Robotic surgical arm performing minimally invasive procedure.

Single-Site Surgery… Performing Complex Surgery Through a 1-inch Incision!

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Another First for Tomball Regional Medical Center

As proven leaders in robotic surgery, Tomball Regional Medical Center and Dr. Brian Harkins has accomplished yet another milestone!!! Single-Site surgery on the Da Vinci Xi robot premiered at TRMC on May 4, 2016. Dr. Harkins accomplished the first Single-Site cholecystectomy on the Xi in Houston… in Texas… and one of the first ten in the country.

The FDA recently released approval for the technology to be applied to the Xi platform which allows gallbladder surgery to be done through a single one-inch incision at the umbilicus. Currently, the approved surgeries are Cholecystectomy, Oophorectomy, and Hysterectomy. As experience grows and technological advances continue, expect more and more surgery to be done through ever decreasing incisions!

While one could expect to pay a premium for this state of the art technology the reality is that the cost is ever less than the robotic multiport equivalent. Dr. Harkins is currently seeking patients to assess if they are candidates for Single-Site on the DaVinci Xi. In fact, as of press time for this newsletter, it’s the only place you can get in Houston!

Houston Technology Turns Hard to Easy… and Safe

Some of you may recognize the term Single Site or Single Port. The concerted effort to introduce this approach into laparoscopy began in 2007. Studies proved it safe and effective. The increased degree of difficulty in doing the operation, however, resulted in limited penetration into the field of surgery.
Placing 3 instruments and a camera through once trocar and trying to find enough room to manipulate all of that in close quarters was challenging at best. Not to mention that the limited working room required the instrument on the left of the screen and visa-verse for the other hand. It was kind of like operating looking into a mirror while playing Twister! No wonder it didn’t catch on as expected. But if you connect all the instrument to the robotic platform then Presto… hard becomes easy.

The robot is designed to manage the tight quarters and the computer adjusts the view for the unnatural angles and visual associations. The older model DaVinci Si was the first robotic platform to have this but many surgeons had limited access to a robot making that the rate limiting step for adoption. Robots are increasingly more available and general surgeons are quickly adopting the platform. Couple this with added safety in identifying the ductal anatomy using Firefly visualization (see side panel) and it’s easy to see how the future of minimally invasive surgery is the header in “1” direction. 1 incision, 1 inch long equals 1 happy patient!

“Fly” thru the abdominal cavity, please click here 

Dr. Harkins Guest Lectures in Minneapolis

“One of the aspects I like the most about being on the cutting edge of technology in surgery is the ability to interact with colleagues across the country as the surgical community helps to shape this emerging standard” stated Dr. Brian Harkins in a recent lecture to surgeon colleagues in Minneapolis, Minnesota. He pointed out that the surgical community has seen this happen before.
The early 1990’s saw the emergence of laparoscopy as a standard practice in general surgery. Most laparoscopy prior to that was performed by gynecology. In less than a decade, laparoscopy became a gold standard in many procedures and general surgeons became the most prolific laparoscopists.
While urology and gynecology have lead the way in robotics since 2000, it’s the new advanced technologies and latest robotic platform, the Xi, that have opened the door for general surgery to perform an increasing number of complex multi-quadrant procedures. He concluded, “This is paving the way for robotic surgery to be the new minimally invasive standard in general surgery. You could say, its laparoscopy with a long overdue upgrade to advance technology!”

Dr. Harkins is recognized as a world leader in experience using the Da Vinci Xi system in General Surgery.

Download Newsletter Issue #3 [PDF]

Doctor with medical equipment and logo.

Robotic Surgery – General Surgery

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M. Brian Harkins, MD, FACS | 31 January 2016 |  Issue 2

General Surgery…The Fastest Growing Specialty in Robotic Surgical Procedures!

Tomball leads the way in the Greater Houston Area

Tomball Regional Medical Center has become the first hospital in the Greater Houston Area to have two of the latest Da Vinci Xi robotic surgical systems in use. This doubles patient access to this highly sophisticated platform compared to other local hospitals. Dr. Harkins continues to be the most prolific user of this advanced technology. He is able to perform increasing numbers of more complex surgical cases. The winners…patients who are receiving state-of-the art care from a leading expert without the need to travel out of the area.

Incisional Hernia Repair—Why the Robotic platform is Unparalleled in Performing Ventral Hernia Repair

The repair of an incisional or ventral hernia using an open technique requires a large incision with all of the pain and recovery delays that go with that but the approach allows for more options to close the defect. Using laparoscopy results in less pain and a quicker recovery but most laparoscopists don’t close the defect. A mesh is placed and bridged across the defect and then it is usually tacked into place. This leads to higher event ration rates and increased recurrences. Each approach has advantages, but also significant disadvantages.

The robotic platform solves the problem! It is a minimally invasive platform which gives the patients the benefit of smaller incisions, less pain, and a quicker recovery. With the incredible 3D HD magnified view and wristed instrument dexterity, closing the defect and suturing in the mesh is even easier than doing this in an open approach. The result is a platform that has the best of both of the previous approaches without the downsides. So, the problem must be the cost right?…Wrong, many major studies are showing not just similar costs to laparoscopy, but decreased costs when using the robotic approach. Dr. Harkins stated, “For many years I have done open and laparoscopic repairs. Since I began using the robotic approach over a year ago I can comfortably say that I am now doing the absolute best incisional/ventral hernia repair I have ever done!”

Fastest Growing Procedure in Robotics

Incisional/ventral hernia repairs using the robotic platform represent the fastest growing procedures in robotics. With nearly 200% year over year growth since 2012, the procedure is on its way to becoming the new standard of care. More than 17,000 incisional/ventral hernias were done in 2015. Many of the most renowned leaders in hernia repair surgery have shown enthusiastic support. Dr. Harkins has vast experience with this approach using the Da Vinci Xi system!

“Fly” thru the abdominal cavity, please click here 

Dr. Harkins Speaks as Surgeon Expert in Las Vegas M. Brian Harkins, MD, FACS

The “All-In” adoption of the robotic platform has “quickly” caused Dr. Harkins to be recognized as a leader in General Surgery in overall experience using the Da Vinci Xi system. Because of his success he was recently invited to be one of only 6 surgeons to attend the Intuitive Surgical World Wide Meeting. He spoke as a surgeon expert to help improve the knowledge of the attendees and to help them understand the literature, the medical and surgical facts, and the perceptions and interactions from the surgeon’s viewpoint. While he happily fielded questions from all areas he specifically focused on incisional and ventral hernias when interacting with the over 1200 attendees at the Bellagio Hotel in Las Vegas, Nevada.

He found the 4 day event invigorating and re-energizing. He stated, “It was incredibly exciting to be involved with the company that is providing the technology to take the practice of surgery to unprecedented levels of quality, precision, and improvement in patient care!”

Dr. Harkins is recognized as a world leader in experience using the Da Vinci Xi system in General Surgery.

Download Newsletter Issue #2 [PDF]

Hotel fountain show, empty theater seats.

Dr. Harkins to Speak as “Surgeon Expert” in Las Vegas

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Las Vegas Nevada is the site for this year’s Worldwide Sales Meeting for Intuitive Surgical, the maker of the Da Vinci Xi Robotic Surgical System. Dr. Brian Harkins is one of a select group of surgeons who has been invited to be in attendance as a “Surgeon Expert” to help educate and provide the surgeon’s perspective to the attendees. His focus at this meeting will be his experience and knowledge regarding the robotic surgical system to accomplish hernia repairs. Across the country and worldwide the robotic surgical system, an advanced minimally invasive platform, is demonstrating rapid growth and acceptance in many areas to include ventral, incisional, and inguinal hernias. As a leader in experience using the Da Vinci Xi, Dr. Brian Harkins is proud to offer this state-of-the-art surgical care. In his over 20 years of practice in Northwest Houston he has cared for patients who have sought him out from across the United States and abroad.

Robotic surgical system components displayed.

Know the Robotic Surgery Facts

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M. Brian Harkins, MD, FACS | 30 August 2015 | Volume 1, Issue 1

 

Know the Facts!

Your Patients Will Be Asking!

Robotic-Assisted Laparoscopy… An Evolving Standard in Minimally Invasive Surgery

Its too expensive! Its adding technology without adding benefit! It will never last!…Robotic Surgery? No! Those were pushback comments in the early 1990’s about the introduction of laparoscopy into the world of surgery. Improved patient outcomes rolled right over those objections to create a new standard in many surgical procedures. But if we recognize that minimally invasive surgery is better for patients, then after 30 years of laparoscopy, why isn’t every procedure being done that way? The short answer…some procedures were just too “hard”. Laparoscopy had limitations that kept it from completely replacing open surgery altogether.

Enter Robotic-Assisted Laparoscopy!! With the addition of a highly sophisticated robotic interface, many of the limitations of laparoscopy have been overcome making the benefits of minimally invasive surgery accessible to greater numbers of patients for many more procedures. The end result is an evolving trend of better pa-
tient outcomes in terms of lengths of stay, complications, post-operative pain, blood loss, and readmissions. Wow! The long awaited upgrade for laparoscopy is finally here!…and its available right here in Tomball!!

Safety, Experience, New Horizons

Little did I know when I did my first robotic case on 29 September 2014 that by the end of my first year I would be the second most experienced general surgeon in performing cases with the Da Vinci Xi system in the world, but that’s what has happened! I already have many personal examples of patients who would have likely undergone an open procedure if it weren’t for the robotic platform. The vast majority of these patients have enjoyed the benefits as complication rates have remained low when compared to the previous year. I wish I could say that low meant zero, but that’s just not the reality with surgery and medicine. However, I do have great hope that in the robotic platform I now have the tools and ability to move even closer to that zero complication rate threshold.

In my efforts as the Robotics Chairman of the Department of Surgery I have continued to focus the program on patient safety and staff education. TRMC Administration and Surgical Services have responded in establishing us as the only robotic program in Houston with 24/7 full access to accomplish surgeries on the robot. The evolving standard is always available here!

I am very excited to be on the forefront of this new horizon in general surgery and will continue to offer your patients the most advanced surgical care available. Best of all, they can get that care right here in Tomball.

A Brief History of the DaVinci Robot M. Brian Harkins, MD, FACS

Intuitive Surgical Incorporated’s first robot was developed in 1997 but the system did not get FDA approval until the year 2000. Improvements over the original resulted in the Da Vinci S release in 2006. In 2009 the DaVinci Si platform furthered propelled the success of the robotic surgery movement with ongoing transition of prostate surgery and malignant gynecological surgery to being almost completely done with the robotic platform. The advanced technology additions to the DaVinci Si platform began to show promise in the adoption by general and colon and rectal surgical specialties. The “game changer” as many surgeons refer to it, was the release of the Da Vinci Xi platform in 2014.

Our first robot at TRMC was the early model DaVinci S which we obtained in 2012. We traded that in for our new DaVinci Xi, the second one to arrive here in the Houston area, in July 2014. The rest, as they say, is history…in the making!!!

Download Newsletter Issue #1 [PDF]

Doctor with da Vinci surgical robot system.

TRMC advances robotic surgical platform for patients

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A new robotic-assisted surgical system is paving the way for improved patient outcome statistics at the Tomball Regional Medical Center.

TRMC purchased and implemented the new robotic surgical platform in 2014. Dr. Brian Harkins, a surgeon at Tomball Regional Medical Center, said he has carried out the second highest number of general surgery cases using the new robotic platform of all surgeons in the world.

Dr. Harkins spoke at the Greater Tomball Area Chamber of Commerce luncheon Aug. 7 about the benefits and drawbacks of using robotic technology in surgery

“The robot doesn’t do surgery any more than a scalpel or hemostat does surgery,” Dr. Harkins said. “It has to be manipulated by a surgeon. This is the way the system is set up, and it doesn’t actually do anything on its own.”

During a robotic surgical procedure, a surgeon is seated at a console with an armrest and headrest and can control the precise movements of the robot with his hands, Dr. Harkins said.

The robotic technology allows for improvements in dexterity with “wristed” instruments, ergonomics of hand motions, 3-D vision and an increased possibility of single-incision surgeries, Dr. Harkins said.

“In this case where the surgeon is sewing, instead of reaching way out to do all of that, it’s right here in front of you,” Dr. Harkins said. “You see it in front of you and move your hands in a very simple motion.”

A significant portion of procedures traditionally carried out by open surgeries that may require multiple large incisions are now being conducted with the robotic platform, such as hysterectomies and prostatectomies, Dr. Harkins said.

However, one of the drawbacks of the robotic surgical platform is its financial cost, Dr. Harkins said. When first implemented several decades ago, laparoscopic surgery was a more costly option for hospitals, and now it is recognized as a standard for many procedures, he said.

The robotic surgical platform is the most advanced technique available for abdominal surgery, Dr. Harkins said.

“In the robotic world, it’s always crystal clear and magnified, and you are fully in the picture,” Dr. Harkins said. “Precision and complete control of the instrument makes a difference over time. Technology allows you to have better information in the operating room, which should lead to better decisions and better outcomes.”

TRMC plans to continue improving recovery times for patients and reduce surgical complications with the robotic platform, Dr. Harkins noted. With more funding, TRMC seeks to upgrade and implement a newer model of the robotic platform with additional surgical capabilities in the near future, he said.

“This is the current revolution in minimally-invasive surgery,” Harkins said. “It is a long awaited upgrade for laparoscopy and something we needed for awhile. I’m going to continue offering my patients at Tomball Regional Medical Center the best, the safest and most advanced care possible using the robotic platform.”

For more information, please call us: 281-351-5409 or click here to fill out the form

Surgical robot in action during a minimally invasive procedure.

Robots lead the way in minimally invasive surgery

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Susan Caesar is about to perform a minimally invasive procedure using a robot.  It’s her first time and she’s not even a doctor.  She actually works at Hewlett Packard.

“Two small movements and I learned how it reacted to my movements. I was picking up the little circles and putting them on the cones so it was pretty great.” she said afterward.”

Ok, the robot is real but the patient is not. This is just a demonstration of the Davinci Xi robot by Intuitive Surgical.  Doctors affiliated with Tomball Regional Medical center are showing it off and letting employees at HP put it through it’s paces. The robot can take the operators large motions and make them smaller with incredible precision. Its the newest thing in minimally invasive surgery. The doctors love it and say the patients do too..

“Right now with this I get better visualization and the patient experiences less pain and quicker recovery with it.” claimed one surgeon.

Not to mention fewer complications afterward like post operative infections that could lead to costly readmissions.

But at two million dollars, many hospitals might balk at buying one.

“But just like laparoscopy is still more expensive for a gallbladder than an open surgery yet we do it anyway because the patient outcome is better.” said Dr. Brian Harkins. He says surgical robots like this are the future of medicine, and the future is here.