DA VINCI ROBOTIC ASSISTED SURGICAL SYSTEM OFFERS LESS PAIN, FASTER RECOVERY

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1 DA VINCI ROBOTIC ASSISTED SURGICAL SYSTEM OFFERS LESS PAIN, FASTER RECOVERY 6 health & harmony spring/summer 2008 Roy Frizzell was able to take advantage of St. Luke s new robotic surgical system to help him get back on his feet more quickly after prostate cancer surgery

2 FB Y A N D R E A M O N G L E R For years, when a prostate cancer patient chose to have his prostate removed, it almost certainly meant he would undergo an open radical prostatectomy. This procedure involves a 6- to 8-inch abdominal incision. Patients lose a lot of blood, end up with a sizable scar and take a couple of months to recover. A few years ago many surgeons began performing laparoscopic operations instead. Laparoscopic surgery involves a few tiny incisions instead of one large one, which results in less blood loss and scarring not to mention a much faster recovery for patients. And at St. Luke s Hospital, surgeons are now performing laparoscopic prostatectomies with the latest cuttingedge technology. Recently, St. Luke s purchased a state-of-the-art da Vinci robotic-assisted surgical system. The da Vinci translates the surgeon s hand movements into precise movements by microinstruments. It is honestly a remarkable piece of equipment, says John McCarthy, MD, a urologic surgeon at St. Luke s. The more I use it, the more amazed I am by it. According to Asim Razzaq, MD, also a urologic surgeon at St. Luke s, the da Vinci has three features that give surgeons more precise control than they ve ever had. First, the surgeon has a 3-D view, he says. You also have more magnification, and the robot gives you your hands and wrists back meaning you have more range of motion. The benefits for patients are just as important. We have found that men need much less pain medicine after this procedure, says David Bryan, MD, another urologic surgeon at St. Luke s. They clearly have less pain and blood loss and get on their feet more quickly. IT S A GODSEND Roy Frizzell should know. Roy, 65, was diagnosed with prostate cancer in July He knew he had decisions to make Radiation or surgery? An open or laparoscopic operation? but he put them off. He and his wife were building a new home, and he was doing much of the work himself. He knew that if he chose an open radical prostatectomy, he would be off his feet for several weeks. And the possible side effects of radiation frightened him. So he opted for a temporary solution: He got a shot of Lupron Depot, which can slow the growth of cancerous cells. And he put off his decision even longer. Then his wife read about the da Vinci surgical system. Roy had never heard of it, so he did some research. I got on the Internet and looked up the procedure, he says. It looked good. And now I can tell you for a fact: It s a godsend a miracle. On March 12, Drs. Razzaq and Bryan performed a da Vinci prostatectomy on Roy. The next day he was up and walking well enough to go home. The doctors didn t even prescribe pain medication for him to take once he was discharged because he wasn t in pain. With the robotic surgery, patients feel normal far more quickly, Dr. McCarthy says. That s worth a lot. And Roy had to deal with a catheter for only about a week half the time required with a traditional open prostatectomy. I consider this a miracle process, plain and simple, he says. I would recommend it to anyone who has this condition and tell them plainly, If you re delaying over indecision, stop and get it done. Roy and his wife will be able to enjoy their new home, knowing Roy is cancer-free st. luke s hospital 7

3 Dr. Razzaq says Roy did exceptionally well. He had minimal to no pain afterward. The procedure went as smoothly as one could expect. Roy is grateful he won t be off his feet this spring the prime time for working on his new house. He says he couldn t have asked for a better experience than what he had at St. Luke s. Those guys are something else. DA VINCI DETAILS With the da Vinci surgical system, the surgeon operates while seated at an ergonomic console and viewing a 3-D image of the operating site. He or she grasps master controls, and the system translates the surgeon s hand, wrist and finger movements into precise real-time movements of surgical instruments held by robotic arms. It s a totally different way to approach the prostate anatomically, and I like it, Dr. Bryan says. Ergonomically it makes it easier on the surgeon just by the fact that magnification, instrumentation and visualization are so precise and so much better. A da Vinci prostatectomy involves five tiny incisions. Three of them measure 5 millimeters, and the remaining two are 10 and 12 millimeters. The ports don t cut the muscle, Dr. Bryan says. There s really no hole just a nick in the skin. One of the ports is enlarged to 1.5 to 2 inches so the surgeon can pull out the prostate which has been enclosed in a plastic Endo Catch bag. According to Dr. Bryan, a surgeon hopes to achieve three things with prostate surgery: Get rid of the cancer. Leave the patient continent. Maintain the patient s ability to have an erection. 8 health & harmony spring/summer 2008 The DaVinci Robotic Surgical System allows surgeons a more precise and scalable experience. The data is too immature for us to know for sure, but the da Vinci prostatectomy seems equivalent, if not better than, other types of prostatectomy when it comes to achieving these three goals, Dr. Bryan says. If I had prostate cancer, I m quite sure that first, I would want surgery and second, I would want my prostate removed robotically, Dr. Razzaq says. Having seen it all radiation and other types of surgery this is what I recommend to my patients.

4 I WAS AT THE RIGHT PLACE YOUNG CANCER PATIENT FINDS SUPPORT AT BREAST CARE CENTER WB Y A N D R E A M O N G L E R When Raylene Hollrah was 33, she and her husband decided to have a second child. So she scheduled an appointment with her obstetrician-gynecologist, Daniel Wagner, MD, of St. Luke s Hospital. 4 health & harmony fall 2008 The Hollrahs are taking steps on the next journey of their lives together. Raylene expected a routine appointment. Little did she know it would be her first step in a sometimes-terrifying journey. Dr. Wagner found a lump in Raylene s right breast. Neither a mammogram nor an ultrasound showed cancer. But Dr. Wagner being the wonderful physician he is referred me to Dr. Fahrner, Raylene says. Dr. Wagner provided an amazing level of personal care. So on April 10, 2007, Raylene met with Mari Anne Fahrner, MD, a general surgeon at St. Luke s Breast Care Center. She underwent a needle biopsy that same day. The Breast Center can provide a diagnosis rapidly," Dr. Fahrner says. Usually we have the results to the patient within 24 hours sometimes within eight hours.

5 On April 11, Dr. Fahrner called Raylene with the news: She had Stage 2 breast cancer. Often when young women have lumps, they are benign, Dr. Fahrner says. But in Raylene s case it was infiltrating ductal carcinoma. She had a medium-sized tumor with no nodal involvement. The very next day Raylene came to the Breast Care Center to meet with Dr. Fahrner again. It s so important to go to a doctor and a hospital you feel comfortable with. There s no question I was at the right place, Raylene says. I was greeted warmly by the nurses to start my journey, and then Dr. Fahrner and I discussed our options I say our because she was very much a part of my journey. My husband, mom and best friend were with me, and Dr. Fahrner spent an hour and a half with us. Raylene decided to have a bilateral mastectomy. On April 20 just nine days after Raylene s diagnosis Dr. Fahrner performed the surgery. She removed all the cancerous cells in Raylene s right breast and precancerous cells in her left breast. I had such a wonderful doctor and team at the Breast Care Center, Raylene says. And I ve also completely changed my life since my diagnosis. I ve changed my eating habits and exercise routine and have a lot of faith. It s a holistic approach, and today I m living at 100 percent. The Breast Care Center offers a full range of diagnostic and treatment options, including screening and diagnostic mammography, physical exams, ultrasounds, biopsies, MRIs and PET scans. It also provides genetic and supportive counseling. In addition, the American College of Radiology's Commission on Quality and Safety and the Commission on Breast Imaging have designated St. Luke's Hospital's Department of Radiology a Breast Imaging Center of Excellence one of only three in Missouri. Several departments are consolidated right here in our building, and we all work very closely together, says Sally Rappold, nurse manager at the Breast Care Center. Patients only need to come to one place, and we can coordinate all their appointments. We have radiation oncology on the first floor and medical oncology on the third floor. The building is also home to St. Luke s Cancer Resource Center, which provides educational materials to cancer patients. After Raylene had surgery, she went through four months of chemotherapy with Julie Gill, MD, at St. Luke s. Dr. Gill was another addition to my wonderful St. Luke s team, Raylene says. She was incredible she explained everything and answered my questions. When I had concerns, I would call the office, and I always got a call back. From Day One, the staff members at the Breast Care Center were just as impressed with Raylene as she was with them. Everyone here was amazed by her, Dr. Fahrner says. She always had such a positive, upbeat attitude. She not only handled her own situation with courage and grace but reached out to others. Specifically, Raylene bonded with Inga, another young breast cancer patient she met at the Breast Care Center. Inga, a 31-year-old mother of five, and Raylene traded stories about their disease and their children. Raylene even traveled to Houston to visit Inga, who had been sent there for treatment. Raylene, who sells insurance, also served as a source of comfort and inspiration for Rhonda, one of her clients who was diagnosed with breast cancer, and for her daughter s pediatrician, whose wife had received her own diagnosis. Just as much as chemo was part of my treatment, so was talking to and helping others, Raylene says. But it wasn t always easy for her to stay positive and upbeat. While sitting in the waiting room at the Breast Care Center before learning the results of her surgery, she was scared and distraught to the point of tears. That s when she met Cindy, an 11-year breast cancer survivor. Cindy told me: I never stopped living because of cancer. I don t want to say that I just wasted 11 years. That became my theme, Raylene says. This September, Raylene had her final reconstructive surgery. It was the last stage of the most difficult journey of her life. She says her doctors and nurses gave her the support she needed every step of the way. I felt so good about being at St. Luke s. It really sets itself apart, she says. You can be standing in the hall, looking at a directory, and even doctors stop to see if they can help you. People at St. Luke s are incredible. Shirley Bowling owes her newly pain-free days to St. Luke s Brain and Spine Center and Dr. Anne Christopher st. luke s hospital 5