MDNews - Greater Boston

board-certified OB/GYN who is a Fellow of the American College of Obstetricians and Gynecologists. "The benefits to patients include smaller incisions, faster recovery and less pain. The robot makes ergonomics easier, gives you binocular vision and improves your dexterity because of the multiple planes of movement with the different instruments." Building on the medical staff is an additional focus for Winchester Hospital. In the past few years, it has trained six medical professionals for the robot. Along with Drs. Fuller and Carpentier, gynecologists Michelle Rotter, M.D., and Glen Dixon, M.D., and urologists Martha Dyer, M.D., and Peter Tiffany, M.D., are trained robotic surgeons. Other undertakings include the completion of a 43,250-square-foot multidisciplinary cancer center and a 31,200-square-foot ambulatory surgery center, which added much-needed surgical capacity. The hospital is now ramping up its outreach efforts to make sure referring physicians and their patients are aware of its gynecologic surgical capabilities. The field remains highly competitive, but offering exceptional women's services is critical to solidifying the hospital's position in the market. With so many capabilities already in place and a clear vision for continued evolution of OB/GYN services and gynecologic surgery at Winchester Hospital, there is little need for patients to fight the traffic into Boston when this community hospital can offer the quality experience they seek. " The way we've structured our program has enabled us to operate with a high level of productivity that decreases the cost of providing care," says Dr. Fuller. "Delivering this kind of care out in the community is better for patients because we can provide the resources and services they need closer to where they need them." For more information about women's health services at Winchester Hospital, vi sit w w w.winchesterhospital.org / surgicalservices. ■ careful selection and rigorous training at heart of robotic surgery program When WincheSter hoSpitAl became the first community hospital in eastern Massachusetts to acquire the da vinci surgical system in 2007, arlan Fuller, M.d., was at the heart of its nascent robotic surgery program. he had recently joined the staff at Winchester from Massachusetts General hospital, where he had been chief of gynecologic oncology and was instrumental in building the robotic surgery program from the ground up, including implementation of a rigorous training program for surgeons interested in learning the new technology. now that da vinci is suffering from a spate of bad publicity, including a wrongful death lawsuit in Washington state, dr. Fuller feels confident the training programs implemented at Winchester hospital have allowed the hospital to rise above the fray and continue to offer the highest quality and safest level of surgical care. "From day one, we have put a lot of thought into properly selecting the doctors who are going to use the da vinci and making sure they have been adequately trained," he explains. "the first step is recognizing that not everyone is going to be a suitable candidate for this type of surgical skill." the da vinci system at Winchester hospital is now used by six surgeons to perform an average of six to 10 procedures per week in three broad surgical categories: oB/ Gyn, urology, and ear, nose and throat. dr. Fuller himself has performed more than 500 robotic procedures and believes the relatively high number of cases is a large part of the reason Winchester hospital's robotics program is safer than most. "the one thing that's required with both complex laparoscopic surgery and robotic surgery is proficiency," he says. "the difficulty is that not every obstetrician-oncologist can become an expert in robotic surgery. there just aren't enough cases. that's one reason why gynecologic oncologists, who do cancer operations all the time, have taken a lead in using robotic surgery on cancer patients." richard Weiner, M.d., Medical director of surgical services at Winchester hospital, explains the training candidates go through once it has been determined they might be suitable. "First, they observe some robotic cases, then they have a robotic training program with da vinci manufacturer intuitive, during which they have a specified amount of hands-on time with the robot in what we call an inanimate lab," dr. Weiner says. "there's no patient involved. "once they've completed that, they work with a proctor on a specified number of cases, in which the proctor has a separate screen and can offer advice and guidance. these supervised cases continue until both the proctor and the candidate feel the surgeon is working independently." even after it has been determined a surgeon is ready to perform robotic procedures without supervision, there is a series of 15 cases in which the surgeon submits the results, the time at the console, how long the procedure took, what the blood loss may have been and all manner of other yardsticks that measure the surgeon's increasing level of expertise. With the three factors of careful selection, rigorous training and high patient volume, the surgical team at Winchester hospital feels confident that robotic surgery offers a safe and effective course of action in spite of recent publicity. MdneWS.coM ■ MD News Greater Boston | 11

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