The future of surgery is happening in Hamilton now.
Hospitals across southwest Ohio and the country have for years performed robotic-assisted surgery, and Kettering Health Hamilton started its program in March 2020. Since then, they’ve had more than 600 cases, and that number will grow exponentially in the months and years to come because of a $2 million investment in the robotic-assisted surgical system known as the da Vinci Xi nearly 18 months ago.
It’s been a surgical game changer, not only for the teams that use it multiple times a day, but also for their patients. The latest version of the da Vinci surgical system helps reduce post-operative pain ― the dependence on prescription pain medication is limited, and in some cases, replaced with an OTC like Tylenol, if it’s needed at all. It also limits scarring to the body, blood loss, and the risk of infection, as well as promotes quicker recovery.
“The technology you see here is mainly at tertiary centers,” said Dr. Ryan Grote, referencing large hospitals with specialties that receive referrals from primary and secondary care providers, “and at bigger hospitals, not smaller hospitals like this. We can do the same things they can.”
“We’re performing surgeries at a tertiary level expertise. Cases here that before had to go to downtown (Cincinnati or Dayton), we can keep here now. It helps with their recovery. Each patient is in their community. Their loved ones can see them better; they don’t have to travel downtown and can see more often if they have to stay for longer periods of time.”
The robotic-assisted da Vinci Xi Surgical System is used in many surgical procedures, though not all, and provides patients with minimally invasive surgical procedures, which is what the Kettering Health Hamilton surgical team has always performed.
“All of our focus is in high-quality, minimally invasive surgery,” said Dr. Andrew Lichter, one of three general surgeons at the west side hospital, though as many as a dozen surgeons use the surgical tool. “So we use this robot to do the same thing everybody else does in town, but hopefully, smaller incisions and less pain.”
A big reason for this is the dexterity of the probes, as they can rotate and bend at high degrees of angles, and the magnification allows doctors to see super close ― you can read all 26 states listed on the back of the $5 bill ― and into the body where they weren’t able to before.
The use of the robotic-assisted system has also changed the way Lichter practices.
“I do open surgery the way I do it robotically,” he said. This means he makes the smallest incisions possible because he knows that means the patient returns to their normal, everyday life faster.
They now have people searching Google for the doctors at Kettering Health Hamilton ― and Lichter said they’ve been called the “robo docs” ― as they’ve built the robot program, but the hardest thing for Lichter, and the other surgeons, is to say, “I know you’re here for the robot, but you’re not a robot candidate. That’s been most disappointing.”
Though not every procedure is a candidate for the da Vinci Xi, that doesn’t mean another surgeon won’t be able to do so, Lichter said.
“We’re subspecialized within our group, and there are certain things (another surgeon) does robotically that I do (as) open (surgery) that I would hand off,” he said.
But some surgeries just have to be done openly.
“Carcinoids, for example, there’s such a high rate of finding a second lesion, you have to feel with your fingers to know there aren’t any other spots because you can’t see it because it’s in the bowel,” Lichter said.
They also don’t use the machine for trauma surgeries.
“If someone has a cracked spleen from a car accident, we’re not doing trauma robotically,” Licther said. “You’ve got to be in, you’ve got to be out, you’ve got to grab stuff ... so there are some things that just don’t lend themselves to the robotic platform.”
But a lot of the time, for procedures like for complicated hernias, many elective surgeries, or cancer surgeries doctors have time to prepare for, “it’s a great tool, and we’re seeing really accelerated returns to normal activities and daily living,” Lichter said.
Dr. James Parker, a minimally invasive surgeon, said this allows all of Kettering Health Hamilton’s surgeons ― such as urologists and OBGYNs ― to be able to do “the biggest surgeries in the smallest way possible,” adding that surgery with the da Vinci Xi is “is a more precise, safe surgery.”
The doctors said a recent hysterectomy patient returned to work a week after the procedure, where it could take as long as six weeks to recover without this tool.
Though other area hospitals have some level of robotic surgical systems, Parker said Cincinnati “is a void in the country” when it comes to robotic-assisted surgery. “For some reason, Cincinnati is behind,” he said.
For Lichter and Grote, though, the popularity of the da Vinci Xi has put some extra pressure on them, given both are Butler County natives practicing near their hometowns. Lichter is a Fairfield native, and Grote grew up in Ross Twp. and is a Hamilton Badin graduate.
“It’s a higher stakes game when it’s your hometown,” said Lichter. “You can’t hide because you’re two degrees removed from literally almost every person we operate on, so you have to have a very holistic mindset that says, ‘These are our people.’”
Grote said he had a physician that sends patients to the Kettering Health group regularly had a gallbladder attack while out of town some four hours away and drove back so the Badin grad could perform surgery.
So while the stakes are higher because Hamilton is a tight-knit community, it’s still a “privilege and an honor,” Grote said.