Early Friday morning, Kim Westbrook — an OB-GYN working with Laramie Physicians for Women and Children — began the first robotically assisted surgery to ever take place at Ivinson Memorial Hospital.
When the procedure was complete — and once the room was turned over and instruments sterilized — she began the second.
Westbrook said both patients, each receiving a hysterectomy, were excited about the benefits of robotic surgery.
“One of (the patients) had already had a robotic surgery in the past, so she was familiar with it and was seeking that (and) had been waiting for this,” Westbrook said. “And the other one was also very excited and well aware of what the robot is.”
IMH installed a da Vinci Xi Surgical System — the latest in a series of surgical robots by the company Intuitive Surgical — in September. The machine allows surgeons to be more precise in their movements and work with more detailed information during minimally invasive procedures.
The robot has two main components. One is attached to the operating table and includes several surgical instruments. The other component is a console — displaying a high-definition, magnified 3-D image of the surgical field — from which a surgeon can direct the procedure.
By refining the surgeon’s movements and eliminating the hand’s natural tremor, the robotic system requires smaller incisions than more traditional methods of surgery, cutting down on post-operation recovery time.
“The other thing that we really noticed, with these two cases — that the staff was a little bit surprised about because they had never seen robotic surgeries before — is the blood loss was almost minimal,” Westbrook said. “There was hardly any blood loss and hysterectomies by other routes (have) significantly higher amount of blood loss.”
While neither of the procedures Friday experienced insurmountable complications, Westbrook said she was thankful to have the robot, especially for the second patient, who would have needed a larger incision, experienced more blood loss and required a longer recovery time if not for the machine.
“The second case was a patient who had something called endometriosis, which is something that can cause scarring and it causes chronic pelvic pain,” Westbrook said. “It makes surgeries more difficult because of what we call adhesions and scar tissue, and the robot really helped to dissect out that tissue with minimal blood loss.”
She added patients undergoing treatment by robot might also require less anesthesia as procedure duration drops.
“(It) is going to cut down my operating time, as opposed to making it longer,” Westbrook said. “People in the community may have heard this is going to extend your operating time, it’s going to make it more difficult. And that was the case 10, 20 years ago when they first came out with these robots, but this is actually going to shorten my time.”
Westbrook will not be the only surgeon using the robot. General Surgeon Jack Ullrich said in September he will use the robot to remove gallbladders and conduct intestinal surgeries, as well as surgeries on abdominal wall hernias.
While Westbrook worked with a surgical robot during her residency, she had to complete a training curriculum before being approved by Intuitive Surgical and IMH to work the robot.
The training process included sitting in on surgeries performed by experienced users, online modules, an exam, on-site training with a simulator, hands-on skills drills and a one-day course in Houston.
Westbrook must also complete three cases proctored by a surgeon of her speciality, chosen and employed by Intuitive Surgical.
“Afterwards, they make a recommendation as to whether or not you are safe and prepared to operate independently,” Westbrook said.
She added the training she received in her residency gave her an advantage and reduced the length of the procedure.
“It was actually, for me, faster than I would have been able to do by my own routes prior to having the robot,” Westbrook said. “And it’s not always that fast initially, but I have quite a bit of experience with the robot prior to coming here so the learning curve for me wasn’t quite as high. We wouldn’t expect to see cases go quite that fast for other surgeons when they’re first starting.”
The robot will not be used for all gynecological surgeries, Westbrook said, though it can be used for most laparoscopic surgeries on the abdomen or pelvis.
“We do even have some surgeries in the abdomen or pelvis that we will not use it for,” she said. “We do a large number of vaginal procedures and hysteroscopic procedures, which is a scope in the uterus through the vagina. None of those will be performed with the robot.”