From rare to standard of care: Robotics a growing tool among Northwest Arkansas surgeons

Robotic surgery has gone from rare to the standard of care in some fields in the last 15 years, according to surgeons in the region.

The global market for surgical robots was $3.6 billion in 2021 and is expected to reach $18.2 billion by 2030, according to market analyst Grand View Research. North America holds more than one-half of the current market share.

"If we look where robotics was in the early 2000s and then look 15 years later, to the point where almost everything in urology is robotic, it's definitely here to stay," said Dr. John Terrell, urologist at Baptist Health in Fort Smith.

As robotic technology becomes more advanced, it will only lead to more precision, smaller instruments and better outcomes for patients, Terrell said.

Advanced technology has been applied across multiple fields in recent years from gynecology to orthopedic surgery to neurosurgery.

The University of Arkansas for Medical Sciences in Little Rock began a multispecialty robotic surgery curriculum last fall, training residents in general, gynecologic and urologic surgery.

In Northwest Arkansas, doctors at Mercy, Northwest Health and Washington Regional Medical Center use Intuitive's da Vinci robotic surgical system.

There have been several thousand robotic surgeries at Baptist Health in Fort Smith in the decade since the hospital acquired its first da Vinci robot, Terrell said.

Washington Regional does many robotic surgeries with most surgeons having completed hundreds of cases, according to Dr. Jeffrey Bell, assistant chief medical officer for surgery at Washington Regional.

Mercy Fort Smith acquired a da Vinci robot about a year ago, according to Dr. Adeel Shamim. He said he uses robotic technology in about 25% to 30% of his surgeries, and he expects about 70% of his surgeries could be robot-assisted in the future.

Dr. Raj Nangunoori at Mercy Northwest Arkansas in Rogers is one of a small group of neurosurgeons across the country who have access to Synaptive's Modus V robot.

The robot is the only Modus V in Northwest Arkansas, one of two in the state and one of about 30 in operation in the United States, according to Nangunoori.

In about 10 years, Nangunoori could be using the Modus V in about 80% to 90% of his surgeries, he said.

Many surgeons said the term "robot" is a bit of a misnomer.

"When people think of a robot, they're thinking of something on 'The Jetsons,' something that is going to be thinking on its own. This is almost like any other instrument in that you control its movements precisely with your hands," Terrell said of the da Vinci system.

"It should really be called robot-assisted surgery," Shamim said.

COSTS AND BENEFITS

Surgical methods have evolved over the last 50 years, moving from open surgeries with large incisions to laparoscopic surgeries with smaller incisions, to even less invasive robotic surgeries that use three-dimensional imaging, according to Shamim.

Although there may always be surgeries that cannot be done with a robot, the technology will continue to improve, Bell said.

As a part of this evolution, the medical industry will continue to see more specific and precise robots for a growing number of niche purposes, Terrell said.

Bell added one drawback is the learning curve for more experienced surgeons.

"Most surgeons coming out of residency programs now have robotic experience as part of their surgical training," Bell said. "For surgeons who did not experience robotic training in residency, there is a process to follow."

Bell said the training process involves an informational course, a simulator program, formal training and more simulated procedures supervised by experienced robotic surgeons followed by proctored cases.

The da Vinci system costs as much as a few million dollars, but the benefits outweigh the cost, according to Shamim.

"It's made me a more efficient surgeon," he said, adding that some three-hour surgeries now take him around 50 minutes with the da Vinci system.

That efficiency allows the hospital to take on more patients in addition to giving those patients better care, he said.

The benefits for patients include less pain and quicker recovery times without adding any cost, he said.

"This has enhanced patient care," Shamim said. "Everyone's talking about the cost, but surgeons are able to do a better surgery, period."

ROBOTICS IN UROLOGY

Urology has always been at the forefront of technology, according to Terrell.

The need for very precise incisions "made it very fertile ground for robotics to grow in," Terrell said.

"The da Vinci tech is just a means to control the instruments in a more precise way," he said.

Unlike traditional laparoscopic surgery, the robot allows a smaller incision, uses a smaller instrument, has better movement and shows a 3D image, he said.

Procept's AquaBeam system is another recent application of robotics to urological procedures.

After ultrasound is used to plan the treatment, the system uses a heat-free water jet, controlled by robotic technology, to treat urinary tract symptoms due to enlarged prostate.

"It's almost like a self-driving car," Terrell said. "We're just giving it a program that it's going to run and do."

Baptist Health in Fort Smith has used the robotic system for over a year, according to Terrell. Northwest Medical Center in Bentonville also recently began using the technology.

"It has cut those hospital stays shorter. It's also allowed us to expand our treatment of older people that traditionally were not eligible because of their age or size of prostate," Terrell said.

Physicians guide the parameters of the robot as it completes the surgery under constant monitoring, according to Dr. Chad Brekelbaum, urologist at Northwest Arkansas Urology Associates.

The treatment is unique because it allows doctors to have a real-time understanding of the tissue they are treating and see the results throughout the process, according to Dr. Matthew Kincade, urologist at Arkansas Urology in Fayetteville.

"I foresee this treatment becoming the standard of care in urology in the near future," Kincade said. "As more and more patients are able to get this treatment, we will see not only how well patients do during the short term, but the medium- and long-term benefits really exceeding current treatments with much less risk of bothersome side effects."

ROBOTICS IN NEUROLOGY

In neurosurgery, robotic technology is still in its infancy, according to Nangunoori, the Mercy neurosurgeon.

Mercy's Synaptive Modus V system is a robotic, digital microscope that projects a high-resolution, 4K image onto a monitor.

"The key is visualization," Nangunoori said.

Like several other surgical robots, the Modus V also makes surgery more comfortable for the physician, he said.

"The surgeon operates while looking ahead instead of looking down, so ergonomically, it is much easier to use," he said. The system can also be controlled by the surgeon's voice.

By reducing the toll surgery often takes on a doctor's neck or wrists, the technology could prolong surgeons' careers and help combat a shortage of medical personnel, Nangunoori said.

"There almost isn't a reason not to use it," he said. "It really is an honor and privilege that we had a very generous donor who provided the funding to get this technology."

The development of surgical robots

1985: The first recorded robot-assisted surgical procedure was performed at the Memorial Medical Center in Long Beach, Calif.

1992: Computer Motion’s AESOP system became the first surgical robot to be approved by the U.S. Food and Drug Administration.

1995: Robotics company Intuitive Surgical was founded.

2000: Intuitive’s da Vinci robot became the first robotic surgery system cleared by the FDA for general laparoscopic surgery.

2001: Computer Motion’s ZEUS became the first commercially available surgical robot to complete a transatlantic surgery.

Source: National Center for Biotechnology Information