In the early 1970s, Dr. James Croak was one of the first Toledo-area doctors to perform laparoscopic surgery, using small incisions and a telescopic system that has become routine for many operations.
Now his son, Dr. Andrew Croak, is among local doctors taking laparoscopy to the next level, controlling robotic arms that hold cameras and surgical instruments from a console near the operating table.
Led by St. Vincent Mercy Medical Center, where robotic surgeries have been performed for nearly five years, four Toledo-area hospitals now have da Vinci Surgical Systems - which cost roughly $1.5 million each - from Intuitive Surgical Inc.
University of Toledo Medical Center and St. Luke's Hospital doctors last year started using their robotic systems, which allow surgeons to make small incisions that decrease blood loss, pain, chance for infection, and recovery times. Toledo Hospital introduced its da Vinci system last month.
Tracy Hammond of Cygnet, a patient of Maumee urogynecologist Dr. Andrew Croak, had outpatient robotic surgery to have her painful ovaries and tubes removed at St. Luke's on Dec. 21. She took her last prescription for pain two days later, enjoyed the holidays, and returned to work in a week, she said.
"I didn't have any trouble at all," said Mrs. Hammond, 38. "I feel good now, as far as the surgery goes. I don't even realize I had surgery, except for the little scars."
Locally, urologic surgeries - such as prostate removal - are the most common done with robotic systems. But gynecologists, vascular surgeons, cardiothoracic surgeons, and others also are performing robotic operations.
Dr. Bernardo Martinez, who long has performed robotic surgeries at St. Vincent, is the only doctor nationwide who has received Food and Drug Administration approval to repair abdominal aortic aneurysms robotically. More than 200,000 of the bulging abdominal arteries are diagnosed nationwide every year; they often are fatal if the vessel bursts.
A good surgical candidate has not been found yet for Dr. Martinez's pilot research study, said Cathy Wiegand, manager of the Laparoscopy, Simulation & Robotics Training Center at St. Vincent.
Not everyone is a good candidate for robotic surgery. Patients cannot have a lot of abdominal scarring, for example, or be too overweight.
Toledoan Gary Masters had his prostate removed Jan. 8 at Toledo Hospital by Dr. Emmett Boyle, a urologist who started using robotic surgery at St. Vincent in 2003. Mr. Masters, a 56-year-old diagnosed with both colon and prostate cancer within six days last summer, said he spent less than 24 hours in the hospital instead of days and had a catheter for a week instead of at least two.
"I felt good even before the catheter came out," said Mr. Masters, who previously had a cancerous polyp successfully removed from his colon.
He added: "I've come out of this with no problems."
Eventually, robotic systems will be used more widely in telesurgeries on patients in remote areas, including battlefields, Ms. Wiegand of St. Vincent said.
Robotic surgeries performed through incisions in natural orifices, such as mouths and rectums, also are in the future, said Dr. Jeffrey Gold, dean of UT's college of medicine, which includes the former Medical College of Ohio.
"To me, it's definitely a matter of time before the robots can be designed with a flexible arm," said Dr. Gold, who also is UT's executive vice president and provost for health affairs.
Other minimally invasive surgery techniques are being studied. High-intensity focused ultrasound proved too powerful to treat kidney stones, for example, but it may be used to destroy tumors in kidneys and prostates, said Dr. Boyle, Toledo Hospital's director of minimally invasive surgery.
Meanwhile, robotic surgery may not be an option for all types of surgeries, such as the removal of large tumors to be analyzed by pathologists, some doctors and experts said.
For doctors, robotic surgery has many advantages over laparoscopic surgery, they said. While images used to guide surgeries during laparoscopic procedures are two-dimensional and instruments are rigid - which Dr. Boyle described as being like using chopsticks - doctors get three-dimensional views with robotic systems and instruments that move more freely as they would if wielded by hands.
There is a learning curve for surgeons, who have been trained to use their hands to guide them while operating, said Dr. David Franzblau, chief medical officer for Mercy Health Partners.
Robotic systems, meanwhile, eliminate tremors and fatigue that can be experienced during surgery, said Dr. Andrew Croak, who operates at St. Luke's.
"It's going to expand," said Dr. James Croak, a retired Maumee gynecologist who watched his son perform some robotic surgeries at St. Luke's.
He added: "We've seen it come from very crude instruments to very sophisticated surgical robotic tools."
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