, Derry, New Hampshire

March 21, 2012

Parkland urologist does robotic surgery

By Dustin Luca

DERRY — A surgical robot works to remove a cancerous prostate from a patient in a nearby hospital. The robot moves through the body quickly and effortlessly, cauterizing tissue and moving organs aside like an assembly-line robot executing pre-programmed maneuvers.

Working nearby, not even needing to scrub in, is Andover, Mass., resident and doctor Sté©fanie Seixas-Mikelus, who works at Parkland Medical Center.

She peers at a three-dimensional video feed from inside the person's body as her arms and legs control a camera and light, three separate surgical instruments... and the life of her patient. Not even 24 hours later, that patient will walk out of the hospital with a prescription for pain medication that he might not even need to fill.

This is the future of surgery, and Seixas-Mikelus is one of six fellowship-trained, female urologic oncologists doing it in the United States.

"We deal with stones. We deal with urinary tract infection. We deal with the whole gamut of infections," Seixas-Mikelus said. "It's hard to appreciate without seeing the actual instrument."

Working out of Parkland and Andover Urology in Haverhill Street-based Doctors Park, Seixas-Mikelus is a recent transplant to Andover.

Last summer, she moved from New York state after completing a five-year residency at Buffalo's Roswell Park Cancer Institute. While there, she completed two years of surgery cases with the million dollar da Vinci surgical system.

"These days, people do better with robotic surgery by far," Seixas-Mikelus said.

Take, for example, the nerves that wrap around a prostate and provide for male potency. When the nerves are damaged or destroyed, the patient cannot achieve an erection. But with a surgical method that decreases blood loss and provides a much closer view of a the internal area, many things that would be lost can now be saved.

"With the robots, you actually see them. You're able to spare them in a much more accurate fashion," Seixas-Mikelus said. "Seeing the nerves responsible for erections is critical."

There are other reasons to undergo robotic surgery. The robot compensates for tremors in the surgeon's hands, and the operations are more precise and therefore less damaging to the body, so hospital stays are much shorter.

Additionally, some patients report feeling so little pain afterward that a bottle of Tylenol is all it can take to eliminate what amounts to just internal aches, said Seixas-Mikelus.

The surgery is much more expensive, she said, but the shorter hospital stay makes up for that cost — meaning insurance companies and co-pays can go either way and pay close to the same amount.

Many doctors are trained with shorter, less intensive programs about surgeries with robots, but Seixas-Mikelus believes in the importance of the longer fellowship training.

The robot "can be a very dangerous instrument if the surgery is not performed in the hands of someone specifically trained in robotic surgery, and fellowship-trained," she said. "The newer generations out of training will be exposed to both. You have to have that fellowship time to get on the robot, to learn it and to do it well."

While the surgeon has to develop the motor skills necessary to guide the robot — kind of like driving a car, according to Seixas-Mikelus — robot-assisted procedures can also be dangerous for those assisting the surgeon, she suggested.

The popularity of robotic surgery is slowly expanding into other areas over time. Today, it is also used in kidney and bladder surgery, heart surgery, hysterectomies and much more.

The only question that remains is if the health-care industry will favor robotic surgery more in the future. Currently, the da Vinci surgical system can cost $1.2 million or more depending on the model.

Seixas-Mikelus uses the system at Burlington's Lahey Clinic and Parkland Medical Center. She is also a surgeon at Holy Family Hospital in Methuen, but they don't have a robot, she said.

There will always be a need for open, human hands-only surgery, Seixas-Mikelus said, but there's no reason not to do more with robotics.

"Having seen and trained in both, I think this is the way medicine is turning, and I think you have to offer your patient the best technology available," she said. "It is the question of the day."

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