Robotic surgery helps docs improve efficiency, outcomes

ARM’S LENGTH: Dr. W. Scott Walker, the first Lifespan surgeon to perform single-site robotic gynecologic surgery, said advances in robotic technology “really makes [him] a better surgeon.” / COURTESY LIFESPAN
ARM’S LENGTH: Dr. W. Scott Walker, the first Lifespan surgeon to perform single-site robotic gynecologic surgery, said advances in robotic technology “really makes [him] a better surgeon.” / COURTESY LIFESPAN

Dr. W. Scott Walker is the first Lifespan surgeon to perform single-site robotic gynecologic surgery in Rhode Island and Massachusetts. Part of a second phase of surgeons across the country selected for training in this highly technical field, Walker has performed more than 300 multiincision OB/GYN robotic surgeries, including ovarian cystectomy and surgery for endometriosis.
Robotic single-site surgery is part of an innovative, new approach to hysterectomy surgery, which involves the removal of a woman’s uterus. The single-site surgery is performed through only one incision, about an inch long, in a woman’s bellybutton. Walker lauds this type of surgery as an effective advancement to robotic laparoscopic surgeries, which are usually performed through multiple incisions.

PBN: How did you become the first surgeon in Rhode Island and Massachusetts to perform the single-site robotic hysterectomy?
WALKER: I’ve been doing robotic surgery since 2010. I’m the highest-volume robotic surgeon in the area. I was approached by Intuitive Surgical, the company that makes the daVinci robot (used to do the surgery) to be one of the initial surgeons, so that when the formal rollout of single-site hysterectomy in the beginning of 2014 comes they’ll have experienced surgeons for case observations and teaching.

PBN: Why is robotic technology becoming increasingly important to the medical field?
WALKER: It’s really been a logical extension of minimally invasive surgical techniques, which have taken over in all fields of surgery. There are still some difficulties with really complex gynecologic surgeries. The advantages of robotic surgery, which include wristed instruments that can move like my hands and the ability to operate in 3-D with high-definition cameras, really makes me a better surgeon. It’s kind of like being miniaturized. Once you do the surgery for a while it’s almost like you’re not even thinking about the robot and the instruments. You’re just moving your hands as if you were holding onto the instruments directly.

PBN: Is single-site robotic surgery at all controversial in the medical community?
WALKER: I think there has been some conversation about robotic surgery in general because of the expense of the technology. In my feeling, it’s better because it allows me to do surgeries in a shorter time and with a lower chance of having to convert to an open procedure. With regards to single-site robotic surgery, it’s a logical next step now that the technology has been developed. In 2008 single-site, laparoscopic surgery, including hysterectomies, was approved by the FDA but it never took off because of limitations with the technology. It was just technically very challenging to perform.

PBN: How do you describe the daVinci Surgical System to your patients?
WALKER: I explain [that] instead of me holding the instruments directly, I sit right next to them at the surgeon console and [the movements of] my hands holding onto the instruments at the surgeon console [are] directly transmitted to the instruments inside their body. It’s important to remind patients that I’m right next to them in the same room. Initially some people are afraid I’m in a different room but it really is very intimately connected. The technology is so advanced that every movement my hand makes is transmitted exactly to the miniature instruments inside the patient.

- Advertisement -

PBN: How does the robot make up for the tactile responses that you have in traditional surgery? WALKER: That is one of the real challenges with robotic surgery because we don’t have any tactile feedback at the surgeon console. The interesting thing is that our brains are very adaptable and all of us learn to substitute visual cues for the tactile cues that we have in other types of surgery. I really almost feel that I can feel the tissue now because my brain has gotten so used to looking at the way the instruments indent the tissue, how tissue blanches under pressure En dash again substituting visual for tactile cues.

PBN: Do you worry about malfunctions?
WALKER: I think the short answer to that is no because the technology is so advanced and there are so many backups that it’s not something that has been an issue. We use technology for everything now. We’ve got instruments that are connected to different energy sources, just like you do in the robot. You have light sources and cameras that need to function. So I think surgery in general has become very technologically advanced. One of the reasons that medical care is expensive is all the checks and balances and safety features that are in these technologies so they don’t malfunction. One of the things that’s really nice about the robot is that I’m able to do it all myself. I’m controlling the camera. I’m controlling the instruments. I’m controlling where the camera’s placed and exactly what it’s looking at; I’m controlling the energy source myself. In other types of surgeries there may be two, three or even four people sharing those roles amongst themselves and while a good surgical team has great communication it’s still multiple people instead of just one.

INTERVIEW
Dr. W. Scott Walker
POSITION: Obstetrician and gynecologist with Ob/Gyn Associates, which recently partnered with Women’s Medicine Collaborative at Lifespan. He is also a clinical assistant professor at the Warren Alpert Medical School at Brown University.
BACKGROUND: Since 1988, he’s been in private practice in Providence, working in advanced microscopic procedures with Ocean State Women’s Health until they disbanded in 2005. He has practiced with OB/GYN Associates since then, transitioning into robotic surgery in 2010.
EDUCATION: Bachelor of arts in biology, Harvard University, 1979; M.D., University of Texas Southwestern Medical School at Dallas, 1984; residency, Yale-New Haven Hospital, 1988
FIRST JOB: Tennis-camp instructor, summer job at Trinity University in San Antonio
AGE: 56
RESIDENCE: Barrington

No posts to display