“The main message I’d like to convey is that I think second opinions are extremely valuable,” said Bothell resident Tom Bishop.
Two years ago, Swedish Medical Center urologic surgeon James Porter removed a small mass from Bishop’s kidney. During the surgery, Porter was sitting about 10 feet away from Bishop, looking at a video screen. He completed the entire procedure using a group of four robotic arms that reached into Bishop from behind and, presumably neatly, removed the offending growth.
According to Porter, his surgical group still is the only one in the country doing what is technically called partial nephrectomy (kidney removal) in the manner used for Bishop’s surgery.
Swedish Medical Center is featuring both Bishop and Porter, the hospital’s director of robotic surgery, as part of its 100th anniversary celebration.
For Bishop, now 57, the story began with some odd abdominal pains. CT (computerized axial tomography) scans and an MRI (magnetic resonance imaging) revealed the reason: a tumor on his kidney.
“At that point, all they knew is there was a mass there,” Bishop added. No one could tell him if that mass was cancerous or something more harmless, but the odds were not remotely in his favor. Statistics said there was a 90 percent chance the growth was malignant.
“That was probably the most difficult time, not knowing,” he said. Initially, his doctor told him the next step was a traditional and complete removal of the troubled kidney.
“In years past, that was the standard procedure,” Bishop said, adding he just felt a strong need to look around for alternatives.
A photojournalist for KING-TV, Bishop helps shoot the station’s local programming. By pure coincidence, he had worked on a story on the da Vinci robotic surgery system.
Bishop said his understanding is that Porter mostly used the machine in connection with prostate cancers. The surgeon has decidedly branched out. He said he uses the da Vinci for numerous surgeries, from reconstructing kidneys to bladder procedures. One clear advantage is the surgeries are minimally invasive, which greatly reduces surgically related risk, as well as recovery time.
Porter added the da Vinci system has several advantages over other, possibly better known laparoscopic surgical techniques. The da Vinci scope has two lenses or eyes. They allow the surgeon to see three-dimensional images, essentially getting the same view as they might get with traditional surgery.
The unit further features what Porter referred to as elbows on the robotic arms, obviously adding to the flexibility of those arms and the surgeon’s overall control.
For Bishop’s surgery and other kidney procedures, Porter inserts the arms through the back of the patient whereas most laparoscopic kidney procedures are completed with the instruments entering from the front of the abdominal cavity.
Porter said by entering through the back, he avoids having to manipulate his patients’ intestines in order to reach the target kidney. This change benefits the patient by again reducing surgical risk, cutting down on the length of surgery and reducing recovery time.
From Porter’s point of view, the next step in robotic surgery is cutting down even further on the entry into the patient. Presently, each of the da Vinci’s four arms uses a separate entry point. Advances are being made so that eventually all four mechanisms can enter through the same incision. The advantages should sound familiar: less risk, less discomfort and even lower recovery times.
Porter said he completes eight to 10 robotic surgeries a week. He estimates that overall he has done more than 1,000 robotic procedures.
For Bishop, his outcome probably couldn’t have been better if someone at KING had scripted the surgery.
“They tell you the odds are 90 percent against you and you try to prepare yourself for the worst, while hoping for the best.”
Bishop said his wife and the mother of his two daughters was with him when Porter told him he had indeed beaten those long odds, that the growth was benign.
“I couldn’t figure out why my wife was jumping up and down,” Bishop said. “It took 10, 15 seconds to realize I’d just won the lottery.”
Bishop had nothing but good things to say about Porter.
“I could never go to medical school,” he said. “Doctors, surgeons… they are just amazing.”