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Healthcare Quarterly
The Doctors Clinic: Expert urology care close to home

A few years ago, local residents who needed urology services may have been likely to travel on the ferry to Seattle. In the case of patients with kidney or other cancer, that meant multiple trips for follow-ups and extra expenses for families.

That is no longer the case. A collaboration between The Doctors Clinic’s Urology Department and Harrison Medical Center has created a strong program in Kitsap County, and thanks to Harrison’s investment into top-of-the-line robotics equipment as well as state-of-the-art oncology services, patients can find the most advanced care close to home.

Dr. Marc Mitchell, who joined The Doctors Clinic Urology Department last year, has training and expertise in robotic surgery and is the director of Robotic Surgical Services at Harrison. As one of two robotic surgeons with The Doctors Clinic (and the only two north of Tacoma and west of Seattle), he says all prostate cancer and many kidney surgeries he performs use a robot — a device called daVinci.

“Robotic surgery has the same or better cancer control as traditional open surgery,” he said. “It is a very technical and detailed procedure that can be done with a small incision in a precise and controlled fashion.”

The benefits of using daVinci include quicker recovery — Mitchell says about 95 percent of his patients go home the next day (compared with three days after traditional surgery), and usually can return to regular activity within one or two weeks, vs. four to six. The blood loss is only 20 percent or less, and in his experience, he has never had to do a transfusion for a robotic surgery patient.

Harrison acquired the $1.8 million daVinci Surgical System in fall of 2008. The system uses a 3-D, high-definition camera to magnify, about 10 times, the operating site for the surgeon, who has complete control of the console. The surgery requires several very small incisions, and there is much less pain and scarring post-op.

Initially the prototype was developed in the 1980s for the U.S. Army for performing remote surgeries in the battlefield, and in the mid-19902 was tested for commercial applications.

Currently, daVinci can be used for bladder, kidney cancer, prostate cancer, kidney reconstruction, hysterectomies and other procedures, as well as heart surgery. Mitchell said, however, it takes more than an expensive robot to be able to deliver good care.

“You have to have a program in place to make a service for patients work well, and that’s what Harrison has put together,” he says.

The Robotic Surgery Services program has a team of more than 30 professionals to help, from trained assistants and anesthesiologists to patient navigators. “(Battling cancer) is a difficult journey and having trained nursing staff available is very important,” Mitchell said.

The Doctors Clinic Urology Department, which has four urologists on staff, offers comprehensive treatment options for various conditions and diseases, which for prostate cancer include medical surgery, oncologic and radiation therapy, as well as cryotherapy for kidney tumors (the tumor cells are frozen), minimally invasive vasectomies and other procedures. While most patients are seen at the Ridgetop West location in Silverdale, patients can also schedule visits with the urologists at the Salmon Center in Silverdale and at the clinic’s Bainbridge Island site.

Mitchell, who trains other surgeons in using the daVinci, said as technology continues to evolve, robotic surgery will become more common. One of the new and upcoming trends in the industry is moving to a dual-console robot that would allow for teaching, and a single incision instead of several. “The goal is to train other surgeons, improve outcomes and improve access,” he said.

One of the biggest challenges as an urologist for Mitchell has been patient education. He said the trend in the Pacific Northwest among male patients is to ignore their prostate health, for example. Prostate cancer is to men what breast cancer is to women — it’s the most common form of cancer, except skin, in males and has much better survival rates if treated early — yet men tend to think prostate problems are a normal occurrence of aging, so they ignore screening.

“Men traditionally ignore their health,” he said. “If you catch prostate cancer early, it’s very treatable… Our desire here (at The Doctors Clinic) is to educate the patients that some of the problems… are not an issue they have to put up with. We want to treat these things, there’s no reason not to offer the options to people close to home.”

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