By Cindy Atoji Keene
Robot-assisted prostate cancer surgery is not a new phenomenon, but still some patients think of sci-fi automatons at work, said urologist Stefanie Seixas-Mikelus. But the procedure is better typified as as smart tools operated by competent clinicians, said Seixas-Mikelus. Seixas-Mikelus is one of a handful of fellowship-trained, female urologists who applies robotic surgery techniques to operate inside the body. “Instead of large incisions needed to allow a surgeon’s hands access to organs, a surgeon controls robotic-type hands in real time, precisely manipulating small scopes and instruments – without the possible hand tremors or fatigue that a surgeon can experience,” said Seixas-Mikelus, 36, who practices at Andover Urology in Massachusetts and at the Parkland Medical Center in Derry, N.H. But refinements in urologic surgery are not the only changes she’s seen in the past two decades –urology is a rapidly changing specialty, with ever-changing therapies and diagnostic methods, said Seixas-Mikelus. “Urology is evolving toward a better understanding of genetic, social, and psychological factors, and as with other medical fields, an increasing emphasis on prevention,” said Seixas-Mikelus.
Q: How do you feel, being a woman in a largely a male specialty?
A: More and more women are entering the urologic work force. I got exposed to the field through my mom, who needed to see an urologist, and I tagged along with her. Then, early on in medical school, I shadowed a urologist and liked the fact that there’s a good balance between clinic-based medicine as well as spending time in the operating room. I give a lot of credit to the women who paved the path before me. In fact, at one point, a male surgeon even told me I should go into a practice more acceptable to females, such as pediatrics or psychiatry.
Q: What was your first exposure to robotic surgery?
A: I completed my urology residency at Roswell Park Cancer Institute in Buffalo, N.Y., where I specialized in urologic oncology. I treated patients with various types of urology malignancies such as kidney, prostate, bladder and testicular cancer. I had two years of hands-on training with the daVinci Intuitive Robotic Surgical System, which was approved by the U.S. Food and Drug Administration in 2000 to treat some conditions. Fine-tissue manipulation – such as dissecting and suturing – is more difficult than in traditional surgery; robotic surgery is not something you can learn over night.
Q: Is a surgeon using robotics operating in “virtual reality”?
A: Not virtual reality but 3-D; everything is at least 10 times magnified, so surgeons are able to see tissues better and possibly spare critical nerves. When a prostate gland is removed, for example, the prostate lies deep within the male pelvis. Neurovascular bundle and muscle fibers need to be preserved. With traditional surgery, visibility can be limited; the robot allows for better vision as well as more precision.
Q: How does robotic surgery work?
A: The patient is on the operating room table with an assistant standing nearby. As the robotic surgeon, I sit at a separate console a few feet away. My fingers are placed into two arm pieces; my feet control pedals. I’ll ask the bedside assistant to introduce the instruments of choice, “Please give me a scissor in the right hand and grasper in the left.” Then I’ll begin manipulating the three or four-armed robot; I could use one arm to grab tissue and with another for a cauterization instrument. The robot’s technology mimick the movements of my wrist. The robot lacks the tactical feedback of open surgery but an experienced surgeon such as myself learns to ‘feel’ by seeing how the tissue separates. Because the incision is so small, the patient usually has less blood loss, less pain and a shorter recovery period.
Q: How can patients best find an experienced surgeon?
A: I believe that patients must be their own advocates. With the availability of the Internet, patients should be informed and ask questions so they’re actively involved in the decision-making process. Patients should research surgeons that have not only the greatest volumes but have excellent outcomes with minimal complications.
Q: How has Obamacare affected you?
A: Of course it’s still in its early stages, and as physicians we still don’t know what to expect. There’s definitely some apprehension; we are obviously concerned about reimbursement, especially for some of the more complex surgeries. The costs of maintaining an office are going up, while reimbursements are going down.
Q: Do you like wearing scrubs?
A: Believe it or not, I think they’re one of the most comfortable clothing you can wear. They’re very light and loose and feel like jogging pants.
Q: You grew up as part of the Nintendo generation – does that give you an advantage in using these robotic systems?
A: Studies have shown that physicians who use the robot well early on are also adapt at video games. I even asked some other skilled robotic surgeons if they played video games when they were kids, and the majority did. It helps with hand-eye coordination, so I guess it makes sense. So when your kids are playing video games, remember there might be some benefit down the road.