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The hospital's minimally invasive program began eight years ago with robotic prostatectomy, an approach to prostate cancer resection that dramatically reduces the risk of complications or side effects. Today, Providence St. Jude is one of the few hospitals with nationally recognized centers of excellence in multiple specialties from spine procedures to general surgery. Not everyone is a candidate for minimally invasive, robotic surgery. Talk to your doctor or to find a Providence St. Jude doctor, call 844-925-0944. PELVIS Pelvic-organ prolapse—caused when the ligaments supporting the uterus and bladder weaken—affects nearly 50 percent of women as they age. Once only correctable through a significant abdominal incision, Melanie Santos, MD, a Stanford-trained urogynecologist, now almost exclusively uses a robotic procedure, allowing patients to go home the next day. "Robotic surger y allows a precision that isn't possible through other techniques," explains Dr. Santos, who is using robotic techniques to successfully treat abnormal uterine bleeding, and other pelvic disorders. " The result is patients heal faster, experience less pain, and return to their lives much more quickly." Robotic-assisted surger y is also creating remarkable benefits for women with uterine, ovarian or cer vical cancer. The maneuverability and exactness of the robotic "wrists" are enormous assets in narrow areas such as the pelvis, while the robot 's sophisticated imaging allow the hospital 's gynecologic oncologists to more accurately identify structures and areas affected by cancer cells. "It 's the most significant advancement in the surgical treatment of cancers in many years," explains Alberto Mendivil, MD, a highly respected gynecologic oncology surgeon. COLONS TO GALLBLADDERS Virtually ever y surger y in the abdominal cavity – from gallbladder removal and hernia repair to colon cancer resection—is benefitting from a little help from a sophisticated surgical robotic platform. "Robot-assisted surger y has significantly changed what we can offer patients in terms of safety and outcomes," says Theodoros Daskalakis, MD, a board-certified surgeon whose expertise has helped established Providence St. Jude as a robotic training site for general surgeons throughout the western United States. "Because there is far less trauma and blood loss, surgeries that once required a multiple day hospital stay are now same-day procedures." The robot 's fluorescent imaging capabilities—in which dye is injected allowing the surgeon to clearly visualize anatomy and blood flow—is invaluable in minimizing injur y or complication. " We can identify issues before ending surger y," he says. "An advantage not possible with traditional surger y." Our general surgeons are adding one more benefit: virtually scarless. Gallbladder removal is now routinely per formed through one small incision across the belly button, leaving almost no scar. "It 's another example of how robotic surger y is reducing the physical and emotional impact of surger y," explains Dr. Daskalakis. ESOPHAGUS As the incidence of GERD has increased, so has the number of minimally invasive solutions offered by the hospital 's GI experts. Both LINX (a new anti- reflux device) and fundoplication (considered the gold standard for GERD treatment) are per formed robotically by foregut surgeons who specialize in upper GI conditions. The result? Fundoplication now only requires an overnight stay, while LINX is a same- day procedure per formed in less than an hour. More dramatic are the benefits for those with esophageal cancer. Esophagectomy—resection of the diseased portion of the esophagus—typically requires ver y large incisions—along with an extended hospital stay. We are the only hospital in Orange County and one of only four in Southern California with the expertise and technology to achieve the same degree of cancer resection, but through tiny incisions and a shorter hospital stay. Patients also benefit from a multidisciplinar y team approach: robotic esophagectomies are per formed jointly by thoracic and upper GI surgeons. " The difference is night and day for patients," explains Nikolai Bildzukewicz, MD, a highly experienced GI surgeon who is fellowship trained in robotic surger y and a leader in advancing less invasive surgical techniques. " We're reducing risks and improving outcomes in ways that weren't possible before." Health Matters: Providence St. Jude Medical Center | 9

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