2015-16 Cancer Network Annual Report

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Terryl Times, M.D., General Surgery, Sentara Williamsburg Regional Medical Center

Surgery

The Practice of Precision

Significant breadth and depth of surgical specialties lies within the Sentara Cancer Network. The value of the network collaboration is that complex, high-end procedures can be piloted at one location to identify best practices and evidence-based outcomes, and then share throughout the network. Proven outcomes come from specialized surgeons with vast experience and the right technological advances.

da Vinci® Surgical Robot for gynecology, head and neck, urology and colorectal surgery

Sentara CarePlex Hospital, Sentara Leigh Hospital, Sentara Norfolk General Hospital, Sentara Northern Virginia Medical Center, Sentara Virginia Beach General Hospital
The da Vinci robot empowers a surgeon to perform a very precise, nerve-sparing operation through several dime-sized incisions. With this minimally invasive surgery, the goal is to accomplish internal repair while leaving the body surface as natural as it was prior to surgery.

The robot dramatically enhances visualization by presenting a 3D view, rather than a two-dimensional view from traditional laparoscopic surgery. The precision, control and dexterity offered by the da Vinci system allow physicians to perform complex surgery in a more effective manner than open surgery or traditional laparoscopic surgery.

For example, head and neck cancer teams at our quaternary facility, Sentara Norfolk General Hospital, use the da Vinci surgical system to perform transoral robotic surgery, a significantly less invasive treatment for cancers in the voice box, throat and tongue. Surgeons use the advanced components of the da Vinci Robotic Surgery System, and patients benefit with less trauma, faster recovery, shorter hospital stays and fewer scars.

Additionally, use of the da Vinci prostatectomy surgical robot has revolutionized prostatectomy surgery by making it a more precise, minimally invasive procedure with excellent results.  One of the most common treatments for prostate cancer, traditional radical prostatectomy, requires an 8- to 10-inch incision which results in substantial blood loss, a lengthy recovery and the risk of impotence and incontinence.

A da Vinci Robotic Surgery System is also used to enhance the gynecology, urology and colorectal surgery programs at Sentara Virginia Beach General Hospital.  This system supports oncology services and development of a comprehensive women’s health program for women in midlife.

Transanal Endoscopic Microsurgery

Sentara CarePlex Hospital, Sentara Virginia Beach General Hospital
The minimally invasive Transanal Endoscopic Microsurgery (TEM) offers a quicker recovery, with less scarring and fewer complications. This surgical procedure uses a natural orifice to remove select rectal tumors that traditionally would require a more involved and invasive surgery.

Neurosurgical Oncology

Sentara Norfolk General Hospital
New surgical advances for brain tumors are offered at our quaternary hospital. Endoscopic neurosurgery allows lesions and tumors that may have previously required an open craniotomy to be accessed through natural pathways. Intraoperative brain mapping allows surgeons to map functional areas of the brain and remove the tumor without damaging the critical areas. With the 6 Pillars Approach and the NICO BrainPath, further precision and safety are introduced to the patient. The NeuroBlate® System offers minimally invasive robotic laser thermotherapy with MRI-guided neurosurgical ablation and real-time imaging to support a surgeon’s clinical decision making. And the OptuneTM portable medical device produces alternating electric fields that can slow or stop cancer cells from dividing for at least 18 hours per day for adult patients with recurrent glioblastoma.

Minimally Invasive Pancreaticoduodenectomy

Sentara CarePlex Hospital
What was once a major operation is now performed at Sentara using a minimally invasive technique, offering the benefits of smaller incisions and faster recovery. Pancreaticoduodenectomy, often called the Whipple Procedure, involves the removal of part of the pancreas, a portion of the bile duct, the gallbladder and the duodenum.

Minimally Invasive Esophagectomy

Sentara Leigh Hospital
This cutting-edge, minimally invasive technique for removing esophageal cancer gives patients significant advantages over a traditional open esophagectomy. This procedure requires surgeons to be specially trained with advanced laparoscopic and thoracoscopic techniques. The approach results in potentially less blood loss, fewer blood transfusions, shorter hospital stays and quicker recovery.

Video-Assisted Thoracic Surgery

Sentara CarePlex Hospital, Sentara Leigh Hospital, Sentara Martha Jefferson Hospital, Sentara Norfolk General Hospital, Sentara RMH Medical Center, Sentara Virginia Beach General Hospital
This surgical procedure of the chest is performed with a thoracoscope (a small video-scope) using small incisions. Surgeons can more easily remove masses close to the outside edges of the lung and test them for cancer, requiring a much smaller surgery than in the past.

Hyperthermic Intraperitoneal Chemotherapy (HIPEC)

Sentara CarePlex Hospital, Sentara Norfolk General Hospital
Complex and advanced abdominal cancers are difficult for physicians to treat because cancer cells are woven through the thin membranes of the peritoneum that wraps around the abdomen and internal organs. These microscopic cancer cells are often left behind during surgical procedures that remove abdominal tumors. HIPEC uses high doses of chemotherapy to penetrate and destroy the cancer cells that remain in the abdomen after surgery. Physicians apply the high-dose solution of chemotherapy locally within the abdomen, minimizing side effects and improving the absorption.

HIPEC can be administered as a palliative measure to help control disease and prevent fluid collection. It can also be used preventively.

Advanced Breast Reconstruction

Sentara Martha Jefferson Hospital, Sentara Obici Hospital, Sentara Princess Anne Hospital, Sentara RMH Medical Center
Reconstructive surgery is an option many women choose following breast cancer surgery and treatment. Innovative procedures that use a woman’s own tissue are an option. Advanced microsurgery techniques, including the Deep Inferior Epigastric Artery Perforator (DIEP) flap method, complete the reconstruction while also preserving the abdominal muscle.

Mayor Will Sessoms using DaVinci machine

City of Virginia Beach Mayor Will Sessoms test drives the da Vinci Surgical Robot at Sentara Virginia Beach General Hospital