business

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.