Audio clip
Dr. Jim Hu
When Dr. Del Ashcraft sat down and grasped the two gamelike hand controls to perform his first robot-assisted hysterectomy at Parkridge East Hospital, he didn’t get up for more than two hours.
More than 200 robotic surgeries later, Dr. Ashcraft now can whip through the procedure in 20 to 50 minutes.
Even after his extensive preparations for the robot — known as the da Vinci Surgical System — that first surgery was “mentally exhausting,” said the 44-year-old gynecologist.
Adapting to the new techniques two years ago was “intense,” he said. Watching a 3-D magnified video image of his patient’s internal organs, he painstakingly worked to detach his patient’s uterus, knowing that five inches of hand movement translated into one inch of motion at the end of the robot arm, buried inside his patient’s abdomen across the surgical room.
He tapped a foot pedal to make a tiny video camera zoom in, another pedal to activate a blood vessel cauterizer. Manipulating the robot arms to tie sutures, he watched the video feed to see when liquid stopped seeping from the vessels to know when he’d pulled tightly enough.
Article: Robotic medical arms race
Article: Researchers say more study needed
DA VINCI SYSTEMS WORLDWIDE
* 2003 — 210
* 2004 — 286
* 2005 — 394
* 2006 — 559
* 2007 — 795
* 2008 — 1,111
* 2009 — 1,395 (1,028 in U.S., 248 Europe, 119 rest of world) - 73 percent in U.S.
SOURCE: Intuitive Surgical SEC filings
ROBOTICS AT MEMORIAL IN 2009
* Hysterectomies:
Open surgery — 35
Vaginal — 45
Robotic surgery — 69
Laparoscopic without a robot — 154
* Prostatectomies:
Open surgery — 9
Robotic surgery — 179
Laparoscopic without a robot — 0
Source: Memorial Hospital
PRICEY INVESTMENT
The purchase and maintenance of da Vinci equipment doesn’t come cheap.
In addition to the $1.7 million purchase price and annual maintenance fees of $140,000, a robot-assisted prostatectomy can cost a hospital about $2,000 more per patient, since the procedure can take longer and replacement equipment, purchased through the device manufacturer, is more costly.
That extra cost is diminished as patient volumes and physicians’ proficiency with the equipment increase, physicians said.
For leaders at Parkridge Medical Center, the first hospital in Chattanooga to get a da Vinci system in 2002, the ability to offer a minimally invasive option to more patients is more than enough to justify the expense.
The da Vinci’s increased agility allows surgeons to navigate in different ways than laparoscopy, giving a minimally invasive option to patients who previously would have needed open surgery, said Adam Royer, executive director of surgical services at Parkridge, which has two da Vincis.
“With that alone, I think that’s certainly a benefit,” he said.
In Chattanooga, like much of the United States, the number of da Vinci robotic surgical systems is exploding. Three hospitals in Chattanooga and one in North Georgia have at least one da Vinci robot, which now cost $1.7 million each.
Robotic surgeries, particularly in urology and gynecologic-oncology, are being promoted as the new standard of care. Hospitals are marketing it, patients are asking for it, and young physicians are expecting to be trained on it.
The number of da Vinci robotic surgical systems installed worldwide has ballooned from 210 in 2003 to 1,395 last year, with 1,028 of those in the United States, according to records from Intuitive Surgical, which makes the da Vinci robot.
For Dr. Ashcraft, his patients’ rapid recovery times and little to no reported post-operative pain have sold him on the da Vinci.
But some researchers are concerned that the popularity of the technology has outpaced the clinical evidence of its superiority over standard — and less costly — treatments.
New medical technology can spread like wildfire, as hospitals strive to keep up with their competitors and patient demands, even before the benefits are proven, said William Lowrance, urologist at Memorial Sloan-Kettering Cancer Center in New York City. He recently published a study in the Journal of Urology comparing minimally invasive prostate removal surgeries, including those that used the da Vinci, to open surgeries.
The proliferation of da Vinci systems is “not atypical of how new technologies are taken up in medicine,” Dr. Lowrance said. “Marketing, combined with Americans’ desire for new technology, in a way fuels people’s demand for those type of procedures.”
For Debbie Littlejohn, who works at the Bank of LaFayette in Georgia, the popularity of robotic surgery is well-deserved. She got a robotic hysterectomy at Parkridge East Hospital in January and left the next day.
The 41-year-old LaFayette resident said she didn’t even need any pain medicine once she got home.
“I was so shocked at how easy it was to come off of this and recover,” she said.
Parkridge Medical Center got the first da Vinci robot in the region in 2002 and its second in 2008. Erlanger hospital is planning to buy its second robot in the upcoming fiscal year. Memorial has one, so there soon will be five in Chattanooga alone, plus one at Hamilton Medical Center in Dalton, Ga.
“ARMS RACE”
Today, it’s more of a necessity than an option for hospitals to have a robot, some researchers and hospital officials said.
“Hospitals feel like it’s kind of an arms race or they’re going to lose market share,” said Dr. Jim Hu, urologist at Brigham and Women’s Hospital in Boston.
That was the case at Hamilton Medical Center in Dalton, which was losing hundreds of both urology and gynecology patients to Atlanta or Chattanooga for robotic surgeries, said Jan Keys, vice president and chief nursing officer. So despite the tight economy, the hospital decided to invest in the equipment, which arrived in September.
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Staff Photo by Dan Henry/Chattanooga Times Free Press Certified surgical technician Kim Daggett, left, assists Dr. Lee Jackson, Memorial Hospital's robotics and urologic cancer surgeon, as he uses a da Vinci robot to perform prostate surgery.
“You just can’t afford not to do it,” she said. “It’s going to become the standard of care. You have to ... just to stay competitive.”
The latest equipment can help hospitals maintain volumes in other service lines as well, Dr. Ashcraft said.
“Hospitals are not just looking at what those robots cost. They’re looking at their whole book of business,” he said. “That’s why they have robotic surgery billboards all over the place. They want to get you in the door with that and keep you with all the other stuff when you have a good experience,” he said.
Extensive marketing of the technology is another driver for the growth in robotic surgery, as hospitals strive not only to lure patients but to attract new talent, said Dan Kara, editor at Robotics Business Review.
“Individual hospitals are using it as a marketing tool to get top, primarily young, talent. The young physicians coming out of medical school want to be tied into the latest technology,” he said.
Hospitals everywhere are feeling the pressure, said Dr. Amar Singh, a urological oncologist who joined Erlanger three years ago with the specific goal of developing the hospital’s use of robotic surgery in kidney and bladder cancer treatments.
“It’s the keeping-up-with-the-Joneses phenomenon,” he said.
GREAT EXPECTATIONS
Still, despite benefits of the robot in some areas, a worrisome number of advertisements — including a billboard he spotted in Macon, Ga., that reads “Miracle Surgery” — have overstated the long-term outcomes and uses of the robot, Dr. Singh said.
“When I talk to patients, they expect this is a miracle,” he said. “At the end of the day, is it a great technology? Fantastic. Is it used properly in most cases? Of course. Is there a lot of marketing bias? I don’t doubt it.”
The role of direct-to-consumer marketing is a new and growing concern among U.S. clinicians, said Dr. Matt Smith, OB-GYN at Hamilton Medical Center.
“Marketing in medicine, it’s kind of a scary thing,” he said. “I think it’s up to the surgeon to explain to the patient what the expectations are. You may have somebody that’s not a good candidate for the robot.”
The robot has a “steep learning curve,” but once a surgeon becomes adept at using the technology, the robot has authentic benefits that only increase as a surgeon gains experience, said urologic oncologist Dr. Lee Jackson, who came to Memorial Hospital from the Cleveland Clinic in Fort Lauderdale, Fla., to develop its robotics program. He has done more than 700 robotic prostatectomies.
Still, criticism of some marketing claims about have been valid, Dr. Jackson said.
“There has been some rather distasteful and overreaching marketing associated with this, and that opens it to that kind of criticism,” he said. “It’s got a gee-whiz factor to it and the assumption would be, ‘Well, this is new and this is highly advanced, therefore it’s better.’ Well, not necessarily.”
Health care reporter Emily Bregel has worked at the Chattanooga Times Free Press since July 2006. She previously covered banking and wrote for the Life section. Emily, a native of Baltimore, Md., earned a bachelor’s degree in American Studies from Columbia University. She received a first-place award for feature writing from the East Tennessee Society of Professional Journalists’ Golden Press Card Contest for a 2009 article about a boy with a congenital heart defect. She ...
This article makes it sound like the Da Vinci robotic surgical system to perform hysterectomy is simple and inconsequential.
It describes this gynecologist controlled robotic surgery as less invasive, implying that it is safe. If you watch the surgery being performed on the Da Vinci web site (click on the video for physicians, not the sanitized patient version) you will quickly see that this is highly invasive destructive surgery.
Hysterectomy is the surgical removal of the uterus, a reproductive, sexual, hormone responsive organ that supports the bladder and bowel. Whether the surgery is performed abdominally, vaginally, hands-on laparoscopically or laparoscopically by a gynecologist controlled robot, a hormone responsive sex organ is removed, the vagina is shortened, and there is a loss of support to the bladder and bowel. Women who experienced uterine orgasm before the surgery will not experience it after the uterus is removed.
When the uterus only is removed women have three times greater incidence of cardiovascular disease than women with an intact uterus. When the ovaries are removed the incidence seven times greater.
There are 22 million women in the United States whose female organs have been surgically removed. Only about 2% were life saving and 98% were elective, a euphemism for unwarranted. Girls and women are not educated about the functions of female organs and they are not informed about the adverse effects of hysterectomy that have been well documented in medical literature for over a century.
Women who might ignore this promotion in a commercial advertisement will be vulnerable to believing there are no adverse effects of the surgery. An article that makes hysterectomy sound simple and inconsequential is dangerous to women.
Read the new book THE H WORD, and find out what the medical literature documents about the well-known consequences, and what women report about the effects of hysterectomy on their bodies, their health and their lives, and read the Adverse Effects Data at http://www.thehword.org.
I agree with moretothestory. The method used to remove a woman's sex organ(s) is not the issue. The issue is that an organ vital to a woman's life-long physical, mental, emotional and sexual health is being removed unnecessarily in 98% of cases. The surgeons, hospitals and insurance companies are defrauding women into hysterectomy. I don't know of one woman who would have consented to having her uterus (and/or ovaries) removed had she been told the adverse effects. And there are 22 million women alive in the U.S. today that have had their sex organ(s) removed.
Go to http://hersfoundation.com/ to learn the truth about female organ surgeries.
OMG! Are you proud of yourself Dr. Ashcraft by removing hormonal sexual organs from 200 women using the robotic method? A hysterectomy is a hysterectomy no matter how it is done. Now you really having to get going and pay for that expensive machine at 1.7 million. There won't be a woman in the Chattanooga area with their sex organs intact. If you are removing the ovaries, uterus and cervix for fibroids, cysts and polyps, these women have the wrong doctor. There are alternative surgeris that will leave the sex organs.
These women you have hysterectomized and castrated will never be the same. They will most likely loose their marriage, career, but most of all, their health and well-being and zest for life.
This article made me sick to my stomach because I am one of those women that was not informed about the consequences of this surgery and the effect it has on your life, marriage and career.
Why are you removing healthy sexual organs from women? Would you like to be castrated Dr. Ashcraft and would you take the sexual organs from your Mother, Wife, Daughter, Sister or Aunt?
If they castrated men like they are doing to women and young girls, there would have been a law passed years ago. It is barbaric to remove gonads from men, but it is ok to remove gonads (ovaries) from women.
WAKE UP WOMEN! If your doctor mentions a hysterectomy along with castration for fibroids or cysts, run don't walk out of his office. Call the HERS Foundation 610/667-7757 and get the correct information and read the blog what other women are saying about their life after and watch the DVD 'Female Anatomy' before you consent to this barbaric surgery.
It's really awful that the news would brag up a doctor who is performing the most unnecessary barbaric surgery of all time. There is no balanced reporting here describing the damage this does to a woman's body. Regardless how this doctor amputates a woman's uterus and/or ovaries, extensive damage is caused to her pelvic area. It sounds simple to just remove a uterus, but it is anything but. The uterus has a massive blood supply running through it, large ligaments that support giving child birth, and the pelvic area, and millions of nerves that are connected to the spine, genitals and breasts, which are all severed when the uterus is amputated. The uterus is cut away from the bladder leaving it damaged. That is why so many women have urinary problems after this has been done to them. Women who have been hysterectomized have a shorter life span than intact women. This is a horrible unnecessary surgery that has been perpetrated on nearly half the female population in the U.S. and instead of the news bragging it up, they should be informing women of the truth. Women need to know that when they are told they need a hysterectomy, to run the other way. They need to know that this surgery is done for profit 98% of the time. They need to know that the uterus and ovaries are sex organs, just like a man's penis and testicles, and to remove them is castration. Uterus amputation has many long term side effects, which show up overtime, not the next day or week. It is the nightmare that continues for the rest of a woman's life, causing one health problem after another. This is no different than any other corporate crime, except that it on top of the doctor and hospitals making billions, it ruins a woman's health permanently. This horrible barbaric surgery needs to be stopped, not promoted!
Unfortunately, this latest refinment of surgical approach to hysterectomy (for the doctor) only serves to create distance from the patient and reduce the seriousness of the procedure at hand.
There are no benefits (zero) for the woman, anymore than grape-flavored poison over non-flavored poison.
The purported veiled benefits are marketing pitches, to confuse prospective patients and create demand. Less invasive (although organs are removed); minimal pain (maybe short-term, but definitely not long-term); and quick recovery (although surgery is permanently destructive).
I wonder how eager hospitals would be if the demand actually was more in line with the 2% for life-saving measures. We have turned the unfitting of women into sport, too bad for women.
I only wish we could castrate every perpetrator and enabler in the hysterectomy industry. That includes the ob/gyns, their office staff, the hospital administrators, Chiefs of ob/gyn, the assisting residents, the anesthesiologists, the nurses that are involved...
The February 25 Dr. Oz Show's main topic was "The #1 Surgery you don't need: Hysterectomy." Thank you, Dr. Oz!
I was hysterectomized and castrated with no medical need and without my consent. I was knocked out and strapped to a table and all six of my healthy female organs removed. Now, I have a list of medical issues too long to go into to here. I will say that losing my vision or at least most of it was not a consequence I expected or told about. I woke up asexual and have to live this way for the rest of my life. No wonder the divorce rate is so high in the U.S. I am a walking dead women. I have attempted suicide numerous times due to the physical and mental trauma brought on by hysterectomy and castration. No matter how you perform the surgery; it is a very destructive surgery and has life-long consequences that women are not told about until it's too late. I really believe the doctor who came up with this robotic idea must be criminally insane. Doctors (although many think of themselves as God) are not God. There is a spiritual aspect to hysterectomy that has implications that are beyond devastating. Hysterectomy is so much more destructive than abortion and yet nobody talks about that. After hysterectomy, there is no possiblity that a baby will ever come forth from that woman and the woman is left a mental and phsical wreck. Doctors and those who assist them are treading on very dangerous ground here. God commanded that man and women become one flesh and produce. It is not up to a doctor to decide which women should have children or how many and which women should have no children at all. This is for God and God alone to decide. God is the giver and taker of life; not doctors. Doctors are destroying God's potential seed when they hysterectomize and castrate a women. It is my humble opinion that they will answer dearly for this horrific deed and pay a heavy price; maybe the price of their own soul. Doctors who perform hysterectomy; especially without the patient's consent (as in my case) should be criminally prosecuted at the state's expense. There is nothing that can be done to 'fix' a woman once her organs have been taken or 'stolen'. I am now disabled and unable to work for the first time in my life. I don't even have a way to care for myself; much less buy medicine I need to live post-hysterectomy. It makes me furiuous that my only recourse is to file charges against the doctor who took my life in the civil court system. Yet, there is nothing civil about what he did to me. It was clearly criminal. It's time many of you in the hyserectomy money-making machine industry stop and consider what you are doing. For those who call yourselves Christians; I encourage you to repent and turn from this wicked and evil practice. I realize that many of you escape being held accountable in the court system on this earth. Make no mistake. There is a court system much higher than the one on this earth and you will not escape punishment for your crimes.
I was given the option of the robotic hysterectomy in June and I have no regrets ! Obviously the people with the previous opinions have not lived with the pain of an enlarged uterus with fibroid tumors causing pain and excessive bleeding preventing them from being able to even get through the grocery store without being in severe pain, perhaps they prefer that we all be on pain pills and live our life stoned, I prefer to be pain free and able to enjoy an active life again. The concept of your life being over and divorce being caused by this surgery baffles me also, when you have a very enlarged uterus sex is very painful and not very fulfilling it also presses on the bladder causing urinary leakage, since my hysterectomy I have enjoyed a very fulfilling sex life with my husband and have no more symptoms of urinary incontinence. I think if you are blaming your marital problems on this surgery you need to examine the state of your marriage before the surgery. The bottom line is if you don't want a hysterectomy don't consent to one, no one forces you to have surgery. But don't bash everyone who chooses this for their health.
Let me begin by saying that I am proud patient of Dr. Del Ashcraft,Jr. The point of needing a hysterectomy comes as a last resort, not your first or only option. The Da Vinci makes it less invasive and and easier to endure. When you live your life in chronic pain and bleeding on a daily basis, surgery is an option. But, with the Da Vinci, the method of surgery changes things. After enduring four C-sections, the opportunity to not have an open cut again was very appealing to me! I had my Da Vinci Hysterectomy in Nov. 08. During surgery it was discovered that my bladder had attached to my uterus. The precision and magnified view of the camera, and the micro movement of the robotic arms allowed my doctor to take care of me in the best possible way. He removed from by body the things that were making it toxic. I will be forever grateful. I would do it again in a heartbeat!! Surgery is elective and based on each individual and their needs. I find it disappointing that so many comments previously listed are being judgemental about something so miraculous. The method does make a difference!! The pain and bleeding simply didn't exist as a part of my recovery.... period! This surgery gave me my life back. My quality of life, energy level, and overall well being has improved 100% since my hysterectomy. I am so grateful to have had a doctor/surgeon like Dr. Ashcraft, who is so passionate about his job to make his patients as comfortable and as pain free as possible. Simply put....For him, it's all about you, not about him. Bottom line. I send my gratitude and appreciation to Dr. Ashcraft and his caring staff who stayed with me every step of the the way. Thank you all from the bottom of my heart!!!
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