St. Vincent surgeon trains peers in Robot Surgery 101

Michael Jackson croons over the speakers. The lights are dim. All three students and their teacher, Dr. Kirpal Singh, wear masks. A multiarmed robot completes their circle. In the center, lies an unconscious patient, upon whom everyone, including the robot, is concentrating.

Consider this Surgery 101, a program that draws visiting students from all over the state, country, and on this morning, the world. Dr. Zong Qiang Hu, a Chinese doctor, has come to learn from Singh, a surgeon at St. Vincent Indianapolis Hospital, how to use the da Vinci robot that can cost up to $2 million.

It’s all part of the Indianapolis hospital’s role as one of about 25 epicenters nationwide for training in robotics-assisted surgery. The only hospital in the state with this designation, St. Vincent has trained about 10 to 15 physicians in the past year since it became an epicenter.

When Union Hospital in Terre Haute wanted to expand its use of the robot, they asked Dr. Anand Patel, a surgeon with UAP Clinic who operates there, to go for training. Patel could have gone to Chicago. Instead, he chose Indianapolis.

“Dr. Singh is quite the expert in this field,” Patel said. “He’s a very good teacher. He’s very patient.”

When Patel saw a patient this week who needed Whipple surgery, an extensive procedure, he referred the person to Singh, the only person in the state who does this using the robot.

Singh, himself, did not begin using the robot until about 3-1/2 years ago. He went through the training and was hooked. Since then, he’s performed about 450 operations with the robot.

Only skilled surgeons can undergo the training, which also involves training modules, a stint in a lab where they practice using the robots on pigs, and eventually performing procedures observed by some of the trainers. The trainees know how to do the procedures; what they’re learning is how to introduce the robot into their operating room.

“The robot is a tool to do the same thing that you did,” Singh said.

Much of the education centers on teaching surgeons how to move the robot’s arms. Surgeons accustomed to having instruments in their hands know how hard to pull or when not to pull.

The robot changes that. Now, the physician is not manipulating the instruments with his or her own hands, but through the robot.

“You can’t feel what you are doing robotically. They’re working on giving you the sense of feeling,” Singh said.

The robot system lends itself readily to such training, he said. Trainees can’t take part in any of the actual surgery, but they can watch. Because St. Vincent is an epicenter, it has two consoles, allowing the trainee to see on his or her screen what Singh and the robot are doing.

And while they’re there, Singh may educate them about some of the benefits of the da Vinci robot: smaller incisions that significantly lower the chance of wound infections; shorter post-surgical hospital stays; and a significantly reduced chance of developing a hernia post-surgery, another possible complication of minimally invasive surgery performed without the robot.

Intuitive Surgical, the manufacturer of the da Vinci robot, declined to provide specifics about its training centers in an email, referring questions to Singh.

While the most commonly performed da Vinci procedures are gallbladder and hernia surgery, Singh said the doctors he trains are not picky.

“If they’re a beginner, they want to see pretty much any case,” he said.

While Hu watched, Singh let Dr. Aziz Sadiq, a surgical fellow, take over the robot controls — not unlike a driver’s ed teacher in a car with two steering wheels — for a bit. On a recent morning, Hu observed a much less common surgery, a robotic sphincteroplasty used to correct dysfunction of the sphincter muscle, which no other surgeon in the city does using a robot. Singh has performed about 20 of these.

Singh could employ an arrow on his screen, which popped up on Sadiq’s screen, giving him precise instructions on where the robot should go.

“This makes it safer, much better communication,” Singh said.

For Hu, a Chinese surgeon who is in Indianapolis for a year to do research at Indiana University-Purdue University Indianapolis, having the opportunity to see Singh and the robot was too good to miss. His hospital, Kunming Medical University in southwest China, ordered a da Vinci robot last year.

“Almost nobody has trained to use this, so if I can take back some experience on the da Vinci robotics system, it will be useful for my hospital,” he said.

Terre Haute’s Patel can attest to that. Since training with Singh, he has performed many of his cases alongside the robot. Last week, he said, he did more robot-assisted cases than anyone else in the hospital.

Call Star reporter Shari Rudavsky at (317) 444-6354. Follow her on Twitter: @srudavsky.