Dipen Parekh, M.D., a urologic oncologist at The University of Texas Health Science Center at San Antonio, deftly operates the handles and pedals of a console located 6 feet away from his patient’s operating table.

The handles and pedals control robotic arms positioned above the patient, Donald Martinez. Gripping sterile instruments, the robot mirrors Dr. Parekh’s micro-movements with amazing precision to remove a tumor on Martinez’s kidney. Two days later, Martinez, a branch manager for a medical and compressed gas distributor, is already moving around his hospital room at CHRISTUS Santa Rosa Hospital-Medical Center in San Antonio.

“I had never been sick a day in my life,” Martinez, an active cyclist and swimmer, said. “I thank God and Dr. Parekh and the robot. You can’t live with cancer in your body.”

A bird’s-eye view

The introduction of robotics into the operating room suits the high-tech 21st century, eradicating a patient’s cancer while leaving less chance for side effects than conventional surgery.

The da Vinci® Surgical System, which CHRISTUS Santa Rosa Health Care purchased last year for $1.6 million, enables Dr. Parekh to view kidney, bladder and prostate cancers in three dimensions and at 10 times the magnification of traditional surgery. “It gives a remarkably clear view, which is important because we are trying to extract only the cancerous tissue and preserve the anatomy necessary for body functions,” he said. Dr. Parekh is one of the few fellowship-trained urologic oncologists in San Antonio.

Surgery and consultations

An associate professor in the UT Health Science Center Department of Urology, Dr. Parekh has performed a large number of cases of robot-assisted laparoscopic surgery to remove prostate cancer, bladder cancer and kidney cancer. In several cases, he has saved patients’ kidneys. Dr. Parekh also sees patients for initial consultations and surgical follow-up visits at The Cancer Therapy & Research Center (CTRC) at the UT Health Science Center San Antonio, one of only three National Cancer Institute-designated Cancer Centers in Texas. (Patient appointments are at the CTRC Genitourinary Oncology Clinic, 210-450-1300.)

Less pain, quicker recovery

To put the advantages of the new robotic system in perspective, conventional kidney surgery requires a 6- to 10-inch incision on the affected side and breaking at least one rib to allow surgical access. The kidney is supplied by several small blood vessels, and this makes nephron-sparing surgery (saving the rest of the kidney while only removing the tumor) challenging.

Thanks to the view on the console during robotic surgery, Dr. Parekh is able to leave blood vessels intact while removing tumors through three or four small keyhole incisions. This reduces pain, blood loss, scarring and risk of infection, and naturally shortens recovery time. Most patients are up and around in the hospital the next day and return to their regular activities in a few days.

Experience

According to Intuitive Surgical Inc., which tracks all surgeries using its da Vinci system, Dr. Parekh has performed more robot-assisted partial nephrectomies (resections of a kidney tumor while sparing the organ) than anyone else in Texas’ major academic medical centers. He has performed the most robot-assisted cystectomies (surgeries for bladder cancer) of anyone in Texas, whether in an academic or private practice.

Robot-assisted prostate surgeries are more common. Many U.S. centers perform those.

Technology for patients

“We are very pleased to have someone with Dr. Parekh’s rare expertise performing this type of surgery at CHRISTUS Santa Rosa Hospital-Medical Center, and we are excited to offer such procedures to our patients,” Don Beeler, FACHE, president and CEO of CHRISTUS Santa Rosa Health Care, said. “This is part of our strong commitment to provide the best medical technology possible for their care.”

To demonstrate its commitment to technology, CHRISTUS Santa Rosa Health Care also recently purchased a 64-slice CT system for its Medical Center hospital and the same system for its new Westover Hills hospital in San Antonio.

Controlling cancer

Using the robotic approach enables Dr. Parekh to achieve at least the same level  of cancer control as is possible with conventional surgery, he said. “Because the surgeon sees the operating field so much better, the robotic procedures may translate into better surgery and therefore better cancer control, but we don’t have any head-to-head research studies comparing open versus robot-assisted surgery,” he said. “However, it is true that with the robot we get very good oncologic results.”

Other uses of the robotic system include gynecological, general and heart surgery.

Sharing the skills

Urology residents from the Health Science Center are also benefiting as Dr. Parekh teaches them how to use the system. In the future, more urologic oncologists such as Dr. Parekh will be able to perform surgery in this manner. For Donald Martinez and patients like him, that is good news indeed.