Northwest Brings Brilliance, da Vinci

Flying cars, floating cities and routine space travel might still be off in some distant, cartoon future.

However, at Northwest Health System, the future has arrived – to the tune of about $3 million – in two different high-tech machines.

The da Vinci Surgical System, designed by Intuitive Surgical Inc., of Sunnyvale, Calif., is a robotic device that allows surgeons to operate with mechanical exactness, eliminating the need for large incisions while reducing human imprecision such as hand tremors. Northwest Health bought the system in December 2006.

The Brilliance 64-slice CT scanner, created by Philips Global Medical, can create 3-D images of internal organs in minutes, providing physicians with a critical view of emboli or blocked arteries. The scanner has been available at Northwest Health’s Springdale campus since February 2006 and at the Bentonville facility since June.

Neither of these devices would look out of place on the set of “Star Trek,” and the da Vinci isn’t currently available anywhere else in the region.

Such technological advances aren’t usually cheap; the da Vinci system was about $1.5 million, while the two CT scanners were $750,000 each.

But improving results for patients was much more of a consideration for the hospital than price, said Joyce Heismeyer, administrator and COO of Northwest Health.

“The advantage of the da Vinci system is in improved patient outcomes,” she said. “It reduces length of stays, blood loss and risk of infection.”

Another reason the hospital chose to acquire the new machines was that they weren’t previously available in Northwest Arkansas.

Many patients had told the staff at Northwest Health that they were forced to travel to Little Rock or Tulsa for access to the technologies, Heismeyer said.

 

Renaissance Machine

The prospect of surgery can give pause to even the steeliest of patients. Many concerns arise, not least among them pain, scarring and recovery time.

One advantage of the da Vinci system is that it significantly reduces many of these factors by dint of much smaller incisions than those necessary for traditional surgery.

The system facilitates what is referred to as a robot-assisted surgery. Patients are never at the mercy of the machine; the surgeon is in control at all times.

Surgeons sit behind the machine and their hand motions are translated into precise robotic movement. The mechanism is very intuitive, said Dr. Chad Brekelbaum, who has performed 22 prostatectomies with da Vinci.

The physician uses two free-floating devices that look a bit like pencils, the movement of which dictates where the arms of the machine go in the body.

“If I move my hand left, it goes left. If I move my hand farther in, it goes farther in,” Brekelbaum said of da Vinci.

During surgery, the physicians can see the inside of the patient’s body on a console via an internal camera with two lenses. This provides the surgeon with a magnified, three-dimensional view of tissues and organs.

Much like its namesake, the da Vinci system doesn’t focus on one area of specialty. Physicians have the potential to perform several different minimally invasive procedures, including prostatectomy, hysterectomy, cardiothoracic surgery, gastric bypass and other general surgery.

At this point, though, prostatectomy and hysterectomy are the primary applications for da Vinci at Northwest Health.

The two physicians who use the da Vinci system for prostatectomy are Brekelbaum and Dr. Robert Zimmerman. Dr. Scott A. Bailey is the physician who uses the system for hysterectomy, and was the first in the state to do so.

To an extent, the surgeons at Northwest Health determine which applications the da Vinci system will be used for. If and when the hospital offers further applications of the system depends on whether physicians there decide to go through the training to use the machine.

Many new fellowship candidates and recent medical school graduates were trained on the da Vinci system, and want to work with it, Heismeyer said.

“Physicians who were trained that way expect to have the system and feel strongly about using it,” she said.

But as more and more physicians are trained to use the system during medical school, it’s likely that one day these options will be available at Northwest Health.

Another reason Northwest Health chose to invest in the system ties into the fact that the system is becoming more common. Having the da Vinci system available will help the hospital to recruit top surgeons, Heismeyer said.

Since the arrival of da Vinci, the machine is used an average of six to eight times a month for a total of about 60 surgeries to date.

 

Detailed Diagnosis

The 64-slice CT scanner is a drastic improvement from the previous two-slice scanner available at Northwest Health, said Dr. Todd Logsdon, of Bentonville Radiology Consultants at the Bentonville Northwest Health campus.

It can produce 64 images per millimeter, as opposed to the 2 images per millimeter of the older machine.

This generates a highly detailed, three-dimensional image of a patient’s kidneys, brain, heart or other organ, giving physicians a much better glimpse inside the body.

The new scanner provides improved organ imaging for diagnostic purposes, as well as enhanced vascular imaging, Logsdon said.

“Vascular imaging with a CT scanner is preferable because it is a noninvasive procedure,” he said. This is better than the angiograms that were performed more frequently in the past, and which involved inserting a catheter into the skin.

The new procedure is also much faster. A full-body scan can be finished in a few minutes, while the older machine could take much longer. A heart scan can be performed in as quickly as 30 seconds.

The images produced by the scanner can also be stripped away layer by layer, allowing doctors to see tiny changes that wouldn’t be visible otherwise, Heismeyer said.

Certain studies couldn’t be done on the older scanner, such as coronary and vascular imaging of the lower extremities, while imaging of other areas was vastly improved with the new machine, Logsdon said.

Northwest Health isn’t the only healthcare provider with a 64-slice CT scanner. Washington Regional Health System has had one of the machines since December 2006, said Terry Fox, marketing and public relations director for the hospital.

Mercy Health System doesn’t currently have a 64-slice scanner, but will likely acquire one when moving into its new facility next spring, said Mercy Health spokesman Kyle Weaver.

Neither Mercy nor Washington Regional is planning to purchase a da Vinci system any time soon.