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Health Matters: Providence Saint Joseph Medical Center | 9 L eonaliza Siason wants to live life to the fullest but has already faced a number of health issues, including needing a kidney transplant due to renal failure. When she got the diagnosis of endometrial cancer, it was another health challenge to overcome, especially because having cancer meant she could not be on the kidney transplant waiting list. Her OB-GYN referred her to Richard Friedman, MD, who specializes in gynecologic oncology at Providence Saint Joseph Medical Center. Dr. Friedman explained to Siason that endometrial cancer is often caught in the early stages. "With endometrial cancer, the standard of care is to perform a hysterectomy [removal of the uterus and the ovaries] and then remove a sampling of lymph nodes to see if the cancer had spread." He noted that robot-assisted surgery would be ideal for these procedures, allowing him to make smaller incisions and perform the surgery more quickly. HOW ROBOTIC SURGERY WORKS "There's a big shift to robotic surgery because of the capabilities, and the system of choice is the da Vinci Xi," says Dr. Friedman. Providence Saint Joseph has invested in this robotic platform, where it's most frequently used for urological, gastrointestinal and gynecological surgeries, as well as some general surgeries. "Robot-assisted surgery is also ideal for many patients, including those who are very overweight," says Dr. Friedman, "who typically face higher risks of complications from surgery." The da Vinci Xi robot consists of three components: a console, a 3D camera and tiny arms that can manipulate a variety of instruments. The surgeon sits at a console placed next to the patient, where the camera provides a high- definition, magnified view inside the body. "The robotic arms translate my hand and finger movements," says Dr. Friedman. "But they can operate in a much tighter space with much more dexterity and flexibility than is possible for human hands." Robot-assisted surgery offers many benefits to patients and can result in: • Smaller incisions • Less blood loss "Patients typically go home the same day or the day after surgery. They 're often feeling better within a couple of days of their surgery," says Dr. Friedman. A COMPLEX SURGERY RESULTS IN A POSITIVE OUTCOME By using the robotic platform, Dr. Friedman was able to perform Siason's hysterectomy using incisions that were about the size of a dime. The next step was to see if the cancer had spread. The traditional method for endometrial cancer is to remove and test 20 to 30 lymph nodes. Removing this much tissue carries the risk of triggering lymphedema—excess buildup of fluid, which results in swelling in the legs. "With robot-assisted surgery, I can do a procedure called sentinel lymph node mapping," says Dr. Friedman. Sentinel lymph nodes are the lymph nodes to which cancer cells are most likely to spread from a primary tumor. There are usually just one or two per side. "To find the sentinel lymph nodes, we inject a fluorescent green dye into the cervix, which highlights the path to the lymph nodes." After removing and testing the sentinel lymph nodes, Dr. Friedman was able to determine that Siason's cancer wasn't invasive and that she was cancer-free. She left the hospital the next day. "I thought I would have this heaviness or feel pain, but I had no pain after I left the hospital. I'm very happy with Dr. Friedman, and very happy with the surgery," she says. Although Siason will require further evaluation, Dr. Friedman notes that she should be able to get on the list for a kidney transplant. Dr. Friedman finds that robot-assisted surgery is not a hard sell. "Patients are requesting it," he notes. "There are major advantages to using robots for certain kinds of cases, but not every procedure needs it," he says. "With each surgery, you have to decide what the best tool is to do the job. It's nice that at Providence Saint Joseph Medical Center we have the flexibility to use the tools that provide the best outcomes for patients." Please visit to find out about upcoming physician lectures for the community. The Matthew Smith Photography • Reduced pain and scarring • Less time in the hospital

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