210114ind SCH marchand

Dr. Robert Marchand was the first hospital surgeon at South County Hospital to begin performing robotic-assisted surgery. The hospital, which recently celebrated the 10th anniversary of its first-such procedure, was one of the nation’s early adopters of robotics in the operating room.

Robotic-assisted surgery – while still in growing stages – shows a bright future for patients, doctors and hospitals embracing this advanced technology, say local and national experts studying this surgical evolution having roots in South County Hospital.

Wakefield’s Ortho Rhode Island and South County Hospital are celebrating the 10th anniversary of using this technique transforming surgery in thousands of local cases – nearly a million nationwide last year — and whose use is forecasted to expand more widely.

“The robot now is highly accurate and highly precise and very protective of soft tissues and it does some really perfect things that I cannot do as a human,” said Dr. Robert Marchand, hospital surgeon who first started using this technology.

For instance, Jeanne Callaghan of Wakefield is one of those patients. She had disabling pain and through robotic-assisted surgery had a quicker recovery time and what she believes is a better outcome than through open surgery, she said.

“My sciatic pain was like a severe toothache down my leg, waking me up at night and I needed a cane to walk because my leg would just give out occasionally,” she explained, adding that “the outcome of the surgery was wonderful.”  

Good for Doctors, Hospitals, Patients

These physicians are at the water’s edge of a growing U.S. and global trend estimated today to be a $4 billion market in the United States alone, according to Amit Hazan, equity analyst in medical technology with Goldman Sachs Research.

Last year in the U.S. about 900,000 procedures were done by robotic-assisted surgery, which is about 5% of all surgeries, he said. With an aging baby boomer population coupled with more development of the robots, that number is expected to grow to 17% in the next 10 years.

In terms of expansion nationwide for practices becoming involved in robotic surgery, the market jumps in one decade to $17 billion in the United States, Hazan said.

As seen with the pressure needed for a rapid – rather than customary – development pace for a coronavirus vaccine, medicine does not turn quickly to adopt changes until benefits have been proven over long periods of time, trial and testing.

However, the potential in robotic-assisted surgery a decade ago was clearly seen by Marchand and his partners at Ortho Rhode Island as well as officials at South County Hospital, home base for these physicians. They started slow and built on their successes with it, Marchand noted.

The hospital later even formed an Institute for Robotic Surgery and positioned itself to be a state leader in the effective uses of this technique now and in the years ahead.

Today, the Ortho Rhode Island and other doctors said, they are happy with the results, investment of time and training, and ready for the next stages.

“I always say, this (the current iteration) is the flip phone of robots. So, what is the next level? The next level is coming within a year or two. I’ll call it smart robotics,” said Marchand, who estimates he’s done about 7,500 robotic-assisted operations in the last decade.

It’s all about advancing technology and algorithms, he said, echoing Hazan.

“Think of the power of the smart phone. In this instance with robots, you add artificial intelligence and machine learning – following the hands of the surgeon and then incorporating that into a movement to address a specific kind of surgery the surgeon maps out beforehand,” he said.

Next bring in augmented reality overlaying high-tech radiology scans and join them with advanced multi-dimensional and microscopic views of the area needing surgery.

When all this is combined together, an algorithm can be developed to produce exacting precision in the way the human hand – sometimes subject to slight tremors – cannot do and the naked eye cannot see, Marchand said.

“Now you have not just a powerful precise robotic tool, you have powerful, precise robotic brain linked to the tool,” he explained.

Hazan emphasized those same points, noting it means rapid new developments to modern surgery’s continuing evolution toward exactness, efficiency and satisfactory – or even better – results for patients.

He said he expected to see training in virtual reality begin soon because machine-learning capabilities are taking off.  He envisions GPS-like systems that help a surgeon microscopically cut in the right way and in the right location.

In about five to 10 years, Hazan said, he thinks robots will do suturing and perhaps behave airplane-like in autopilot as surgeon oversees a robot doing more and more of the surgery.

Marchand added that “robots help to remove subjectivity and replace it with science based on precision and successful outcomes for the variety of conditions and bodies of patients a surgeon must deal with.”

Patient Experience

A patient – and nurse – who agrees with that view of robotic surgery is Callaghan of Wakefield. Her severe debilitating pain prevented her from even playing with her grandchildren because she lacked mobility.

Sleeping was difficult. She needed a cane or walker to get around. She tried weeks of physical therapy and cortisone injections. Hip and back problems were bearing down on her at once.

On January 7, 2019, Callaghan became the first person in Rhode Island to have spine surgery using a robot named ExcelsiusGPS. Not long after, on April 17, she had a total hip replacement done with another robot named Mako.

“I would definitely recommend robotic surgery to anyone. I just know it has improved my quality of life, as now I can go to the gym, do yoga and best of all have fun with my grandchildren,” said 67-year-old Callaghan.

While there are other methods and combinations of surgery, such as open or laparoscopic, robotic-assisted surgery is less-invasive in operating rooms, which were once ruled only by a scalpel that drew long and invasive incisions.

Ian Madom, a partner of Marchand’s, started doing robotic-assisted spine surgery more than a year ago and now uses it on about half of his cases.

He pointed to the efficiency for both surgeon and patient. Madom noted a particular kind of spine operation that once took five hours and had a lot of blood loss.

Today that same surgery takes about three hours, has far less blood loss and patients spend about 50 percent less time in the hospital, he said.

“The health-care economics are so drastic there because now we’re keeping people in the hospital fewer days, which means fewer potential complications from the hospital stay,” he said.

Dr. Joseph Renzulli, the hospital’s chief of urology, uses the da Vinci Xi robotic surgical system.

His specialty is treating cancers and tumors in places like bladders, kidneys, prostate glands and other areas that are part of the urological network. He uses the robot in most cases, he said.

“These 98 percent of surgeries are going to have better outcomes because they have the advantages of the robotic system,” he has said.

One large observational study, according to one medical journal, showed that patients undergoing robotic prostatectomy experienced fewer complications.

The study found a hospital stay cut from three days to two, drastic reductions in blood transfusions and fewer postoperative respiratory and other complications when compared to open radical prostatectomy,

Renzulli said, “We’ve been able to apply robotic surgery to almost every aspect of urologic issues and the reason why is that it was very difficult to do this laparoscopically.”


Changes Ahead

Dr. Michael Bradley, president of Ortho Rhode Island, hailed guided precision as an important development in surgery and that training is available for those who want it.

“Robotics was not part of our original training, but as surgeons it is important to develop with technology and to continuously seek ways to improve efficiencies. Industry leaders that have robotics in their product portfolio have strong training platforms for surgeons,” he said.

For his part, Marchand has branched out to also teach the robotic system and often cameras will light up in his operating room each week with other surgeons from around the globe watching him in action.

“It’s changed my whole practice. It’s changed my whole life,” he said about becoming a consultant to other doctors, co-author of medical journal articles on the subject and first-in-line reviewer before release of robot software under development.

One over-arching satisfaction, he said, is that the efficiencies of robotic surgery allows him to treat more patients and get the expected results discussed beforehand with patients, he said.  

The other is that his interests led him to a form of advanced medical technology that is both profitable and rewarding for himself and his practice as well as South County Hospital, which has invested millions of dollars in robotic technology as part of a partnership with Ortho Rhode Island.

Hazan, of Goldman Sachs, would agree with that strategic approach, especially since he sees in the United States by 2030 continued opportunity to expand an expected 17% growth in robot-assisted technology in surgery.  

“We are expecting an acceleration of growth over the next 10 years,” the researcher said, especially with the addition of machine-guided data, analytical capabilities, augmented reality, and automation.

Marchand sees clearly how his risk in joining the robotic-assisted movement a decade ago was a wise investment now paying off.

“I think I’m very fortunate to have come along into this kind of surgery. It wasn’t planned. I had no idea what a computer was in 1988,” he said with a laugh.

Bill Seymour is a freelance writer covering news and personality feature stories in Narragansett, North Kingstown and South Kingstown. He can be reached at independent.southcountylife@gmail.com.

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