An appreciation of technology and innate curiosity collided in May 2001 when a urologic surgeon now at Hartford HealthCare (HHC) used a surgical robot to remove a patient’s prostate cancer for one of the first times nationwide.
Twenty years later, that surgeon – Dr. Joseph Wagner, now HHC’s director of robotic surgery – remembered watching colleagues in New York use robotic technology to help cardiovascular patients for several years. In 2001, the Food & Drug Administration approved robotic pelvic surgery, including prostatectomy, his specialty.
“I was working in Manhattan at the time and saw the possibilities that could be used for prostate patients,” he said, detailing the inanimate training he and other surgeons devised in operating rooms after hours, putting rubber weights on the end of the robotic tools to practice maneuvering them.
Broaching the subject with the first patient, Dr. Wagner said, was simple.
“I told him there were pluses and minuses, but that if we used the robot, it would be a lot easier and I thought there were more benefits,” he recalled, adding that the patient, now 79, came through the landmark procedure “great.”
Dr. Steven Shichman, now chief of HHC’s Tallwood Urology & Kidney Institute and Dr. Wagner’s medical school friend, recognized the potential of robotic surgery immediately and enticed him to come to Hartford Hospital in July 2003. Five months later, the first robotic cases ever performed in Connecticut started and have not stopped since.
“Hartford Hospital has always been a forward-thinking institution. We were the first to get a surgical robot in Connecticut,” he said.
As for the technology’s application in urology, Dr. Wagner said it seemed a natural progression for specialists who had been using scopes in procedures since the 1930s.
“Maybe the robot was an extension of that,” he surmised.
After years and thousands of successful procedures after the first robotic surgery, however, he still finds himself explaining to patients and families that the robot does not operate independently of the surgeon.
“The word ‘robot’ is Czech for slave. It does what you tell it to do. It does not think independently,” Dr. Wagner said. “It’s like a backhoe in construction.”
The technology has always afforded surgeons greater flexibility and visibility in tight spaces, and greater precision. Through the years, techniques have become sophisticated and standardized, and training is done in the system’s Center for Education, Simulation and Innovation with special simulators replacing the weighted tools he used early on. Today’s machines have higher-resolution visuals, fluorescence that illuminates parts of the body during a procedure with a simple dye injection, and energy modalities designed to control bleeding and tissue damage.
Dr. Wagner — who went on to log other robotic “firsts” at HHC, including the first robotic ureter replacement — has performed more than 5,000 robotic prostatectomies. Only three have needed to be converted to traditional open surgery for various reasons.
“Almost all of our prostatectomies are robotic at Hartford Healthcare,” he said. “Patients go home earlier, lose less blood, etc. When we looked at the results 10 years after starting to use the robot, we saw better outcomes than open surgery.”