Left, Riley Lloyd, M.D., and Teresa Tam, M.D. instruct residents at Presence St. Francis Hospital in minimally invasive robotic surgery.Photo by Mary Mumbrue
Left, Riley Lloyd, M.D., and Teresa Tam, M.D. instruct residents at Presence St. Francis Hospital in minimally invasive robotic surgery.
Photo by Mary Mumbrue
Residents in Presence St. Francis Hospital’s obstetrics and gynecology program honed their skills last week with robotic arms and a computer screen in a training session for minimally invasive robotic surgery. Guided by arrows and prompts on a computer screen while gripping handles to guide a miniaturized wristed instruments, the young doctors practiced techniques that can address many gynecological problems without open surgery.

Minimally invasive surgery allows the surgeon to go through a small incision with miniaturized wristed instruments and a high-definition 3D camera so they can see a magnified view of the surgical site inside the body. It also increases precision and allows doctors to reach places that were once impossible to access with the human hand.

Dr. Teresa Tam, who leads the robotic surgery program, wrote the curriculum for this procedure. The day began at 7:30 a.m. for Dr. Tam, with morning lectures before the three-hour training session. “Today we’re doing a skills lab,” she said, “so the residents will get to know the technology.”

New this year, she said, is Firefly technology for the camera, which allows fluorescent imaging. “ The dye binds to proteins in the blood cells and gets excited by the infrared laser illuminator from the robotic camera so abnormal tissues become fluorescent green, allowing us to see abnormalities we normally wouldn’t be able to see. We use this for endometriosis. It helps us visualize all the tissue that has been profused and helps us resect the abnormal areas.”

During the training sessions, the residents took turns with the da Vinci Surgical  System, moving a ball across a pink plastic rectangle, about the size and consistency of a uterus, to a targeted area that would be the incision point. This initial, gentle move is to ensure that the patient would not be harmed. The next step, which not all doctors completed on their first try, was “dropping” the ball into the rectangle, again with the precision needed to avoid harm to the patient.

Riley Lloyd, M.D., director of surgical core curriculum at Presence St. Francis, said, “We expose residents to all of the new technology that’s been introduced in their field so they can become familiar with it.”

Mariam Hanna, one of the Ob/Gyn residents took her first turn on the simulator. “How do you like it?” Dr. Tam asked.

“Oh, it’s great,” said Dr. Hanna. “It had a difference and new feel – to see the elegance of the machine,” Dr. Hanna told the RoundTable.

Dr. Tam said “It’s not just robotics we’re trying to [teach] but minimally
invasive surgery.”

Dr. Lloyd said single-port [incision] robotic surgery is becoming more common and said, “St. Francis is the most advanced single-port surgery in the Midwest. …
Any surgery you can do in open surgery we can do with a single port.”

Of the 75 minimally invasive surgeries conducted within the past year, only one had to revert to conventional surgery, said Kevan Citta, R.N., robotic coordinator.

Dr. Tam said, “Studies have shown that any minimally-invasive surgery would provide better outcomes such as a faster recovery, a shorter hospital stay, smaller incisions and less pain and blood loss and a faster return to normal activity. This is better for patients. Better outcomes make better patient safety.”

“Presence Saint Francis is unique in that it is the only community hospital on the North Shore to offer an extensive minimally invasive surgery curriculum for its OB/Gyn residents,” said Roberta Luskin-Hawk, MD, regional president and CEO.