Surgeon performs first robotic kidney removal in Charlotte County

By BOB MASSEY

Feeling Fit Correspondent

Rick Asmega considers himself fortunate to be alive after a bout with kidney cancer, and expressed his gratitude for surgeon Dr. Arvind Sharma -- and a robot.

Well, not a robot exactly, but a robotic surgical system known as the da Vinci, which was installed last year at Charlotte Regional Medical Center (CRMC).

Asmega believes the surgeon's quick intervention may have saved his life. It also gave Sharma the opportunity to perform the first da Vinci-assisted nephrectomy (kidney removal) in Charlotte County.

When Asmega was diagnosed with kidney cancer, he approached two other surgeons -- but neither would treat him immediately. So he sought the advice of a co-worker who had also been through surgery.

But with two surgeons already refusing him, he thought the odds were not in his favor.

No time to wait

To Asmega's surprise, Sharma agreed to see him right away.

"When Dr. Sharma saw my condition, he said we'd get it taken care of as soon as possible.

And I was a new patient! He had never seen me before."

Asmega's condition was a "good-sized" mass on his left kidney, he said.

"The cancer was fairly large," Sharma explained. "It was so large we had no choice but to remove the kidney."

Sharma scheduled the surgery last month -- on the first day the da Vinci was available.

"The growth of the cancer was so rapid, I believe if the surgery wasn't done as soon as it was, it would have spread elsewhere," Asmega said. "Instead of telling people I'm free of cancer, I would have been telling them my days are numbered."

The removal of a kidney ordinarily requires a large incision and a long recovery -- but not with the da Vinci.

Robotic response

Intuitive Surgical's da Vinci Surgical System has become the most famous robotic surgery apparatus in the world. In international circles, it is being lauded as one of the most important advancements in modern surgery.

The da Vinci unit installed at CRMC unit represents a $1 million investment for the hospital.

The da Vinci consists of three integrated components: a console at which the surgeon can sit while performing the procedure, a patient-side cart with four robotic arms, and a video tower with a large monitor so that the entire operating room staff can witness the surgery.

The robotic arms are the centerpiece of the system. Each is equipped with an endoscopic camera that transmits a high definition 3-D image of the surgical site. This classifies the da Vinci as a telesurgical device, since the surgeon does not operate the arms directly.

Instead, he or she sits at the console and manipulates a set of controls. The da Vinci translates the surgeon's hand, wrist and finger movements into precise movements of the miniaturized instruments on the tip of the robotic arms.

The arms allow a greater range of motion and dexterity than the human hand and wrist.

A feature known as "motion scaling" allows the surgeon to adjust the sensitivity of his hand movements to the corresponding micro-movements of the instruments. In addition, the system relays some force feedback sensations to substitute for sensations of pressure the surgeon would receive if using surgical instruments with his or her own hands.

Using the robotic arms has several advantages. One of the most appealing: Instead of a large incision usually required to allow the surgeon entrance into the surgical site, each arm needs a puncture only 1 or 2 centimeters in diameter -- about the thickness of a pencil. In addition, the system virtually ensures less pain, less bleeding, shorter hospital stay and quicker recovery time, among other advantages.

Sharma expected Asmega to recover rapidly.

"He went home a few days after admission with no pain medicine, no blood loss and very small incisions," he said.

Not to mention a positive experience. "The nurses were truly professionals; they really cared about the patients, which was nice to see," Asmega said.

Asmega also appreciated that Sharma made several visits and phone calls to him -- including a 40-minute discussion prior to the surgery. "Instead of just looking at the medical records, he called to get some background -- which helped him with my surgery," Asmega explained.

"In a previous surgery, I had sutures that dissolved prematurely, so they ripped open. Because of his asking me and probing for information to that level, he decided to use a different grade of suture that would stay in there longer before dissolving," he said.

In addition to the nephrectomy, Sharma performed the first da Vinci-assisted adrenalectomy in Charlotte County. He removed an adrenal gland near a patient's kidney. The gland was burdened with a 2.5-inch tumor.

"The patient went home after a couple of days, and had very little pain," Sharma said.

"Blood loss was zero, and there were no complications. Normally, she would have required a stay in the hospital of three to five days, and would have required a lot more pain medicine than she did," he explained.