Health care and technology go hand in hand, and both Clark County hospitals have some impressive technology to their credit.
Complex surgery options
What looks like it’s straight out of a Spiderman movie, the da Vinci Surgical System at Southwest Washington Medical Center brought robotic assisted surgery to Southwest Washington.
It allows physicians to perform minimally invasive procedures most commonly in the treatment of urological and gynecological conditions.
Seated at a console, a physician can view the surgical area through a tiny camera that reveals magnified 3-D images. The controls at the console allow the physician to move robotic “hands” with precision, eliminating the natural tremor of human hands.
The physician can perform complex surgery using 1- to 2-centimeter incisions, and patients generally recover in less than 48 hours.
The hospital spent $1.75 million on da Vinci – the SWMC Foundation has raised about $1.35 million toward the purchase – and the first patient was treated using it in March. Since then, the hospital has averaged about 20 surgeries each month.
There are about 750 da Vinci robots in the country, including about a dozen new units on the West Coast.
‘Miracle of bloodless surgery’
For tumor treatments, SWMC spent $4.5 million to buy and construct the CyberKnife Stereotactic Radiosurgery System in 2006.
The system is the only one of its kind between Seattle and Sacramento, and 130 patients have been treated with the CyberKnife at the hospital.
Using it, physicians are able to deliver high doses of radiation with great accuracy, which allows incisionless surgery for previously inoperable tumors, minimizes radiation exposure to healthy tissue and lets physicians operate on multiple tumors in several locations.
Patients spend between 30 minutes and an hour and a half on the operating table (some cases may require up to five sessions), and there is no recovery time.
“It is extremely targeted therapy and we’re able to use it on cases that 10 years ago, we would not have recommended radiation,” said Dr. Charles Thomas Jr., who practices at SWMC using the CyberKnife system.
Insurance covers most of the cost of the treatment, and Thomas said the community at large and fellow institutions benefit from having the system in the region.
“With the cutbacks we’re all facing, investment in technology will only save money,” Thomas said. “Granted, that’s easier said than done.”
Getting a head start
Legacy Salmon Creek Hospital was the first hospital in the region to offer the Elekta Synergy Cone Beam CT system for image guided radiation therapy, which provides a 3-D view of the patient and can detect very small shifts in position that can be corrected before treatment.
The system incorporates a linear digital accelerator with a built-in CT scanner that, like the CyberKnife, allows physicians to deliver a high dose of radiation with great accuracy, said Dr. Won Lee, a radiology oncologist at LSCH.
“In the past, we couldn’t target the tumor because we couldn’t see it,” he said. “Now we’re able to better visualize the target and critical structures.
It is primarily used to treat prostate cancer and cancers of the head and neck, and about 100 patients have been treated at LSCH using it.
By installing the system when the hospital opened in 2005, physicians there now have three years of experience doing image guided radiation therapy – essentially beating the current rush for most departments to establish image guided radiation therapy protocol, Lee said.
“I think people think you have to go to the major universities to receive this kind of treatment and that’s just not true,” he said. “You can receive the latest and best quality of care right here.”
Highly specialized heart help
Ablation therapy has transformed what 20 years ago was a risky, invasive open-heart surgery for treatment of abnormal heart rhythms to a procedure that takes a matter of hours and has a 95 percent success rate.
The use of ablation therapy in Southwest Washington took off when SWMC opened a dedicated electrophysiology lab in the Heart and Vascular Center in 2007. Now both Vancouver-based Cascade Heart and the Vancouver Clinic employ physicians who specialize in electrophysiology.
The therapy can fix an irregular heartbeat permanently, possibly replacing defibrillators and pacemakers.
Small wires can be routed through the femoral vein and placed into the heart so the electrical conduction system of the heart can be evaluated and the exact location of the problem can be identified using 3-D mapping, said Dr. James Reiss, one of three electrophisiologists in Clark County.
Then radiofrequency energy is transmitted to the problem area and destroys selected heart muscle cells in a very small area to stop the area from conducting the extra impulses that caused rapid heartbeats.
In 2008, doctors averaged about 50 electrophysiology procedures monthly.
“It is a very safe procedure that in most cases is completely curative,” Reiss said. “It is very rare in cardiology that we can actually cure a problem, but I have a lot of patients I never see again. The 3-D mapping has raised our success rate…it’s cut down the amount of exposure to X-ray, increased accuracy and kept the complication rate low.”
Cool technology comes at a price
While there is no question new technology has added huge value for the health care field, there is no question it is extraordinarily expensive, said Bart McMullan, president of Regence Blue Cross Blue Shield of Oregon.
In general, the addition of new technology by a hospital or clinic increases the cost of insurance, he said.
The increase can be attributed to the increased cost of the equipment, the fact that it doesn’t usually replace old technology but is an add-on, and the rapid take-up in use by the professional community, McMullan said.
“People like new things,” he said, adding that the technology may be used more than it’s needed.
“Our health care system rewards new technology by providing reimbursement,” said Dr. Charles Thomas Jr., who practices at SWMC using the CyberKnife system. “It may not be used for the correct reasons, so there needs to be some self-discipline.”
McMullan said the system can no longer afford new technology at its current rate of rise.
“We need a new plan for how we use technology,” he said.
Megan Patrick-Vaughn can be reached at mpatrick@vbjusa.com.
