journey
Saint Joseph’s
your guide to healthy living
PERFORMING SURGERY on beating hearts
● FASTER WAYS to repair the body
● The FUTURE of robotics in medicine
●
journey
Saint Joseph’s
Robotics
Advances from
Head to Toe
3
Lung Surgery
That Keeps Your
Bones Intact
5
New Ways to
Alleviate
Chest Pain
6
Robotics and
Women‘s Health
in the Spotlight
10
The Future of
Robotics
Is Here
Journey through the body
WITH the surgical robot
Dear Neighbors,
In this edition of Journey you will learn about the pioneering work at Saint Joseph’s
Hospital with the da Vinci® Robotic System. The leadership at Saint Joseph’s immediately recognized the potential of this incredible medical machine, and clinical heart
surgery research was initiated in the summer of 2002. Now almost 10 years later, Saint
Joseph’s stands as one of the most advanced robotic surgery centers in the world.
More operations inside the heart, such as valve repairs, and outside the heart, such as
bypass operations, have been done at our hospital than anywhere in the world. We
have two of the largest urology and gynecology robotics practices in the United States,
and we are actively developing robotic lung surgery for cancer removal.
In the 20th century, when the idea of a minimally invasive operation was first entertained, the fear was always that the conduct of the procedure could be compromised
by limited vision and inhibited surgical tasks. That all changed in the 21st century with
the advent of the computerized robot. Now the high-definition, magnified threedimensional (3-D) vision of the da Vinci® combined with the precision of the robotic
instruments not only allow conventional surgery to be performed through tiny holes
but also can significantly enhance the surgeons’ capabilities in many cases.
Each robotic subspecialty team brings together the best of Saint Joseph’s with
surgeons, anesthesiologists, physician assistants, nurses, technicians, and robotic
troubleshooters all coming together to deliver the choreography and precision needed
to offer the best surgical care available in the digital age.
Thanks for reading,
Doug Murphy, M.D.
Chief of Cardiothoracic Surgery
Saint Joseph’s Hospital
saint joseph’s journey | www.saintjosephsatlanta.org
16
2
No Strings
Attached: A
Patient's Story
18
Saint Joseph’s journey
Journey is published by Saint Joseph’s
Marketing and Public Affairs Department,
5665 Peachtree Dunwoody Road, Atlanta,
GA, 30342. The information provided is
intended to educate readers about subjects
pertinent to their health and is not a substitute for a consultation with your physician.
Printed in USA; Summer 2011.
Grab your 3-D glasses and Explore!
See medical robotics through the eyes of our
Saint Joseph’s surgeons with a pair of 3-D glasses
included in this issue of Journey. Anywhere you see
the glasses icon (above) is an enhanced 3-D image.
SAINT JOSEPH'S Robotics Advances
from head to toe
in 3-D
Right entry robotic cardiac procedures:
ThoraCAB (thoracotomy coronary artery bypass)
■■ The chest is entered through three tiny holes on the
right breast or chest wall.
■■
Left entry cardiac procedures:
Mitral and tricuspid valve repair
■■ MAZE procedure
■■ TMR (transmyocardial revascularization)
■■ Robotic closure of atrial septal defect
■■ Epicardial lead placement for
heart failure
■■
The chest is entered through three to five
tiny holes with no disturbance of the
skeleton. In some surgical cases, the groin
left lateral portion of the pelvis is utilized
for femoral vessel access.
Robotic thoracic procedures:
Lung lobectomy
■■ Removal of chest wall tumors including:
1. Thymoma
2. Lymphoma
3. Teratoma
4. Germ cell tumors
5. Neurogenic tumors of the spine
■■
The chest is entered through three tiny
holes with no disturbance of the skeleton.
The women’s pelvis is entered through five
small incisions.
FOR MEN
Robotic urologic procedures:
■■ Neuro-vascular Plexus Procedure
■■ Radical Prostatectomy (local prostate cancer)
■■ Robotic radical cystectomy (invasive
bladder cancer)
■■ Robotic partial nephrectomy (kidney cancer)
■■ Robotic pyeloplasty (urinary tract procedure)
The man’s pelvis is entered through five
small incisions.
Type of orthopedic robotic procedure:
The MAKOplasty® procedure is for patients
suffering from unicompartmental or
bicompartmental knee disease. MAKO is
resurfacing of the joint with much less
bone being removed.
saint joseph’s journey | www.saintjosephsatlanta.org
FOR WOMEN
Robotic gynecological procedures:
■■ Cervical and endometrial cancers
■■ Lymphnode dissections
■■ Ovarian cysts and masses
■■ Hysterectomies (benign or cancerous)
■■ Endometrial ablation
3
| LEADING EDGE OF HEART CARE |
Have You Heard of
Intracardiac
Surgery?
by Doug Murphy, M.D.
Chief of Cardiothoracic Surgery
A
ll four heart chambers can be
accessed from the right side of the
chest using the da Vinci® Robotic
System. Only small holes are necessary
with no disturbance of the chest skeleton.
The robotic surgeon can perform multiple
cardiac procedures through this approach
with the most common procedure being
repair of the mitral or tricuspid valve.
Since the chest is
entered through five
tiny holes with little
to minimal disturbance, the patient is
allowed to resume
normal activities as
soon as the soreness
of soft tissue injury
Doug Murphy, M.D. resolves. There is no
Chief of waiting for any bone
Cardiothoracic Surgery to heal. Although
patients are often
saint joseph’s journey | www.saintjosephsatlanta.org
fastfacts
4
Cardiac robotic surgery allows surgeons to operate on the hearts of
adults and children through tiny openings in the chest, eliminating the need
to crack the breast bone and spread
the ribs.
There are two basic types of valve
prolapse surgery:
•
Replacement: This procedure
has less successful outcomes,
which causes patients and their
physicians to opt for repair.
•
Repair: In cases where repair is
not possible, replacement is performed using the patient’s own
tissue, an artificial valve, or a valve
obtained from a pig’s heart.
One inside look of what the
surgeons see while repairing the
mitral valve.
The key to performing multiple
heart procedures all at once is
intracardiac surgery. Doctors can
access more areas of the heart
all at once.
interested in the rapid recovery and cosmesis of robotic surgery, that is not really
the major advantage. For example, in
the case of the mitral valve, it is critically
important that the valve you were born
with is repaired rather than replaced.
This is a lifelong benefit compared with
incision healing that is a benefit of days
instead of months.
The ability to achieve a valve repair
done rapidly through tiny holes allows
this technology to be applied not only to
relatively young healthy patients who
are interested in returning to their active
lifestyles but also older, more frail patients
who would be debilitated by a big incision. Today with the da Vinci® system we
are performing intracardiac surgery on a
broad spectrum of patients, young and
old, with great success and faster recovery.
mitral valve
The MAZE Procedure Helps Prevent Clots
Chronic atrial fibrillation is a condition characterized by rapid beating, or “racing,”
of the upper heart chambers, rather than slower coordinated contractions. This is a
dangerous condition because blood clots can form in the left upper chamber and
travel to the brain causing a serious stroke.
People who have this condition need blood thinner medicine to prevent the formation of these blood clots. In addition, the uncoordinated rhythm can also reduce
the amount of blood the heart pumps, causing shortness of breath or fatigue.
For cases where the catheter-based therapies and medicines fail to relieve symptoms, there is now a very effective surgical option called a MAZE procedure. This
involves using a thin freezing probe to create a pathway in the upper chambers to
steer the electrical impulses as they travel to the lower chambers. Originally this surgical procedure required a very large incision in the front of the chest but now with
the da Vinci® Robotic System it can be done through five holes in the right side of the
chest. This technique now provides options for millions of atrial fibrillation patients
who suffer from this common condition.
| Lung health |
Changing the Future for Lung Surgery
A Paradigm Shift for Lung Surgery Patients
by Jeff Miller, M.D., Director of Cardiac Transplantation
U
sing a
minimally
invasive
robotic surgery for
thoracic conditions is
a relatively new and
extremely promising
Jeff Miller, M.D.
procedure for the
Cardiothoracic
treatment of chest
Surgeon, Director
organs within the
of Cardiac
chest. This includes:
Transplantation
■■ Surgery for lung
disease, both
malignant and benign
■■ Surgery of the esophagus, such as
esophageal cancer
■■ Reflux disease
■■ Achalasia
■■ Zenkers diverticulum
A Dramatic Difference
Common thoracic procedures such as
lung resection or lobectomy for lung
cancer, lymph node biopsy, or surgery
on the esophagus is very invasive, often
involving the cracking of the sternum or
ribs, and in turn, the additional, painful
recovery.
Robotic thoracic surgery changes that.
The Intuitive Surgical’s da Vinci® Robotic
System with its 3-D high-definition camera and robotic instruments provides the
surgeon with better visualization, greater
surgical precision, increased range of
motion, improved dexterity, and better
access to thoracic organs compared to
traditional open surgery or even video
assisted thorascopic surgery (VATS).
Those common thoracic procedures can
Most people think of minimally invasive surgery as ideal for procedures on the heart,
but this advanced technology is also vital for quicker less painful lung surgeries.
now be performed robotically through
tiny 2-inch incisions, potentially resulting in less blood loss, less chance for
infection, less pain, and faster recovery
and return to work.
First of Its Kind in Georgia
At Saint Joseph’s Hospital of Atlanta, the
renowned team of surgeons performed
the first robotic lobectomy for lung cancer in the state of Georgia and have since
performed more than 300 robotic thoracic procedures. Our surgeons continue
to lead the way, utilizing the latest and
most advanced techniques in minimally
invasive robotic approaches to thoracic
surgery, and giving patients advanced
options for treatment and care.
Do You Need a Checkup?
Just go to www.stjosephsatlanta.org
and click “Find a Physician.”
fastfacts
Surgery to remove the cancer in the
affected lobe of the lung (lobectomy)
is the standard of care for treatment
of early-stage non-small-cell lung
cancer (stages I and II).
Saint Joseph’s performed the first
robotic lobectomy in the state of
Georgia, and has since performed
more than 300 robotic thoracic
procedures to date.
According to the American Cancer
Society approximately 210,000 new
cases of lung cancer are diagnosed in
the United States each year.
saint joseph’s journey | www.saintjosephsatlanta.org
It also is used for surgery of the chest
wall and tumors of the chest, including
thymoma, lymphoma, teratoma, germ
cell tumors, and neurogenic tumors of
the spine.
5
TMR uses carbon dioxide lasers to improve blood circulation to regions of the heart that are unsuitable
for bypass or stenting. The surgeon makes small incisions in the right chest cavity for the robotic arms
to access the chest cavity and applies the laser to the muscle of the left ventricle of the heart.
Questions About Chest Pain? The Answer is TMR
by Averel Snyder, M.D.
A
saint joseph’s journey | www.saintjosephsatlanta.org
n estimated 9.8 million patients
suffer from chest pain each
year. Many times this pain is in
the form of angina—which translated
from Latin means squeezing of the
chest. For some people with angina,
treatment options are limited but the
Transmyocardial Laser Revascularization
(TMR) procedure is changing that.
6
A Range of Symptoms
Patients suffering from angina describe
their pain as pressure, heaviness, tightening, squeezing, or
aching across the
chest, particularly
behind the breastbone. Angina pain is
also known to radiate beyond the chest
into the arms, back,
Averel Snyder, M.D. neck, jaw, or even
Cardiovascular
teeth. This discomfort
Surgeon
occurs when there is
decreased blood oxygen supply to an area of the heart muscle.
In most cases, narrowing of the coronary
arteries, a result of arteriosclerosis, is the
cause of the blood supply shortage.
Of patients suffering from chest pain,
12 percent no longer have conventional
interventional options. When a patient
has severe disease (angina) or has had
multiple procedures, their arteries are
oftentimes not adequate to sustain traditional treatments such as percutaneous
stents or coronary artery bypass.
An Ideal Alternative
Because these patients cannot undergo
the traditional interventional treatments,
robotics offer a better, less invasive
choice. With the introduction of robotics,
that original 12 percent of untreatable
cases translates to up to 200,000 patients
per year who are candidates for TMR.
Robotic TMR is a procedure where
the surgeon uses a laser to create 20-40
laser channels in the area of the heart
that’s not receiving adequate blood supply. The laser works in two ways: first,
it creates new arteries by attaching stem
cells to the area and second, it destroys
the nerves that cause angina. Using the
da Vinci® Robotic System, a TMR procedure requires that the surgeon make
three small incisions on the side of the
chest; this is a drastic improvement over
traditional TMR, which requires openchest surgery, a long hospitalization, and
recovery period. The hospital stay with
robotic TMR averages just 48-72 hours.
Extensive Experience
While only a handful of hospitals in the
United States even offer TMR as a treatment option, we routinely perform this
procedure at Saint Joseph’s utilizing the
robotic minimally invasive technique
we’ve developed. Saint Joseph’s is home
to the most experienced robotic TMR
surgeons and boasts one of largest series
of robotic TMR cases in the country.
PAY ATTENTION TO CHEST PAIN AND OTHER SYMPTOMS
Call 911 if you feel pain or tightness in your chest; shortness of breath for more than a
few seconds; or you feel light-headed, weak, or faint. And don’t drive yourself to the
hospital—paramedics can begin treatment at your home or en route. Patients in
ambulances may also get faster care when they do reach the emergency room.
MAKOplasty Knee Resurfacing: Is It for You?
by Mark Hanna, M.D.
M
illions of Americans suffer from osteoarthritis
of the knee, which can cause pain, instability,
dysfunction, and in some cases, disability.
For those with severe symptoms and for whom noninvasive treatments have been unsuccessful, total or
partial knee replacement or resurfacing may alleviate
pain and help restore regular activity. Various surgical approaches—from the traditional
to the innovative—are available for the treatment of
osteoarthritis at Saint Joseph’s
Hospital. An increasing number of
less-invasive surgical options are
becoming available. For certain
patients and diagnoses, they can
offer great benefits. What is MAKOplasty?
Among the innovative surgical
procedures to treat osteoarthritis
of the knee is the MAKOplasty
partial knee resurfacing.
MAKOplasty is designed to selectively resurface the worn-out sections of the knee and
is similar to partial knee replacement, except that it
uses the RIO® Robotic Arm Interactive Orthopedic
System. The RIO® system is a computer-assisted technique where a surgeon controls a robotic arm during
surgery. It allows for detailed preoperative planning
and precise execution. Only the diseased portion of
the knee is removed and replaced with an implant.
By resurfacing only the affected areas of the knee, the
non-arthritic portions of the joint are undisturbed and
normal anatomy is maintained as much as possible. Mark Hanna, M.D.
Orthopedic
Surgeon
Mark W. Hanna, M.D., is an orthopedic surgeon with
Resurgens Orthopedics. A specialist in reconstruction of
the hip and knee, Dr. Hanna is one of five physicians in the
Atlanta area, all practicing at Saint Joseph’s Hospital, offering
MAKOplasty. fastfacts
■■
■■
■■
■■
■■
MAKOplasty is a technique offering partial resurfacing
of the knee. The surgeon uses the RIO® Robotic Arm Interactive Orthopedic
System which allows for 3-D pre-surgical planning and very
precise execution. The surgery is performed through a smaller incision and is
bone sparing; healthy bone and tissue are not disturbed.
Patients may experience shorter hospital stays (one to three
days) and quicker return to normal activity than with other
treatments. MAKOplasty can result in a more natural feeling knee. saint joseph’s journey | www.saintjosephsatlanta.org
Could You Be a Candidate?
Typically, the ideal candidate for MAKOplasty is one
with osteoarthritis and pain limited to one part of the
knee. The medial, or inside, part of the knee is most
common. Patients who are more active and not significantly overweight are best suited. Currently, Saint
Joseph’s Hospital is the only Atlanta-area hospital
offering MAKOplasty.
Knee resurfacing has been found to ease osteoarthritis for many people.
7
| men's health |
Robotics and Prostate Cancer:
Treating Men Successfully
S
ince its development a decade
ago, robotic-assisted surgery for
treatment of prostate cancer has
continued to gain popularity as more
and more patients demand robotics
as an option for care. Robotic radical
prostatectomy has slowly but surely
replaced more traditional open surgery. In fact, more than 70 percent
of prostate cancer surgeries in the
United States are now done robotically. This trend is driven by patients who
experience quicker recovery, superior
quality-of-life outcomes in terms of both
potency as well as continence (urinary
control) as well as excellent cancer
control and cure rates.
Who Can Get This Type of
Procedure?
Patients who are diagnosed with “localized prostate cancer” (cancer contained
to the prostate gland) are candidates for
robotic surgery. Their average hospital
stay is less than 24 hours and the vast
Tiny robotic instruments act as extensions
of the surgeon's hands.
majority of patients say they experience
little pain after the procedure. Here’s
why: Robotics involves small keyholesized incisions which means no major
incisions, minimal manipulation of
the tissue or muscle, and significantly
decreased blood loss as compared to
more traditional open surgery.
In addition to less pain and quicker
saint joseph’s journey | www.saintjosephsatlanta.org
Double Dose of Experience in Robotics
8
Saint Joseph’s has the expertise of
two fellowship-trained urologists:
Raj Laungani, M.D., and Nikhil Shah,
D.O., specialize in robotic techniques
and have a combined experience of
more than 2,500 urologic surgical
procedures.
Raj Laungani, M.D.,
Nikhil Shah,
Both Dr. Laungani and Dr. Shah
Urology Surgeon
D.O., M.P.H.
completed their residency and fellowUrology Surgeon
ship training at the Henry Ford Hospital
in Detroit, Michigan, an institution
known for the creation and development of the robotic prostatectomy surgical
technique. During their fellowships, Drs. Laungani and Shah were involved in some
of the first robotic surgeries ever completed in the United States, and now offer
that expertise to hundreds of Saint Joseph’s patients each year.
recovery, the “quality-of-life outcomes”
are excellent. Because the surgeon
works using 3-D video from inside the
body and 10x magnification, he can better
visualize and identify vital nerves, blood
vessels, and muscles. This allows him to
preserve potency (erectile function) as
well as continence (urinary control.) That
same visualization also leads to enhanced
cancer control because the surgeons can
better define the margins and borders of
the prostate and determine whether the
cancer has escaped the gland.
Other Uses, Same Outstanding
Outcomes
Robotic surgery isn’t just for prostate
cancer—it’s also being used for surgical treatment of invasive bladder cancer
(robotic radical cystectomy), kidney
cancer treatment (robotic partial
nephrectomy) as well as urinary tract
reconstructive techniques such as robotic
pyeloplasty. All of these have similar
recovery rates and excellent outcomes.
fastfacts
For prostate problems, robotic
surgery's main benefits include:
■■ Decreased blood loss
■■ Decreased pain
■■ Quicker recovery
■■ Improved potency and urinary
continence following surgery
The Nurse Navigator’s Role in Robotics
by Erin Ulrichsen, R.N.
Saint Joseph’s robotics nurse navigators
Erin Ulrichsen and Jeric Lomboy
Saint Joseph’s has set the industry standard
for how to create, operate, and maintain an
outstanding robotics program.
robotics and who would “wake up and
think only about the robot!” The idea
that anyone could be so passionate about
an inanimate piece of equipment seemed
preposterous, and yet I could not stop
thinking about his need. In July of 2005,
the nursing role Dr. Murphy envisioned
was created, and so I informed him I
found the nurse for the job—me.
The Robotics Program
Builds Momentum
As the nurse manager, I was responsible
for the program, yet I had so many other
responsibilities, I was not able to solely
focus on robotics. In the summer of 2006
help arrived. Nikhil Shah, D.O., joined
our staff to launch the urology robotics
program, and with him Saint Joseph’s
brought on nurse Jeric Lomboy to
spearhead this program.
Today, Jeric and I are co-nurse navigators for the Saint Joseph’s robotics
program and truly each day we enjoy
serving in these capacities.
Every Patient Can Benefit
We reach out to every patient who
contacts the robotics hotline and share
with them our expertise regarding the
program. Part of this outreach includes
helping patients determine whether
they are candidates for minimally invasive robotic surgery. Because we also
host and teach other surgeons and their
teams through the International College
of Robotic Surgery, I often speak at
various national nursing conventions
sharing the successes of our program
with other nurses and health care executives. It’s just one more way we work to
educate the medical community on how
robotics is improving patient care.
Saint Joseph’s has set the industry
standard for how to create, operate,
and maintain an outstanding robotics
program. Every day, we live out Dr.
Murphy’s vision to be the team that only
“thinks about the robot,” and Jeric and I
are grateful to be that team. We look forward to continued program growth and
success as we make a difference in each
patient’s experience at Saint Joseph’s!
saint joseph’s journey | www.saintjosephsatlanta.org
A
s a nurse, I have filled many
positions since I began working
at Saint Joseph’s 22 years ago.
Little did I know 16 of those years
would prove to be my training ground
and part of the evolution in preparing
me for my current role as robotics
nurse navigator.
It started in July of 2002 when I was
the nurse manager of the cardiac unit. At
that time my current position didn’t exist
and robotics was in its infancy, but that
all changed on the hot July day our first
da Vinci robot arrived at Saint Joseph’s
doorstep.
That summer Doug Murphy, M.D.,
was selected to participate in the clinical
trials for robotic cardiac procedures. As
he was starting the trials, he approached
me, asking if I could find a nurse for
him with the tenacity to focus solely on
9
| Women's HEALTH |
Robotics
Offer Women More Options for
Cancer Treatment
by Gerald Feuer, M.D.
B
saint joseph’s journey | www.saintjosephsatlanta.org
eing diagnosed with a reproductive
cancer is a devastating diagnosis.
While patients are anxious for a
surgeon to remove
their cancer, many
times these women
are faced with losing the reproductive
organs that make
them feel feminine.
Today the introducGerald Feuer, M.D.
tion of robotics is
GYN Oncology
making those losses
Surgeon
less noticeable by
offering patients the most minimally
invasive procedures available.
10
The Trouble with
Traditional Methods
Before the subspecialty of robotics
existed, gynecological surgeries were
invasive, as surgeons had to routinely
perform open hysterectomies or use
vaginal entry to reach the targeted
organs. Traditional open gynecologic
surgery, which has for many years
been the standard approach to many
gynecologic procedures, required making a large incision to access the uterus
and surrounding anatomy. With an open
surgery approach came significant pain,
trauma, a long recovery process, and
threat to surrounding organs and nerves.
While the above drawbacks were
addressed with the introduction of
laparoscopic surgery more than 20
years ago, robotics is also superior to
the laparoscopic approach for several
reasons. With laparoscopy the surgeon’s
field of vision is limited to a two-dimensional picture and the instruments used
are not comparable to the human wrist.
These limitations are now conquered with
the newest form of surgery: robotics.
How Less Invasive Surgery Works
Robotic-assisted surgery with the da
Vinci® Surgical System is often the most
effective, minimally invasive treatment
option. Sitting 6 feet from the patient,
the surgeon controls and directs the
robot operating with greater precision
and control. Through tiny, 1- to 2-centimeter incisions, robotic instruments are
attached to cylinders that behave like
the human wrist, allowing a significant
advance in the surgeon’s technical ability. Moreover, the surgeon uses a visual
instrument with an independent left
and right camera yielding a 3-D view of
superb depth perception. Most important to the patient, the robotic approach
greatly minimizes pain, scarring, and
risks associated with large incisions.
A Better Day with More Options
Today the gynecologist or gynecologic
cancer surgeon can perform minimally
invasive procedures with the robot for
most procedures, including the majority of hysterectomies and removal of
fibroids. These minimally invasive procedures are also used for the treatment
of endometrial and cervical cancers and
the successful management of ovarian
masses and ovarian cancer.
fastfacts
■■
■■
■■
Unlike the lengthy recovery from
open surgery, many robotics
patients not only return home
in 24 hours.
Patients can get back to work
after only one to two weeks.
Our patients also endure
these complex operations with
minimal pain.
by LaSonya Roberts, M.D.
M
edical research has revealed that
one of the most overlooked and
under-treated patients of modern
medicine is the female urologic patient.
That fact—and the fact that the average
age of the female population is on the
rise—presents a need
for more advanced,
specialized care in
women’s health. To
meet this need, Saint
Joseph’s offers new
treatment options in
gynecologic urology
LaSonya Roberts,
M.D., Urogynecologic that are less invasive
and robotic assisted.
Surgeon
New Conditions
As women mature, they often experience
urinary incontinence, urgency/frequency,
and retention, voiding dysfunction, bowel
dysfunction, interstitial cystitis, chronic
pelvic pain, pelvic organ prolapse, pudendal neuropathy, and female sexual dysfunction. Minimally invasive procedures
such as single incision suburethral slings,
single incision vaginal cystocele and rectle
repairs, full Interstim system implants,
and robotic gynecologic procedures are
now available to treat these conditions.
There’s a Better Way
Traditional gynecologic surgeries use a
large abdominal incision for easy access
to the uterus and surrounding organs
but carry the potential side effects of
intense, prolonged pain and recovery
time, and damage to surrounding tissues, organs, and nerves. The risk of
these life-altering events can cause
severe anxiety for women and may
prevent them from seeking treatment.
Surgical procedures for these
conditions include:
■■ robotic hysterectomy (removal of
the uterus)
■■ robotic salpingo-oophorectomy
(removal of the ovaries and
fallopian tubes)
■■ robotic cystectomy (removal of
ovarian cysts)
■■ robotic sacrocolpoexy (vaginal
vault prolapse repair)
Specialty trained robotic surgeon,
Dr. LaSonya S. Roberts, specializes
in urogynecology and female pelvic
reconstructive surgery and served as
an assistant professor and director of
urogynecologic services at Morehouse
School of Medicine.
For more information on Saint Joseph’s
urogynecologic services or to find a
physician: www.saintjosephsatlanta.org
or call 877-250-STJO
saint joseph’s journey | www.saintjosephsatlanta.org
Robotics Help Women with
Gynecologic Urology Conditions
Less invasive options reduce that risk.
Some options include procedures performed using a vaginal approach which
may not require an external incision.
Other gynecologic procedures may be
complex enough to need the assistance
of a robotic surgical system for guidance
and more accurate surgical results. A
robotic system works through a 1 cm or
less abdominal incision to offer greater
precision and control during surgery. The
da Vinci system allows surgeons to perform the very complex procedures and
still minimize post operative pain, recovery time, and surgical risks to patients.
By offering robotic surgeries for
urogynecologic care, patients are able
to receive advanced treatment of:
■■ abnormal uterine bleeding
■■ pelvic pain
■■ uterine fibroids
■■ ovarian cysts and/or benign masses
■■ endometriosis/adenomyosis
■■ bladder prolapse
■■ rectal prolapse
■■ uterine prolapse
11
| just for kids |
Saint Joseph’s Hospital
Robot School
W
ould your school group like to take a class at robot
school? This innovative, one-of-a kind experience is
designed to give students a firsthand look at how
robotics is used in the medical field. This exciting program
includes a hands-on experience with the da Vinci® Robotics
System, which allows students to work the robots, and “see what
the surgeon sees” when operating.
Our program includes:
■■ A skills lab involving hands-on experience with a da Vinci®
and/or MAKOplasty surgical robot
■■ An age-appropriate (fun!) group lesson on the background
of robotics and how the robots went from military battle to
medical use
■■ A quiz on the topic and a “Robot School” certificate of completion for each student to take home
Investment
There is no cost for Saint Joseph’s Robot School; however, we
require that the students have transportation to and from the
hospital. If the school wants its session to cover lunch hour,
the school will need to provide sack lunches for its students.
saint joseph’s journey | www.saintjosephsatlanta.org
Student Capacity
The program can readily accommodate up to 90 students for a
two-session program (group lesson/skills lab) We can increase
the number of students up to 120, if a third session is added.
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Age Group
The ideal age for this program
is fourth- to eighth-graders;
however, special programs can be
designed for other age groups.
Location
Due to the delicate design of the robotic systems and the liability involved with transporting them,
the Robot School program can only take place at Saint Joseph’s
Hospital. This also enables surgical technologists to assist with
the program and facilitate the “hands-on” portion for the
students.
Notice for Booking
Please allow eight to 10 weeks notice to schedule your visit.
Saint Joseph’s Hospital: Home to the
International College of Robotic Surgery
T
he International College of Robotic
Surgery (ICRS) is the only center
of its kind providing advanced
robotic surgery training in the
Southeastern United States. Since its
establishment in 2008, ICRS has been
considered the authority in robotic training, offering extensive clinical programs
for surgeons and their team members.
ICRS sets itself apart by sharing team
knowledge and the extensive experience gained from performing thousands
of cumulative robotic cases. By using a
peer-to-peer training approach with multiple online training applications, ICRS is
able to educate surgeons across the globe
and in the process is having a great
impact on the future of medicine.
An Unparalleled Education
This is a selective program and medical
teams must meet certain prerequisites to
participate in ICRS’s advanced training.
Once enrolled in the training curriculum,
ICRS has partnered with more than 100 physicians and
surgical teams from all over the world to participate in
an advanced robotic training clinical pathway. This team
approach makes ICRS a unique and well-respected
training program that sets Saint Joseph’s apart from
other robotic surgery programs in the country.
teams become part of a three-month
Robotic Mini-Fellowship that requires each
team training member to complete a clinical pathway of excellence. The fellowship
begins with a team-specific online study
made up of more than 50 interactive modules. In conjunction with the online training, surgical teams are required to observe
eight to 10 actual robotic cardiac cases and
attend a two-day on-site course at Saint
Joseph’s Hospital in Atlanta. The course
consists of case observation, peer-to-peer
training, instructional presentations, and
practice on the robot in a lab setting.
In addition to day-to-day training,
ICRS also hosts two robotic conferences
each year that draw hundreds of surgeons
and their team members from around
the world. The Medical Education Board
approves these conferences as Continuing
Medical Education (CME) credits for
attendees. The conferences are unique in
that they allow medical leaders to instruct
their peers within each specialty. Over
a three-day period, ideas are exchanged
regarding: techniques, surgical applications, new technologies, and how to troubleshoot through challenges encountered.
On the last day of the conference, robotic
surgeons and team members test their
new knowledge on the robotic system
simulated in a lab setting.
Advances in robotics start with small measures that translate into significant gains in
patient treatment.
As a destination site for robotic training
and procedures, patients seek out Saint
Joseph’s to be treated by the industry’s
experts. Patients gain a great deal of confidence in knowing our surgeons teach
other surgeons how to perform their procedures. Consistently patients tell us they
want surgeons with the most experience
and proven clinical outcomes.
With Saint Joseph’s support, ICRS
will continue to expand its educational
opportunities while at the same time,
keeping its promise to patients to deliver
the least invasive medical procedures
with best, safest, clinical outcomes.
saint joseph’s journey | www.saintjosephsatlanta.org
Saint Joseph’s Grows as
International Hub
13
Saint Joseph’s Robotic Surgeons
Cardiac and Thoracic
Douglas Murphy, M.D.
Averel Snyder, M.D.
Jeffrey Miller, M.D.
Gynecology and Gynecological Oncology
Gerald Feuer, M.D.
Stephanie Yap, M.D.
Joseph Boveri, M.D.
saint joseph’s journey | www.saintjosephsatlanta.org
14
Nikil Shah, D.O.,
M.P.H.
Ben Lee, M.D.
Thomas Myers, M.D.
Guy Orangio, M.D.
GYN-Urology
Orthopedics
Mark Hanna, M.D.
Magdi Hanafi, M.D.
General
Robotics
Urology
Rajesh Laungani, M.D.
Matthew Burrell, M.D.
Ken Kress, M.D.
LaSonya Roberts, M.D.
To find a physician that specializes in Robotic Surgery at Saint Joseph’s, please call 877-250-STJO
|AROUND THE SYSTEM |
Mentoring Helps Georgia Tech Students Create
Heart Device
J
ames Fonger, M.D., the Executive
Director for Surgery and Training
at Saint Joseph’s Translational
Research Institute (SJTRI), has been
mentoring a team of four undergraduate
Biomedical Engineering (BME) students
from Georgia Institute of Technology
on their senior design project. The BME
students presented their design for a
cardiac device to the House Science and
Technology Committee at the state
capital in February.
Their device, aptly called
CardioScout, allows the surgeon to gain
access to the beating heart from below
the breastbone and navigate around the
surface of the heart under direct vision.
This is done by mating their device with
a flexible bronchoscope that lights the
way, provides visibility, and allows for
the safe injection of biologic compounds
The heart of the matter—building bridges to Georgia Tech.
to treat specific regions on the surface of
the heart. CardioScout facilitates treatment of the heart without the need for
open-heart surgery.
SJTRI has provided these BME
students the environment in which to
accomplish their development and testing of the CardioScout device.
G.P. “Bud” Peterson, Georgia Tech
President, Mr. Bruce Simmons,
Chairman of the SJTRI Board, and
Representative Paul Battles, the Vice
Chairman of the House Science and
Technology Committee, were also in
attendance and congratulated the team
on their impressive work.
6th Annual Mercy Moves Through Me
Award Celebration
industry. Since 1988, Cambias has lent
his leadership skills to Saint Joseph’s
Health System as a board member, as
chairman of the board of Saint Joseph’s
Mercy Foundation, a member of the
sponsorship committee and the strategic planning committee. Cambias also
served as chair for Saint Joseph’s major
capital campaign which benefited Mercy
Care’s renovation and expansion, as
well as the Florence Hays Erb Oncology
Services Center, the Center for Nursing
Excellence, and Saint Joseph’s Heart and
Vascular Institute.
The award celebration was attended
by 200+ friends and colleagues, community and business leaders, Saint Joseph’s
and Mercy Care board members and
staff and community partners.
In accepting the award Cambias said,
“I humbly accept this award on behalf of
those who truly deserve it. They are the
ones who serve the poor and the vulnerable—the Sisters of Mercy and the dedicated staff at Mercy Care Services.”
L to R: SJMCS Board Chair Jane Haverty,
honoree Timothy J. Cambias, Jr. and SJMCS
President Tom Andrews
saint joseph’s journey | www.saintjosephsatlanta.org
O
n February 17, Saint Joseph’s
Mercy Care Services hosted its
sixth Mercy Moves through Me
Award celebration honoring Timothy
J. Cambias, Jr. for his “committed and
outstanding service and advocacy for
the underserved.” Held at the Atlanta
Biltmore, the Bronze Sponsor for the event
was Anatek, Inc. Other 2011 sponsors
included Catholic Charities Atlanta, Dave
Fitzgerald, Peter Hennessy of Hennessy
Lexus, Patrick McGahan, Edward C.
Mitchell, Jr., Bruce Simmons, SunTrust, Jim
Winchester and Jack Winchester.
Cambias began his career in Atlanta
with American Can Company and went
on to become the major shareholder in
Massey-Fair Industrial and MacSource,
LLC, companies which supply raw
material ingredients to the food
15
| LOOKING AHEAD |
The Future of Robotics
by Nikil Shah, D.O., M.P.H.
S
ince its inception 16 years ago, robotic surgery has grown leaps and bounds and forever changed the way we perform surgery. From the prototype, which was a single robotic arm used in the first robot-assisted brain biopsy, to the present day
where surgeons are using entire robotics systems to remove cancer and repair hearts—this is the age of robotic medicine.
Gaining global acceptance within the last decade, we believe in the next 10 years robotics will expand its reach beyond the
operating room to treat diseases within the fields of imaging, navigation, nanotechnology, and telemedicine. Not only will robotics be synonymous with minimally invasive operations and smaller incisions, but also surgeons will rely on the interface between
robotically controlled tools and real-time intraoperative imaging to access all areas of the body.
saint joseph’s journey | www.saintjosephsatlanta.org
Within robotics development, I predict three major
biotechnology advances in the fields of orthopedics,
nanotechnology, and telepresence robots.
16
Imaging and Navigation-based
Robotic Systems in Orthopedics
Until now, the growth of robotics applications in orthopedics has been poor and
has not met the clinical or technical needs
of the surgeon. Currently in the U.S. and
abroad, total joint reconstruction is
performed using open surgery and is
considered the “gold-standard” of care.
To perform these procedures successfully surgeons must have a large case
experience, tremendous skills, and quality training. The drawback with current
orthopedic robotic
systems is their use
of pins for navigation, limitations on
the joint components,
bulky machinery
associated with poor
ergonomics (body
Nikil Shah, D.O.,
positioning), and
M.P.H.
their limitation to
partial knee or hip
replacements. Because knee and hip
reconstructive procedures are the most
common orthopedic procedures performed in the United States, we see a
need for a viable robotics system that
will significantly improve procedures
and patient recovery times.
The orthopedic surgical robot of the
future will be a computer-controlled,
navigable robotic system with incorporated image-guidance. This will answer
the current need for unprecedented
levels of accuracy, precision, and
accessibility for performing orthopedic
reconstructive procedures.
Nanotechnology
Nanotechnology involves manipulating
properties and structures at a scale often
involving dimensions that are tiny fractions of the width of a human hair.
Nanotechnology is already being used
in cosmetics and sunscreens and will be
used over the next several decades to
create better batteries and improve
electronics equipment.
Within the field of medicine,
experts hope nanotechnology will be
used to regenerate nerves and create
more effective drug delivery systems.
Nanotechnology is already moving from
being used in passive structures to active
structures, through more targeted drug
therapies or “smart drugs.” These new
drug therapies have already been shown
to cause fewer side effects and be more
effective than traditional therapies. In
the future, nanotechnology will also aid
in the formation of molecular systems
that may be strikingly similar to living
systems. These molecular structures
could be the basis for the regeneration
or replacement of body parts that are
currently lost to infection, accident,
or disease. These predictions for the
future have great significance not only in encouraging nano­
technology research and development but also in determining
a means of oversight.
Nanotechnology medical developments over the coming
years will have a wide variety of uses and could potentially
save a great number of lives.
The National Cancer Institute (NCI) has created the
Alliance for Nanotechnology in Cancer (ANC) in the hope
that nanomedicine could lead to breakthroughs in terms of
detecting, diagnosing, and treating various forms of cancer.
Telepresence Robots
The most noticeable change to patients could be the introduction of the RP7 Remote Presence Robot, which is designed to
assist in patient monitoring.
It looks like an old movie robot with a flat screen television
instead of a head. But, in spite of being somewhat unattractive,
the RP7 allows doctors to stay in touch with their patients without making rounds to their hospital rooms every day. Much like
a television, the doctor’s image appears on the screen and he or
she is able to speak to the patients in real time (just as easily as
if the doctor were actually standing in front of them.) Doctors
can keep up with their patients from inside the facility or from
miles away, without devoting so much time to travel.
Beyond patient monitoring, the RP7 can be used as a tool for
both doctors and teachers. The Nursing Institute of Michigan
has used it to teach nursing students and in doing so found that
RP7 enables close supervision of both students and patients for
the benefit of everyone involved. An instructor can use the RP7
to be in several places at the same time, explaining procedures
to one group of students while observing the patient care the
students are providing. The instructor is immediately available
for any questions or emergencies that may arise as the nursing
students and patients interact.
The RP7 is mobile and can operate on high-speed Internet
without having to be connected to a stationary location.
The doctor and patient (or nurse, or student) can discuss anything necessary, face-to-face, enabling the physician to see what is
going on in real time and give immediate instructions or answer
questions. For example, if an emergency arises and the patient
needs medication immediately, the doctor can assess the situation, prescribe the drugs and watch as the nurse administers
them, just as though he were standing in the room. Time is of the
essence in medicine and the RP7 allows for real-time treatment.
These are just a few examples of how robotics is continuing
to change the way we think of medicine. I believe the future
of robotics is an exciting and bright one. As we delve into the
next 16 years, there is no longer a question of “what if?” when
it comes to robotics, but a question of “when?” Robotics is
here to stay today and into the future.
The Height of Robotic Medicine
Please visit our Center for Robotic Surgery online at
www.saintjosephsatlanta.org/center-for-roboticsurgery/ to see how robotics can make your surgery
simpler and your recovery faster.
17
| A Patient's Story |
No Strings Attached
Steven and Angela Sinton
A
saint joseph’s journey | www.saintjosephsatlanta.org
t 6 feet tall and 190 pounds, Steve Sinton is athletic and trim. When he walks into
a room he’s amiable and talkative, and all voice. He’s spent the better part of
his life being a mouthpiece, using his voice to share other people’s stories. He’s
a broadcaster, a storyteller, and so like all journalists, he’s conducted many interviews
sitting on the other side of “I never thought this would happen to me.” Only this time
those words are his own and this story is his.
18
To find a physician, call 877-250-STJO.
See Our Expertise
in Action
Go to www.sjmediaroom.com/
videos/ to see videos on how
we have helped community
members just like you.
An Undetected Heart Problem
At 59 years old, Steve had congestive heart failure and didn’t know it. While he was
aware he had a heart murmur, he had been told it was not serious. “The doctor said it
was slight, I didn’t pay any attention to it. I’ve always been massively healthy,” says
Steve. “I’m the last guy you would think you’d be talking to about this. I’m at the
gym every other day, on the bike and active. I started slowing down and the murmur
got louder but it just didn’t register because there’s no heart history in my family.”
But despite telling himself he was OK, Steve didn’t feel right. On several occasions he
found himself lowering his head between his legs gasping for breath, or waking to the
occasional drop of unexplained blood on the pillowcase. While he didn’t know it at
the time, these were indications of a much more serious issue.
On the day Steve’s wife, Angela, was running by Saint Joseph’s to pick up some
medical records, he felt pressure in his chest and decided to ride along with her to the
hospital. At the records window he said, “Let’s go to the emergency room. Now.”
By the time Steve arrived at the emergency room (ER), he was having difficulty catching his breath. During the ER
assessment, his blood pressure dropped
to 52 over 50. Unbeknownst to Steve, he
had blown his mitral valve and all eight
strings holding his valve in place had let
go one by one.
“Your mitral valve is like a manhole
cover that’s attached by eight strings:
your heart pumps and it closes. It’s what
forces oxygenated blood through your
system. Mine was flapping and blood
was splashing into my lungs, everywhere
it wasn’t supposed to be. My lungs were
partially collapsed. It’s a bad thing when
two of those strings let go, but eight of
them, all eight of them, had let go.
I wasn’t getting oxygen.”
partner will take over care in less than
five hours. These guys usually order
the tests by phone and let their partner
take over on rounds the next morning.
At that the point I knew he was in great
hands,” she said.
Doctors Who Listened
The next morning Steve met with Saint
Joseph’s team member, Van Crisco,
M.D., who “had a confidence that was
contagious,” said Steve. “He came in
and talked with me and he listened. I
want a doctor to listen to me. And Van
listened. That Friday afternoon when my
test results were back, he came in and
told me, pedestrian that I am, in
layman’s terms I could understand.”
Dr. Crisco was about to call in
another team member, who happens to
be the world-renowned robotics surgeon
in the area of repairing mitral valves.
“Dr. Crisco looked at me and said,
‘We are going to fix that valve.’ I said,
‘You’re going to fix it?’ And he said ‘No,
but a guy named Doug Murphy, who
is one of the best in the world will...’
In Disbelief and in the ER
Steve remembers that day well. “They
had me inverted on the ER table working to get me stable and relieve the chest
pain. Alarms were going off everywhere,
and I’m still incredulous because there’s
no heart history in my family. This can’t
be happening to me. Next thing I
know they are rolling me from the
ER up to the floor.”
After being admitted, at almost
1 a.m. Friday morning, the cardiologist on call, Michael Jones,
M.D., drove to the hospital to sit
down with Steve. “He was there
for more than 20 minutes, told
me what was going on, told me
what tests he was scheduling
for the next morning, and what
he was looking for, because we
did not know exactly what was
causing my symptoms. Dr. Jones
Feeling fortunate at
Christmas time.
then explained that his partner, Dr.
Van Crisco, an interventional cardiologist, would assume my care the
next morning.”
When he left, Steve’s wife (who coincidently has worked in the device industry in cardiac surgery) noted, ‘‘In 20
years, I have never seen a doctor drive
from home at 1 a.m. just to talk with,
assess, and reassure one single patient,
who by now is stable, and for whom his
And my wife followed this guy while he
picked up his phone, called Dr. Murphy
to discuss my case, and set up surgery
the following Tuesday. The likelihood
doctors who just happened to be on call
would be world-class doctors would
be unheard of anywhere but at Saint
Joseph’s Hospital.”
That Tuesday, Steve says Dr. Murphy
gave him his life back: “It was about
four hours of pure ‘Star Trek’ medicine.
He used a robot on me. I have four very
small incisions on my side instead of the
huge zipper guys usually wind out with.
I was home three days after the surgery
and walking around. This was the most
phenomenal, modern, futuristic thing
anyone could go through and it was done
by the best, Doug Murphy—the guy who
teaches everybody else how to do it all
over the country!”
Today, 6 months later, Steve is no
longer short on breath or time. In fact,
you don’t need a microphone to be able
to hear Steve’s deep, baritone voice
booming from down the hallway—
sharing a story that begins with,
“I’m happy to be here. I’m happy to
be anywhere.”
Time is the most critical resource in a heart emergency.
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