I'll ask for a second robot."

United spent a total of $1.6 million to buy the da Vinci machine and redesign the operating room to accommodate it, using funds from its hospital foundation.

But doctors argue that the benefits to patients easily outweigh the price tag.

At the University of Minnesota, surgeons are using robotics for a number of procedures, including bariatric surgery, kidney donor harvesting, coronary bypass and pelvic lymph node dissection.

"If you think about the medical economy, when you look at the global impact like being able to return to work more quickly and being a contributor to society, it's hard to see the negative impact of new technology," said Dr. Michael Maddaus, co-director of the University of Minnesota's Center for Minimally Invasive Surgery.

'Scratching the surface'

But not all minimally invasive surgeries are right for machines such as the da Vinci, Maddaus said. "You don't need that $1 million piece of technology to remove a gall bladder."

At St. John's Hospital in Maplewood, urologists have used the da Vinci more than 700 times in the treatment of prostate cancer, and 70 times in kidney surgeries. Like United, it used philanthropic funds to buy the machine.

"We're just scratching the surface. This is going to be huge," said Dr. Robert Gaertner, a urologist who works out of St. John's. Gaertner said the da Vinci began paying for itself after six months of use. "Initially, that was a huge concern. We thought it would be three or four years before it would start making money."

The da Vinci, manufactured by California-based Intuitive Surgical Inc., came on the market in 1999. Minnesota hospitals started using it about three years ago. There currently are nine da Vincis in the state.

Besides United, St. John's and the University of Minnesota, there are da Vincis at St. Mary's Medical Center in Duluth, St. Cloud Hospital, Abbott Northwestern in Minneapolis, Regions in St. Paul and at the Mayo Clinic in Rochester, which has two.

How da Vinci works

With the da Vinci, the surgeon is physically apart from the patient and operating table, and is seated at a console, peering at a high-definition screen that magnifies the work area. Tiny robot-like arms with cameras and surgical instruments attached are inserted into the patient through small incisions.

At the console, the surgeon uses his fingers and hands to operate highly sensitive controls -- like high-tech joy sticks -- and foot controls to perform the procedure, while assistants monitor the robot and its arms.

"It's not that the surgery is new, it's just that the equipment is better," said Dr. Ragvald Mjanger, an obstetrics and gynecology physician at United Hospital. "The robot is very precise. The camera is superb. It's a great leap forward to look inside."

Because the da Vinci procedure is minimally invasive as opposed to open surgery, there is less blood loss and less scarring. Patients go home faster and return to normal activities quicker.

"You can't have a urology cancer center without one of these," said Dr. Peter Sershon, a urologist and director of the robotics program at United Hospital. "Once you're comfortable with the equipment, anything is possible."

Use is patient-driven

Sershon said that getting the da Vinci was "physician driven," as doctors saw its benefits. Then its use became "patient driven," as people went to the Internet and discovered there was another way to have their surgeries done.

"People feel better faster," Sershon said. His group, Metro Urology, performs a dozen da Vinvi surgeries a week in the Twin Cities for prostate cancer, he said.

Dr. Eric English, the obstetrics and gynecology physician who performed Olson's surgery in early April, said he's performed 10 myomectomies similar to the procedure Olson received since the end of March. He has three scheduled for next month.

"This is going to become the gold standard," English said. "Use will only continue to grow. They'll find more and more defined uses."

Olson came across English and the da Vinci almost by accident. She was consulting with a nurse practitioner who referred Olson to English, who then told Olson about the robotic procedure.

"It seemed like a procedure designed for me," said Olson, who liked the idea of quick recovery, as she did not have disability insurance.

English and Olson met around Christmas last year, and English told her that he would be ready to start treating patients in about three months.

"So I toughed it out," said Olson, who had the surgery April 4.

"I was in the hospital for one night," Olson added. "I had good pain control. I had five little incisions and no problems.

"I was a bit apprehensive because I was the first one [at United]. But I didn't want a hysterectomy. It was a good choice for me."

David Phelps • 612-673-7269 • dphelps@startribune.com