When Pam Quilici was told she had ovarian cancer, her first question did not pertain to the disease, course of treatment or survival rates.
Instead, she had one question for her oncologist, Peter Lim, MD, FACOG.
“I asked him when I could start walking again, because I had committed to a 40-mile cancer walk only a few weeks after surgery,” she laughed. “My husband was very concerned about the cancer, obviously. But I only wanted to know when I could walk again, when I could start working out.”
The 62-year-old Carson City resident was not discouraged by the diagnosis; after all, she had raised nearly $4,000 for the two-day Avon Breast Cancer Walk in San Francisco, and she was determined to meet her obligation.
And meet it she did, with the assistance of a very special technology: physician-guided robotic surgery using the da Vinci Surgical System.
“I was so focused on recovery,” she said. “There was really no other choice. I was going to beat this, and beat it quickly.”
The path up to this point was convoluted for Quilici, who in March 2009 went in for a routine annual exam but came out with a disconcerting diagnosis. Her gynecologist wanted her to consider a complete hysterectomy due to abnormalities he discovered in her uterus.
A few weeks later, pathology results from the hysterectomy confirmed she had a rare form of ovarian cancer. She then found herself meeting with Dr. Lim for the fateful conversation.
“He looked me in the face, eyeball to eyeball, and told me I had ovarian cancer,” she remembers. “He was so patient, so kind and understanding yet so thorough in that discussion. He was uplifting, encouraging and very calm.”
Given the fact that her ovaries already had been removed during her complete hysterectomy, Dr. Lim now needed to remove infected lymph nodes to prevent the cancer from progressing.
He told her about the da Vinci procedure and its potential for countless benefits — including far faster healing time.
“I was in complete awe at first,” she said. “It sounded like science fiction. But Dr. Lim explained it all, and it seemed like a perfect solution.”
The procedure combines physician skill with computer enhanced technology and robotics, as the entire surgery takes place through small incisions using a high-powered, 3D camera and small surgical instrumentation.
Dr. Lim, who operates the Reno-based practice called the Center of Hope, was the first local surgeon to perform physician-guided robotic surgery. Renown was the first hospital to offer the technique as a treatment option to cancer patients.
“Traditionally, gynecological cancers involved big, open surgeries as treatments,” Dr. Lim said. “But that all changed with the development of minimally invasive procedures (laparoscopy) and certainly now with physician-guided robotic surgery.”
Leading the way
Dr. Lim acknowledges the leadership at Renown for its foresight in bringing da Vinci technology to the community.
Besides offering da Vinci surgery to patients, Renown has become a leader in research and training in the technology.
“We were an early site contributing to a clinical trial answering questions about open procedures versus minimally invasive laparoscopy versus robotic surgery for endometrial cancer,” he said.
For open procedures, with incisions averaging 10-15 inches in length, the typical hospital stay was five days, followed by six to eight weeks of recuperation time.
Laparoscopic surgeries resulted in incisions the size of a dime with an average hospital stay of 2.6 days. But when examining the benefits of physician-guided robotic surgery, though incision sizes are similar to laparoscopic procedures, the numbers were even more attractive.
“The average hospital stay following robotic surgery is 1.6 days,” Dr. Lim said. “And 90 percent of patients receiving robotic surgery are off pain medication within two weeks, 10 percent of them not requiring any pills at all.”
Further, 90 percent of patients reported performing at 90 percent of normal function by three weeks following surgery.
These results were presented in November 2009 at an international meeting in Florida, where the study itself won the “Best Paper” distinction.
“But all this data begged the question, if the incision size is about the same (as in laparoscopy), why the benefits?” Dr. Lim asked.
It seems the answer lies in the technique: da Vinci allows surgeons to manipulate surgical tools just like they use their hands and wrists, allowing for procedures that are elegant and precise.
“This procedure minimizes the pressure against the abdominal walls and the surrounding muscles, resulting in less bruising and less pain for the patient,” he said. In fact, some of the direct benefits of da Vinci procedures may include:
- reduced trauma to the body, resulting in faster recovery times that enable patients to return to their daily activities sooner;
- smaller incisions, with less scarring and faster recovery times;
- lower risk of infection;
- less post-surgery pain and discomfort;
- reduced duration of hospital stays;
- significantly reduced blood loss and reduced need for blood transfusions.
“I’m living testimony to this procedure,” Quilici said. “I had a mission after my surgery: a 40-mile walk within two months.”
She said she began just a few days later with a trip to the mailbox.
“Five and a half weeks later, I walked my 40 miles,” she said. “Because of the nature of the incision — because there were no stitches and big scars and all that scary stuff that goes with typical surgery — I could function and move normally very quickly.”
Of course, Quilici had more than just the walk as motivation: a golden retriever named Chloe, a German shorthair named Ely, four grandchildren age three and younger, and husband Jim Soumbeniotis drove her toward her personal finish line as well.
“I didn’t have time to sit back, and luckily I didn’t have to,” she said. “This da Vinci System — what a blessing that it is in our community and that we have the expertise of physicians like Dr. Lim to operate it.”
Dr. Lim now serves as a proctor for Intuitive, the maker of the da Vinci Surgical System.
“My role as proctor is to teach other surgeons around the country about robotic surgery and to serve as a consultant when other facilities start using da Vinci,” Dr. Lim said.
“I’m probably the busiest robotic surgeon west of the Mississippi,” he said, adding that he has completed approximately 400 such surgeries since the first at Renown in March 2008.
While Dr. Lim’s specialty and focus is gynecologic oncology, he notes that more specialties are taking advantage of the technology — largely due to Renown’s team approach to patient care.
“I’ve been very fortunate to live in a time when technology has met medicine and come to a definite crossroads,” he said. “Prior to the introduction of minimally invasive surgeries, the surgical profession hadn’t evolved much in more than 100 years. And today, with da Vinci, we’re seeing incredible changes due to this ground-breaking technology.”
From “Walking the Walk” in Volume 2 Issue 2 of Renown Journey. Written by Mikalee Byerman. Read other patients stories from Renown Journey.