First robotic surgery at Lovell FHCC

In hushed whispers, “this is exciting,” was the most heard phrase from clinicians, technicians, and other observers as they took turns peering through the windows of the operating room to get a glimpse of the da Vinci 5 (dV5) robot.

Meanwhile, in a nearby exam room, the Army Veteran who volunteered to be the first patient waited with his wife in a different kind of anticipation. Keith Powers was mostly looking forward to no longer being in pain from hernias he suffered in April on both sides of his abdomen. The fact that his bilateral inguinal hernia surgery would be the first robotic surgery for the hospital only mildly concerned him because he had already had robotic hernia surgery at a different hospital, five years previous.

“I did a CT, met with the (Lovell FHCC) surgeon (Dr. Alex Farnand), and he said, ‘if you want to wait, we’re getting our first robotic machine,’ and I said, ‘I’m good with that.’ It worked out well,” said Powers, who served at Ft. Bragg and in the Wisconsin Army National Guard as a computer operator for field artillery. 

“I’m a pioneer,” Powers said. “I’m looking forward to it.”

Years ago, Powers admitted he wasn’t impressed with the VA. “When I first got out (of the service), I went down to Lovell (when it was North Chicago VA) and promptly left. That was 25 years ago.”

Today, Powers couldn’t be happier with his care, which over the past five years at Lovell FHCC has included a sleep study and consequent use of a CPAP machine. He also participates in the MOVE! program – via telehealth – and has lost 48 pounds to date. He has VA service-connected disability ratings and receives care for his hips and back, the result of jumping out of planes during his service.

Lovell FHCC was the first VA medical center to order the dV5 and put it into operation. To date, 26 dV5s have been installed across the country, said Lindsay Merdinger, Intuitive sales manager in the Chicago area, who was in the room for the surgery. The dV5 is state-of-the-art technology used in minimally invasive procedures. Merdinger said it enhances surgeon precision, reduces recovery times, and lowers risks compared to traditional surgery. 

“To be able to offer this technology to Lovell FHCC patients is incredible,” said Merdinger, who worked with Lovell FHCC staff for the six months leading up to the first dV5 surgery. “I feel the collaboration with the team here has been incredible.”

Surgical Services Associate Chief Nurse Kristen Clark, a key player in the launch of the program, was one of the clinicians waiting anxiously outside the operating room the morning of the surgery. 

Clark listed off various groups involved in the successful launch over a two-year period, including Biomed, Facility Support, Logistics, IT/OIT, Nursing, Sterile Processing Service, Nurse Informatics … “It’s been a huge group effort,” she said. “It took a massive multidisciplinary team to get it off the ground.”

Special equipment was needed, Clark said, such as the unique bed that moves with the robot, a different sink for SPS because the “robot arms are long,” and she pointed to a rack stacked with EndoWrists. EndoWrists, patented by Intuitive Surgical, are surgical instruments that move like human wrists but with even more range of motion. They provide control of suturing and dissection during minimally invasive surgery through tiny incisions. 

And with a big smile on her face, Clark said from the time Lovell FHCC received the dV5 at the end of June, the project stayed “right on schedule.” 

Farnand, the surgeon performing the first dV5 surgery, said the main thing he felt when the day finally arrived was “relief,” relief that Lovell FHCC is now able to provide patients what has become the standard of care for minimally invasive surgery.

“It was a hard-fought journey,” said Farnand, a Navy Veteran. He said he gained a lot of experience with robotic surgery during his residency in 2019, and “loved it.” After that, he was stationed at Lovell FHCC on active duty and was tasked by the chief of surgery to apply for the robot.

But then the timing wasn’t right, due to a variety of circumstances, including the pandemic. Meanwhile, Farnand deployed to Iraq in 2021, left active duty in 2022, and two weeks later transitioned to a civilian surgical job at Lovell FHCC.

“Fast forward a couple of years, and interest was building,” said Farnand, whose title is now Section Chief of General Surgery. “We put together the clinical restructuring request, finally got approved a couple of years ago, then routed up through national process,” he said.

Farnand said the challenge was to show evidence of the need for robotic surgery, in this case the purchase of an approximately $3 million piece of equipment.

“I had to present to the (Lovell FHCC) ELT (executive leadership team). The opening question I asked was, ‘if you had to undergo surgery and your surgeon offered robotic, laparoscopic and open surgery, how many of you would opt for robotic,’ and nearly everyone raised their hand.”

Farnand said he asked the ELT, “‘If this is what we want for ourselves, how can we not do this,’ and that got the ball rolling. That generated buy-in.”

Robotic surgery has a lot of benefits, Farnand noted. “We can keep nearly every surgery minimally invasive, which means less time people stay in hospital, less pain, less blood loss … all things you want in a surgery for yourself, we can now give this to our patients.”

The robot has allowed a lot of innovation in surgery. It allows for “full degrees of freedom, even more than a human wrist or hand, to get into tiny places and reach around,” he said, “in ways that could never be done laparoscopically.”

One of the advantages of the robot is the surgery can be livestreamed, and if necessary, the surgeon can “call a friend” to assist – remotely.

Before his first dV5 surgery, Farnand observed surgeons using the dV5 in cases at other facilities, completed virtual simulations to learn skills with the robot such as suturing and moving instruments, and practiced with models on foam and “tissue-based” models. Pig tissue was used in place of cadavers, which are increasingly expensive to use for training, he said.

The morning of the surgery, the operating room was packed with people. Farnand, the anesthesiologist, and the team of clinicians performing the surgery were gathered around the patient’s bed, and what is called the “patient-side cart” – with the largest thing visible on the cart being the four long robotic arms. 

Lovell FHCC Surgeon Dr. Anna Lakoma and her team, scheduled to perform a gallbladder removal and a hernia repair in separate robotic surgeries the following day, were in the room to watch and assist if necessary. Other observers included Farnand’s proctor, and Intuitive representatives Merdinger and Clinical Sales Associate Tyra Hunter. 

Farnand could barely been seen in the corner, sitting at the surgeon’s console, looking into a viewer that allows for a magnified 3-D image of the surgery site, and operating the robotic arms and instruments using joystick-like hand controls. 

Each surgeon is required to perform five robotic surgeries to be provisioned, or in other words credentialed to perform dV5 surgeries on their own. Besides Farnand and Lakoma, several more Lovell FHCC surgeons are scheduled to be provisioned for more types of surgeries, including stomach, colon and gynecological surgeries. Farnand said the goal will be to keep the room booked nearly every weekday.

Before she went in to assist Farnand with the first robotic surgery, Lakoma said she was “most excited about doing a better surgery for our patients,” one that results in less tissue damage and pain after surgery. Before coming to Lovell FHCC, Lakoma said she did more than 100 robotic surgeries using an older model robot at a community hospital in Indiana. She was hired at Lovell FHCC largely to do robotic surgery.

While Powers was in surgery, his wife, Jacqueline Powers, waited calmly, but somewhat nervously, in the Lovell FHCC Caregiver Support Center. “It’s exciting and a little nerve-wracking wanting to be the first one,” said Jacqueline Powers, herself a nurse. 

“I was eased after talking to the doctor and the nurses. The doctor explained it well,” she said, adding that her main challenge after taking her husband home would be to keep him from “doing projects” around the house. “I said to him, ‘you are not doing anything for three weeks!’”

Contacted a week after his surgery, Powers was already busy at home, taking work calls. He said he was bruised and still swollen but felt his recovery was on track. Until cleared to return in person to his warehouse job at ABBVIE, he planned to telework.

“Every day I feel a little bit better,” he said. “I have three little incisions, and I can touch them without wincing.”

He added he is “super pleased with everything so far. The VA, and Lovell FHCC, have been very good to me, I will say. I was just impressed with the way they handled everything.”