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New robot gives bariatric surgeon more flexibility - Odessa American: Local News

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New robot gives bariatric surgeon more flexibility

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Posted: Sunday, December 8, 2019 4:00 am

With two stations, Medical Center Hospital’s new da Vinci Xi surgical robot is helping surgeons like Dr. Donald Davenport gain more flexibility with their procedures and results in even better patient outcomes.

Davenport, who performs a lot of bariatric procedures, said the new robot allows him to work in smaller, confined spaces easily. The previous robot was the Si.

“… The Xi allows me to work in different parts of the belly, so I can work I can work in the lower belly. I can work in the upper belly, either side all with one robot without having to move it. With the other robot, it’s kind of stagnant to a quadrant of the abdomen so that makes this a lot better from an operational standpoint,” Davenport said.

It also makes bariatric procedures easier.

“Because a lot of times we can be working in different quadrants, especially if we’re doing gastric bypass, working from the lower belly to the upper belly it makes things a lot easier. Plus moving around the intestines inside the abdominal cavity is a lot better for us, as well,” Davenport said.

For more of the simpler bariatric surgeries, like a sleeve, Davenport said you can use the Si.

“Positioning of the patient, positioning of the robot is a little more difficult with the Si. … With this, we position the robot the same way every single time so this new robot allows us to work in different areas with the same position. It’s a safer tool than what the Si is,” he added.

In some circumstances, Davenport said, the new robot makes procedures faster and more efficient.

“As a surgeon, a lot of times we’re used to kind of doing things on our own; being able to control a lot of what we’re doing anatomically. We only have two arms (anatomically), but when I’m operating I have four. In all honestly it’s kind of a nice thing because then I can control four different pieces of what I’m doing at one time,” Davenport said. “From the visual standpoint, the optics on the Si are good. On the Xi, they’re much better so you visually can see so much better. It’s really like operating under a microscope. You can see anything you want to see better than you’d be able to see it just visually with your own eyes.”

The new robot is being used for bariatrics, intra-abdominal general surgery, intestinal surgery, gall bladder surgery and hernia repairs. Urologists are using it for nephrectomies and gynecologists for hysterectomies.

“The idea behind utilizing the robot, as opposed to using our hands laparoscopically, … the belief is that the torque on the body utilizing the robot is less. It’s a mechanical issue, so because of the mechanics of how the robot works, as opposed to what we’re doing externally kind of pushing and pulling with our arms, the belief is there is less damage to tissue from the incisional standpoint, which then leads to less pain and quicker recovery,” Davenport said.

He added that it’s also easier on him as a surgeon.

“You’re more comfortable operating. … If you get into an operation three or four hours where you’re literally bent over the table … you have less strain on your neck, less strain on your back. It’s much, much easier and certainly it will prolong the longevity of the surgeons …,” Davenport said.

Bariatric surgeries take anywhere from just under an hour to an hour and a half to two hours. He said there isn’t much time difference between doing the procedures laparoscopically and with the robot.

He said the platforms for the Si and Xi are similar and the mechanics are similar.

“… We have in-service from the company Intuitive helping us through the first few cases. We have somebody on-site to help us work through problems and issues that we could have …,” Davenport said.

He said there is a lot of discussion about using the robot for cases that come out of the emergency department — whether or not the robot should be used in those cases.

“… I find much more difficult … to do something laparoscopically now than I did before. I transitioned into robotic surgery and I think really the biggest change in what you’re seeing here is three-dimensional, being able to be up close; the ease of manipulation of tissue; the precision associated with the robot, in what you’re doing, whether it’s suturing or manipulating tissue, is so much better. It’s kind of when you transition back to laparascopy. It’s a lot different, and in some instances, it can be more difficult,” Davenport said.

He said there are limits on when and how the robot can be used because of training.

“… There are certain staff that are trained to do this, so we’re limited mainly during operating day time, so on the weekends (we will) not necessarily … be able to use it at night. … But trying to transition into that where it’s available 24 hours a day is certainly a goal,” Davenport said.

The new robot was acquired in September and Davenport said he has been using it since early November.

“We did the first bariatrics on the new robot two weeks ago,” Davenport said Nov. 14. “It worked out just fine. … I’ve probably done about 30 cases on the new robot in the last couple of weeks.”

Daniela Flores is the circulating nurse robotic coordinator. Her duties include making sure all the supplies a surgeon needs are on hand for the best patient outcomes.

“… I’m a circulating nurse, so I am here in the room on occasions and I’m a big fan of the robot. At first, I was very skeptical, just because it’s kind of intimidating. But once I’ve started playing around with it, getting to know more of it, getting to see the patient outcomes, I’m all for it,” Flores said.

“… Nursing-wise, it’s a big change for the patient outcomes, which is the most important thing,” Flores said.

The technology in the new robot allows the doctor to position it where they need it and it’s not hurting the patient. It’s also minimally invasive. She noted that the new robot improves patient outcomes and the surgeon is able to visualize the abdomen wherever he’s operating.

“If anything goes down, we’re going to be the person that’s going to call the help number and be like run us through all of this because the surgeon is going to be busy trying to figure out what’s going on over here, as well as the techs are going to be trying to figure out if there’s something wrong with the instrument. The anesthesiologist is going to be worried about the patient as well, so we’ll be kind of the runners to make sure that we have everything available in the room for them if anything goes down and just to keep it all flowing well,” Flores said.

She added that she sees the robot as becoming the future.

“… It’s already here, but it’s the … new toy. Everybody wants to try it, and again, if it’s going to help the patients then that’s kind of where we want to head towards,” Flores said.

Davenport said nurses like Flores are integral to what the surgeons do.

He added that everyone has to be on the same page with what’s going on so that procedures are like a fluid combined effort.

“Not only is she responsible for knowing what’s going on with the robot, but she has patient care responsibilities, as well. So she does the robotic component of it, helps us get everything set up and then during the course of the procedure she’s responsible for helping what’s going on. …,” Davenport said.

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