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Lawrence + Memorial Hospital touting new urology practice, capabilies

April 27, 2019 GMT

New London — In a robot-assisted procedure that took little more than 90 minutes early Monday morning, surgeons at Lawrence + Memorial Hospital cleared an obstruction that had all but shut down Pam Michaud’s right kidney.

A fit, 52-year-old mother of four adult children, Michaud didn’t figure to be sidelined long.

“She’ll be in recovery for one or two nights, depending on her pain level,” Dr. Joseph Brito, the lead surgeon for Michaud’s operation, said before entering the operating room. “She’ll be up and around today, no heavy lifting for four to six weeks. ... She wanted to know: ‘When can I ride a motorcycle?’”

The surgery is among dozens of robot-assisted urological procedures that have been performed at L+M since the arrival nearly a year ago of a new urology practice. Dispatched by Yale New Haven Health, the practice, headed by Dr. Joseph Renzulli, includes Brito and Dr. Timothy Tran, all of whom met at Brown University’s Alpert Medical School in Providence. Brito and Tran trained there under Renzulli during their residencies.

Since L+M acquired its robotic da Vinci Surgical System in 2013, it’s been used for such procedures as gall bladder removals, hernia repairs and hysterectomies. But the $2 million machine had never been used in a urology case before the new urology practice was in place, according to Michael O’Farrell, the hospital’s director of public relations.

More and more L+M physicians are being trained to use the equipment, O’Farrell said.

Renzulli, who assisted Brito in the operation Monday, said he’s performed some 1,500 robotic surgeries over the last 13 years, and Brito about 500. At L+M, Renzulli said the pair planned to collaborate on all “major operations” for at least a year.

“We want it to be flawless,” he said. “It’s been almost a year, but we’ll probably just continue to do it that way.”

At L+M, Renzulli and Brito also have introduced an MRI-ultrasound fusion biopsy program that enhances the detection of prostate cancer and reduces the need for repeated biopsies that can lead to complications. Tran, meanwhile, has focused on the treatment of patients with kidney stone disease and general urologic care.

“We have expertise in different areas,” Tran said. “We can deliver special types of care that you’d otherwise get at a tertiary (highly specialized) facility.”

‘Scheduling was difficult’

Michaud, who lives in Groton, likely would have been referred to Hartford Hospital or elsewhere outside the region had L+M not been equipped to handle her case. In allowing The Day to observe her procedure, she said she wanted to help call attention to L+M’s expanded capabilities.

“They only have one robot available, which is one of the reasons I had to wait” for surgery, she said in an interview days before the operation. “Scheduling was difficult. ... My goal is for people to see the need for L+M to have at least one more robot.”

Earlier this year, she said, a CT scan revealed a “kink” in one of her ureters, the tubes that carry urine from the kidneys to the bladder. Her urologist, Dr. Steven Schoenberger, referred her to Brito, who inserted a stent in the ureter. Monday’s operation would provide a permanent solution.

“I understand that years ago, this surgery would have required a big cut under the rib cage and a recovery time of four to six months,” Michaud said. “I’m expecting to be in the hospital for two or three days at the most, and then take two to three weeks to recover at home.”

She was glad to hear about the short recovery time, she said, because her church, the Groton Bible Chapel, is building a new sanctuary and “she needs to be there.” She had joined Builders for Christ, the organization behind the project, when it helped rebuild the Roaring Fork Baptist Church in Gatlinburg, Tenn., after it burned to the ground in a wildfire a few years ago.

A former personal trainer, she said she was preparing for surgery by “eating the way I always do” and working out.

“You go in strong, you come out strong,” she said.

Shorter recovery time

Before Brito and his surgical team set about resolving the ureteropelvic junction obstruction that had caused Michaud discomfort, he described the multi-step process it would entail. Once anesthetized, Michaud’s abdomen would be inflated, creating space for Brito to maneuver the robotics. Tubes inserted into the abdomen through small incisions would accommodate the instruments he would use to locate the ureter, the stent he’d inserted weeks earlier and the renal pelvis, a portion of the kidney.

The procedure, known as pyeloplasty, would involve disconnecting the ureter from the kidney, moving it and reattaching it to the renal pelvis. The stent would remain in place for several weeks.

“Robotics makes it easier,” Brito said. “There’s no big incision, and it simplifies the (internal) re-stitching at the end of the procedure. There’s less blood loss and shorter recovery time, which is mostly related to how much pain there is from an incision.”

Less invasive surgery can lessen the use of narcotics afterward, a key consideration given the opioid crisis, he said.

Once inside the operating room, Brito sat at a console stationed several feet from the patient’s side. Looking into a screen that provided him with a magnified, three-dimensional view, he controlled tiny “wristed” instruments, turning and twisting them with a range of motion greater than the human hand. Renzulli stood near the patient when not moving about to view the operation on one of three wall-mounted monitors, and occasionally conferring with Brito.

A half-dozen others — a physician’s assistant and nurses — attended the procedure.

Renzulli said training in robotic surgery often takes place during a residency and that it probably takes about 100 procedures for a doctor to become proficient at it.

“People hear ‘robotics’ and they think it’s a robot working on them, that it’s all automated,” Brito said.

Clearly, that’s not the case.

“I think she’ll do really well,” Brito said of Michaud when he’d completed the procedure. “She’ll be able to eat as soon as she’s hungry.”