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A surgeon sits at an arcade game-like console, his mask-covered face buried in the viewfinder as his hands squeeze, twist and turn handles below.
Feet away, a four-armed robot equipped with tiny surgical tools pokes and prods a patient laying on the operating table undergoing a hernia surgery, transmitting a 3-D view of the patient’s insides to the surgeon working nearby.
It’s not a scene from a science fiction movie. It’s just another day in the operating room at UPMC St. Margaret hospital near Aspinwall.
“There’s no autopilot,” said Dr. Jason Luciano, a general surgeon at St. Margaret who routinely performs such procedures using robotic surgery equipment. “We’re in control the whole time. It becomes an extension of the surgeon’s arms.”
Robotic surgery technology isn’t new — it’s been used throughout the medical community for more than a decade. But the instruments used at St. Margaret, a 250-bed hospital serving the Alle-Kiski Valley, were just returned to the facility last fall.
That’s because more surgeons at the hospital are interested in using the device, according to Luciano. They appreciate how the technique could benefit patients: smaller, more precise incisions and suturing mean less pain and faster recovery times, he said.
The investment is also part of a push within UPMC and throughout other health systems in the Alle-Kiski Valley to bring treatment and preventative techniques that were once only available at facilities in Pittsburgh closer to patients living outside the city.
That includes everything from high-tech devices used to improve cancer radiology treatments or conduct computer-guided surgeries, as well as low-tech programs intended to diagnose and manage pain.
“You don’t just buy technology for technology’s sake,” said John Lewis, president and CEO of ACMH Hospital in Kittanning. ACMH launched a robotic surgery program in January 2019. “Does it allow you to do stuff better and more cost effective at the end of the day?”
Serving suburbs, rural areas
ACMH Hospital is the only hospital in Armstrong County.
Hospital records show that more than 80% of its patients live within a 15-mile radius of the facility, in Armstrong County and the northeastern portion of Allegheny County, such as Harrison, according to the ACMH Hospital 2018 Community Health Needs Assessment, a report detailing the health system’s service area.
About 22% of Armstrong County’s 65,000 residents are over 65, compared to about 18% in 2010, Census data show.
Factors like poverty, high rates of unemployment and below-average per capita income, as well as sparse public transportation systems, all create barriers to accessing health care, the report said.
Dr. Kirsten Newhams is an esophageal surgeon who performs procedures to treat heartburn, hiatal hernias, motility disorders, as well as esophageal and gastric cancers using robotic surgery equipment at ACMH . Newhams said her patients are often grateful that they don’t have to travel to Pittsburgh for treatment.
“They’re really grateful to stay at this hospital that they’ve grown up with, that they know, they’re familiar with, it’s easy for their family to get to, support network is nearby,” Newhams said.
The push to raise the caliber of community health care isn’t limited to high-tech procedures or treatments.
Dr. Desirae Christian, a pain medicine physician with Allegheny Health Network who started working in Natrona Heights, Harrison in September, spends a lot of time asking questions and simply talking to patients about their pain in order to guide a physical exam, tests and imaging, and ultimately developing a treatment plan.
“It’s me sitting across from someone and having a conversation,” Christian said. “Sometimes this results in tears, because they haven’t had a chance to get this out to a physician.”
Christian, who is one of about 10 pain management physicians in the Allegheny Health Network, works with patients to diagnose their pain — is it achy, sharp, burning, shooting — and to identify what is causing it. Treatments could include non-medication treatment options, physical or aquatic therapy, as well as medications to alleviate pain.
While she sees some patients experiencing acute pain, like those who had recent surgery, most of her patients have chronic pain.
Some have been living with pain for 15 to 20 years.
“Distance can be a barrier to care,” Christian said, describing patients who put off seeking treatment for years because they couldn’t get a ride to a doctor’s office.
Patients receiving ongoing or long-term treatments, like radiation therapy for cancer, benefit from the convenience of having health care close to home as well, said Dr. Vicenta Gaspar-Yoo, president of Allegheny Valley Hospital in Harrison.
“When you have a place like Natrona Heights, Kittanning or Lower Burrell, where we don’t have transportation, and elderly patients depend on family members to drive them to these services, it makes a difference if they have to drive Downtown for 35 minutes or here for seven,” Gaspar-Yoo said.
Accuracy, efficiency and convenience
Allegheny Valley Hospital started accepting new patients for radiation therapy treatment using its new linear accelerator in November.
The device is about the size of a small SUV. It slowly rotates smoothly around a patient, giving doctors the ability to quickly and precisely administer high doses of radiation — even in hard-to-reach places — while avoiding healthy organs or tissues.
It also contains imaging components that allow the doctor to monitor the patient’s condition and adjust the treatment accordingly.
“It’s almost like when you draw a picture, using a pencil that’s sharpened, with a very thin edge, that allows you to make that line very thin and accurate,” said Dr. Youssef Arshoun, a radiation oncologist at Allegheny Valley Hospital. “Versus if it’s not as sharpened, that line isn’t going to be as sharp and crisp.”
Treatments performed on older radiation therapy machines could take as long as 20 minutes, Arshoun said.
Those delivered by the new linear accelerator could take half the time per session and could require fewer weeks of visits.
“So all these things are in favor to have those patients getting back on track and not disrupting their lifestyle and what they need to achieve on a daily basis,” Arshoun said.
UPMC Passavant in McCandless started treating patients using its new linear accelerator in late January after about six months of renovations to accommodate the new machine.
“We used to have to send our patients to Shadyside,” said Dr. Kiran Mehta, a radiation oncologist at UPMC Passavant. “And now to be able to keep these people at home in their community, that’s going to be the biggest investment.”
The hospital has also invested in technology to catch cancer before it progresses.
UPMC Passavant was among the first worldwide to offer a robotic, computer-guided bronchoscope capable of peering deep into the tiniest, farthest reaches of the lungs, where cancer may start to form.
The bronchosope is also equipped with tools to collect a tissue sample for biopsy.
“It’s hard to explain just the accuracy that a robotic bronchoscope brings over what we usually do,” said Dr. Peter Kochupura, a UPMC pulmonologist who performs procedures using the device. “Because normally when I’m doing a bronchosopy, I’m thinking, ‘Am I going to get to the right spot, can I hold this position, will I lose it if I insert instruments through my bronchoscope?’ I’m constantly rechecking to make sure I’m in the right spot.
“But it’s amazing, because the robot goes there, it stays there and then you can biopsy with confidence.”
This is critical because it allows doctors to detect potentially cancerous tissue early, before a mass grows or spreads to other areas, Kochupura said.
“The technology is just so new, it really is science fiction in a way, because I would not have previously had the framework to understand how you would do this, even 15 years ago,” he said. “But the technologies change so much. The way we think about the disease is different, and the way we think about procedures to think about the disease is different.”
Jamie Martines is a Tribune-Review staff writer. You can contact Jamie at 724-850-2867, firstname.lastname@example.org or via Twitter .