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Jefferson Surgical Solutions

Authors

Surgeons Cataldo Doria, MD, PhD, Karen Chojnacki, MD, Harish Lavu, MD, Francesco Palazzo, MD and Michael Pucci, MD utilize the da Vinci® Surgical System (shown in the background) for a variety of general surgery procedures.

Since their introduction some 30 years ago, laparoscopic techniques have become the standard for a number of general surgery procedures – enabling patients to enjoy less scarring, shorter hospital stays and faster recoveries. Today, Jefferson surgeons are using the latest robotic technology to perform many laparoscopic procedures, including adrenalectomy, cholecystectomy (gallbladder removal), Heller myotomy, liver resection, thymectomy, repair of hiatal hernia, and distal pancreatectomy for tumors in the tail of pancreas.

At this time, six surgeons in the Department of Surgery are using the robot, which is manufactured by da Vinci®. They include Karen Chojnacki, MD, FACS, Associate Professor and Residency Program Director; Cataldo Doria, MD, PhD, FACS, Nicoletti Family Professor of Transplant Surgery and Director, Division of Transplantation Surgery; Nathaniel R. Evans, MD, FACS, FCCP, Assistant Professor, and Director, Minimally Invasive Thoracic Surgery Program; Francesco Palazzo, MD, FACS, Assistant Professor and interim Vice Chair, Department of Surgery; Michael J. Pucci, MD, Assistant Professor; and Ernest (Gary) Rosato, MD, FACS, Professor and Director, Division of General Surgery. At Jefferson, the robot was first used for general surgery procedures in 2007 – to date over 115 robotic general surgery procedures have been performed. In early September 2013, Dr. Palazzo completed the first general surgery robotic procedure – a cholecystectomy – at Methodist Hospital where he is the interim Chief of Surgery.

SingleSite® Surgery Jefferson is among the first hospitals in Philadelphia to use da Vinci® SingleSite® Surgery – which allows surgeons to perform a cholecystectomy with a single, two-centimeter incision in the patient’s belly button. As Dr. Chojnacki explains, the da Vinci system delivers a magnified, three-dimensional and high-definition view and includes instruments suitable for single-site surgery.

Dr. Chojnacki notes that the single-site instruments are not yet as sophisticated as those she and her colleagues use with the robot during traditional laparoscopic procedures: “When using the robot with multiple incisions, the wristed instruments

actually offer a higher degree of freedom than the human wrist. At present, the single-site instruments have only two degrees of freedom, but we expect the wristed instruments to be available in the future.”

Results for single-incision cholecystectomy have been excellent. Among the potential benefits: a low rate of major complications and a low conversion rate to open surgery. While the small “keyhole” scars of multiport laparoscopic surgery were once considered a breakthrough, single-incision surgery through the navel can virtually eliminate surgical scarring.

To date, the Food and Drug Administration (FDA) has approved da Vinci® SingleSite® Surgery only for gallbladder removal, benign hysterectomy, and removal of the fallopian tubes and ovaries (salpingooophorectomy). But Dr. Chojnacki believes there is tremendous potential for singleincision surgery: “As the technology improves, there will clearly be opportunities to use this technique for gastrectomies (stomach resection), liver resection, bile duct procedures and pancreatectomy,” she says. “The possibilities are virtually limitless.”

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