Five robot arms lead to less invasive surgery at Monroeville's Forbes Regional

| Wednesday, April 10, 2013, 9:00 p.m.

Dr. Mark Rubino has become accustomed to the limitations of performing a hysterectomy. Despite technological advances, he was resigned to the fact that about two-thirds of his patients would have to be cut open for surgery and require a six-week recovery period.

But now, he has access to five arms that can move as precisely as his own hand.

Rubino, of Murrysville, is one of eight physicians at Forbes Regional Hospital in Monroeville to perform robot-assisted surgeries. The operations range from hysterectomies to cardiac bypass surgery, and the procedure enables physicians to make surgery less invasive for the patient and decreases recovery time, Rubino said.

“What robotics has done is, in a relatively short period of time, really allowed the number of open procedures to drop from 65 percent to under 40 percent,” said Rubino, chief medical officer at Forbes Regional. “There is a significant effort in time and training, but for a lot of doctors, the investment is worth it, in light of a decrease in recovery time and not having to open up patients.”

Forbes surgeons use the da Vinci System, a two-part system that enables physicians to control the five-armed robot via a remote console. The technology initially was developed by NASA to operate remotely on astronauts in space, and it has been used by the Department of Defense to operate on soldiers.

Only one other hospital — Excela Health's Latrobe campus — in the east suburbs performs robot-assisted surgeries. UPMC East, which opened last year, does not offer the program, spokeswoman Kara Kessler said.

Since 2009, Excela has performed more than 900 surgeries using the da Vinci System, predominantly in urology, gynecology and general surgery, Excela spokeswoman Robin Jennings said.

Laparoscopic instruments that enable the doctor to use a video camera to see inside the patient are attached to the robot. But, unlike traditional laparoscopic surgery, robot-assisted surgery enables physicians to move the equipment in a manner similar to their own hand. Rubino said he is able to dissect tissue, sew sutures and complete surgery in a similar manner to an open surgery — but without the risks associated with that type of surgery.

“There is a significantly less likelihood of infection at the incision and less chances of blood clots or complications to keep the patient in the hospital,” Rubino said. “There are so many risks to being down — and the more you're down, the longer it takes a patient to get back to their normal routine.”

Rehabilitation time is decreased as well, Rubino said. Mary Valentine, 69, was discharged less than 24 hours after Rubino performed a robot-assisted hysterectomy and bladder-repair surgery. She did not need the narcotic pain medicine that is customary in such a surgery and was back to normal activities within seven days.

In the case of similar laparoscopic or open surgeries, patients would be in the hospital for four days and would have to wait six weeks before resuming normal activities, Rubino said. Valentine said she was surprised by how quickly she recovered. Friends who previously had hysterectomies shared horror stories of two- to three-month recovery periods, but Valentine had none of that.

“It just went so well,” said Valentine, of Murrysville. “I was able to ease my way back into doing things really with no discomfort. I've even recommended it to a few friends.”

Rubino, who has performed about 50 robot-assisted gynecological surgeries at Forbes Regional, said colorectal and gall bladder surgeries regularly are performed at the hospital using the di Vinci System.

Nationally, the da Vinci System is used most for prostate removal. But in the West Penn Allegheny Health System, most of those surgeries are completed at the hospital's other campuses in Pittsburgh, not Forbes.

Last year, Forbes became one of two hospitals in the region to use the system for heart surgery. Dr. Michael Culig has begun performing some single cardiac bypass surgeries — which are considered to be among the most invasive surgeries performed — with robot assistance, Rubino said. Typically, a surgeon will crack open a patient's sternum to replace a clogged artery. In some cases, Culig has been able to access certain arteries in the heart by making a single incision beneath the patient's rib cage.

“It allows a less invasive procedure for a select group of his patients,” Rubino said.

“The robotic assistance has allowed an enhanced capability and precision, similar to an open procedure. Yet, you're able to do this with very small incisions, allowing the patient to go home faster with a much shorter recovery time.”

Daveen Rae Kurutz is a staff writer for Trib Total Media. She can be reached at 412-856-7400, ext. 8627, or

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