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Jason Merrill
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ST. LOUIS - Barnes-Jewish Hospital and Barnes-Jewish West County Hospital are advancing use of robotically-assisted surgery in the operating room by moving forward with new applications of the technology. 

While at most institutions, urology and gynecology are the primary uses of robotically-assisted surgery, Washington University surgeons at Barnes-Jewish are expanding the use into colorectal cancers, head and neck cancers, the Whipple procedure for pancreatic cancer and thoracic surgeries. At Barnes-Jewish West County Hospital, surgeons are using the robot for minimally invasive procedures for not only for prostate cancer, but colorectal cancer, kidney tumor removal, pelvic floor repair and procedures on the esophagus and the stomach. 

For example, Traves Crabtree, MD, Washington University thoracic surgeon at Barnes-Jewish, has begun using the technology to remove certain lung tumors. 

“We’re trying to see if robotic technology provides us with a finer detail in order to perform the operation,” says Dr. Crabtree. “The fine movements allowed by the robot may help us do the procedures we do now a little better but also down the road may help us do more complex procedures.” 

(For more information on Dr. Crabtree's work with robotically-assisted surgery as well as Video Assisted Thorascopic Surgery (VATS), watch this video here.)

The “fine movements” refer to the steady hand robotically-assisted surgery offers surgeons. Rather than a major incision in traditional open surgeries, this technology allows for a few small incisions based on the robot’s arms, two of which hold surgical instruments while a third is a camera allowing a surgeon seated at a nearby computer console to see inside the body. While a patient lies on the operating room table, the surgeon controls the arms holding surgical instruments steady inside the body. 

“The robot allows you to do a case laparascopically that would normally be difficult to do without the robot,” says Michael Awad, MD, PhD, Washington University minimally invasive surgeon at Barnes-Jewish, who did his first robotically-assisted general surgery case in 2009 to perform procedures on the esophagus and the stomach. 

To study the efficacy of the technology in treating colorectal cancer, Washington University colorectal surgeons at Barnes-Jewish Hospital and Barnes-Jewish West County Hospital are lead investigators in a controlled, randomized trial looking at the use of laparoscopic and robotic treatment of cancer compared to open treatment of cancer. The procedure is investigational. 

“The robot seems to be the way of the future in terms of giving the surgeon better control in the pelvis,” says James Fleshman, MD, chief of colorectal surgery at the Siteman Cancer Center at Barnes-Jewish and Washington University School of Medicine as well as Barnes-Jewish West County Hospital. “But I emphasize the effectiveness of the robot for rectal surgery is still investigational.” 

There is some history at Barnes-Jewish in using robotically-assisted surgery in new procedures. For example, in 2008, Washington University surgeons at Barnes-Jewish were the first in the nation to remove a kidney cancer through a single incision at the patient’s belly button with the help of the robot. 

“It’s revolutionary because traditionally patients would get a very large incision on their side for a tumor this large,” says Sam Bhayani, MD, urologic surgeon at the Siteman Cancer Center as well as Barnes-Jewish West County Hospital. 

Barnes-Jewish Hospital began use of the robotic surgery technology – the da Vinci Surgical System in 2007 – while Barnes-Jewish West County began using the robot in 2010.