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Dr. Brent Sharpe demonstrates the robotic surgical device at Decatur General Hospital.
Daily photo by John Godbey
Dr. Brent Sharpe demonstrates the robotic surgical device at Decatur General Hospital.

Robotic surgery at Decatur General
Hospital only facility between Birmingham and Nashville with surgical system

By Eric Fleischauer 340-2435

Try rotating your wrist 360 degrees. Or fitting your hand through a half-inch incision. Or seeing through your fingertips.

It can't be done, but a robotic surgical system recently purchased by Decatur General Hospital helps overcome these inherent limitations in a surgeon's work.

And for 15-year-old Bob Lusco, that meant leaving the hospital April 18, the day after major surgery, and returning to school soon thereafter.

Lusco was fortunate to discover his problem before kidney failure. He had the flu, his mom said, and the pain made her worry he had appendicitis. Tests revealed his kidney was functioning at 20 percent. He had a congenital defect in the tube that connects the kidney to the ureter, causing urine to back up into his kidney.

"If it was functioning at a 15 percent level, they would have had to take his kidney," his mother, Kathy Bealor, explained.

Bealor and her son were in luck. Decatur General had just installed the da Vinci Surgical System, and Dr. Brent Sharpe of Urology Specialists in Decatur was anxious to try it. Lusco needed pyeloplasty surgery, which requires the surgeon to reconstruct the tube that carries urine from the kidneys to the bladder.

According to Sharpe, Decatur General is the only hospital with such a device between Birmingham and Nashville.

"He told us about this robotic surgery," Bealor said. "We were kind of hesitant at first because it was, like, a robot going into my kid's body. It messed me up a little bit."

She trusts Sharpe, though, and he thought it was her son's best option.

"I knew that if the robot didn't work well, he was going to go in by hand to do it," Bealor said.

The da Vinci system has two main components: a computer terminal with a joystick-like control for the surgeon, and a collection of four spidery mechanical arms that hover over the patient. Each arm ends with what looks like tiny fish-nose pliers, equipped with various surgical tools and a camera.

These can be used in hard-to-reach areas and turned in ways that would be impossible with normal wrist dexterity.

"It was pretty tense the day of surgery. That's when it started hitting me, wait a minute, he's going to use a robot to do the surgery," Bealor said. "All we could do is sit and pray."

A problem inherent with conventional surgery, explained Sharpe, is visibility.

"You can't stick your head down into the wound," he laughed. "If you've got a structure you're looking at with your eye and you're standing over a patient, you're now 16 inches away from that structure."

To increase visibility in conventional surgery, the surgeon must make a large incision.

"With this, I can take a camera and put it right up next to it, within centimeters of it, and magnify it," Sharpe said. "You put your camera exactly at what you want to see."

Rather than peering into the incision, Sharpe sits several feet away at the computer terminal watching magnified, three-dimensional images.

"I've done 150 or so (pyeloplasties) open, and after doing a few of them robotically, the visualization is a lot better," Sharpe said.

Improved visualization and dexterity make for more precise surgeries. The tiny robotic "hands" also mean the surgeon can make much smaller incisions, decreasing blood loss and speeding post-surgical recovery.

In Lusco's case, that meant 5 1/2-inch incisions as opposed to one incision as large as 7 inches. The tiny incisions will be nearly invisible in a few months, according to Sharpe.

"There's a faster return to normal activities," Sharpe said. "Discharge from the hospital is a little bit shorter. The main point is it speeds up their ability to return to whatever their normal activities are, whether working, lifting, golf or exercise."

Or school, in the case of Lusco. He was attending classes at Speake High School and feeling fine Monday. The small incisions used by the robotic arms had already healed.

Sharpe said the robot has many applications, only some of which are covered by his specialty. Other uses for the device include cardiovascular surgery, including mitral valve repair; gynecological surgery, including removal of uterine fibroids; and surgery on infants.

He said the most common use for the robot is prostratectomies, removal of the prostate gland for cancer and some other conditions.

"The potential is with a much more precise dissection you'll have a better return of erectile function," Sharpe said.

Bealor is still astonished, both that a robot was inside her son and that he has recovered so quickly.

"That's my kid. I left it in God's hands. But I said to Dr. Sharpe, 'Keep your eye on him, because that's my baby.' "

With a little help from a robotic camera, Sharpe did just that.

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