Intuitive Surgical's latest generation robot, the da Vinci Xi system, has significant advantages

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Dec 18, 2014

Dr. Tseng first to perform endometrial cancer surgery on Intuitive Surgical's latest generation robot, the da Vinci Xi system

Watch Providence's new robot repair a hernia (Video)
Elizabeth Hayes
Portland Business Journal

Dr. Chet Hammill, a surgeon at the Oregon Clinic, quietly made medical history back in September with a robotic-assisted hernia repair.

Hammill became the first surgeon in the world to attempt and complete the procedure using Intuitive Surgical's latest generation robot, the da Vinci Xi system. He performed the repair at Providence Portland Medical Center on a 30-year-old woman who had a large complex hernia from a previous surgery.

"It traditionally required a bigger surgery," Hammill said.

The patient spent three days in the hospital following the procedure, two fewer than with standard surgery, mostly for pain control. The minimally invasive surgery also comes with less blood loss and risk of infection.

Hamill actually wasn't the very first surgeon to use the new device. Providence acquired the new robot in July and Dr. Paul Tseng of Compass Oncology first used it for an endometrial cancer surgery. Tseng said the patient was discharged the following day, down from a five-to-seven-day stay in the past.

The latest generation robot has "significant advantages," Hammill said. The Xi version has four arms that hold a camera and surgical instruments minute enough to slip into the body through openings the size of a pencil.

The surgeon sits at a separate console across the room and controls the robot's movements using mechanical wrists and 3D high-definition vision. Special software minimizes the effects of a surgeon's hand tremors.

"We're shrinking our own hands and putting them inside the patient," Hammill said.

The system is not without controversy, however, mainly due to the high price tag, said to be between $1 million and $2 million. It also comes with a lot of disposable equipment that needs periodic replacing, and there's also an annual maintenance fee.

"A lot of people argue it could be done just as well with cheaper laproscopic (minimally invasive) instruments," Hammill said. "I think there's some truth to that."

Obviously, the more procedures done, the more the device pays for itself. Providence Portland, which does 400 robotic cases a year.

Hammill said the hernia surgery he performed "would be very difficult without the use of the robot, because of the angles you're working from. You're looking up at the abdominal wall and you have to operate in a downward direction. The other issue is sewing on a ceiling is very difficult."

The da Vinci Xi system can be used for a wide spectrum of minimally invasive surgeries, including prostate removal, hysterectomies and other cancer procedures.

Hammill said he expects to use the device about once a month for the large, difficult hernia procedures he performs.

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