The Pulse

Meet our Docs: Through robotics, urologist Dr. Todd Hansen offers minimally invasive surgeries with

By kbleizeffer Jan 8, 2014

In 2008, Wyoming Medical Center got the state’s first da Vinci S™ HD Surgical System. Our doctors are the most experienced on the da Vinci and offer more procedures than any other hospital in Wyoming.

Dr. Todd Hansen, a urologist at Central Wyoming Urological Associates, has performed hundreds of surgeries with the robot, cutting his patients’ recovery times and improving their outcomes.

The Pulse recently sat down with Dr. Hansen to talk about the benefits of minimally invasive surgeries and how patients can determine the right treatment options for them.

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Dr. Todd Hansen poses between the surgical arms of the da Vinci robot. He has performed several hundred procedures with the da Vinci, resulting in smaller incisions and faster recovery times for patients.

Hansen: I grew up in a small rural town in Arizona called Joseph City. My grandfather was a big rancher, but my father went into dentistry. We lived right there with my uncles who took over the ranch and were highly involved. I liked ranching more than I did dentistry.

The Pulse: What interested you about medicine generally and urology specifically?

Hansen: I think it just kind of fascinated me. I was not certain at all when I got started with school that I was going to go into medicine, but it just kind of aligned with my interests and talents.

Urology is kind of a hidden specialty. It is not something a lot of people think of, and I was one of them. I never thought of it going into medical school, though I did feel myself getting pulled toward the surgical side of things.

I was working with a urologist when I began to realize that: One, they were a fun group to work with and, two, the procedures and the surgeries they were doing were very fascinating. I think most of us kind of think urology as old man’s health care. I realized that was anything but the truth. Really, we were on the cutting edge of a lot of surgical innovations, and we did extensive surgeries that I really enjoyed.

The Pulse: What do you mean cutting edge?

Hansen: For example, we do many laparoscopies, robotics and things like that. Quite frankly, urology has been the leader in robotics. Look at minimally invasive surgery, endourology with the ability to do things with scopes that we do. We do some really big, fascinating reconstructive surgeries as well. We do cystectomies and reconstruct a whole urinary system.

The Pulse: What are the advantages of minimally invasive procedures like those that can be done with the da Vinci S™ HD Surgical System?

Hansen: Before da Vinci, I had already done a tremendous amount of laparoscopy, where you are putting ports into the abdomen and doing surgery. The da Vinci is just an extension off of that, but you have a robot, so you have wristed instruments. It is kind of a natural step to be able to provide more care minimally invasive that you could not do with just a plain laparoscope.

With robotics, you do a complex surgery without making a big incision. An open surgery entails going through major muscles, even potentially taking a rib. There is much more pain and discomfort, a much higher chance of hernia and higher risk of infection; da Vinci makes smaller port sites, hernias are much less common. Infection rate drops a lot. Pain and discomfort drop immensely and there is a shorter hospital stay.

The advantages are fairly obvious. A large incision going through major muscle versus some small port sites is not a subtle difference.

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A closer view of the da Vinci's surgical tools. With its wristed instruments, the da Vinci give surgeons greater precision than laparoscopy.

Hansen: That just depends on how you term recovery. The patient will forever be more comfortable without open surgery, because once you go through those muscles, a lot of times you end up with nerve injuries and some muscle paralysis. The short of it is: You are going to be dramatically more comfortable after minimally invasive surgery. Your ability to get back to work and do things is going to be increased significantly in terms of weeks probably.

The Pulse: What can you offer with da Vinci that others can’t?

Hansen: There is a huge gap in the community and their understanding of what is really offered here that is not offered anywhere else in this state urologic-wise.

For example, if you have a tumor in your kidney, we have the ability to remove that tumor without removing the entire kidney – what we call a partial nephrectomy. That results in longer life expectancy and decreased chance of renal failure. There are huge advantages to the patient to do a partial versus a total nephrectomy.

We not only have the ability to do that, and to do that well, but to do it without an open incision. That is not being done anywhere else. The ability to re-implant ureters and do it without an open incision is not being done anywhere else. We can do sacrocolpopexy, or female reconstructive surgery, without making an open incision.

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Surgeons operate the da Vinci via remote control, using a high-resolution and magnified image that offers a more detailed view of the procedure.

If you want to know the truth, I suspect there are a ton of patients out there that are getting total nephrectomies with the entire kidney removed when they should just be getting a partial nephrectomy. I can tell you that no one else is doing that minimally invasively. To be frank, I do not think the community has any idea how much further ahead we are than the rest of the urologic community in this area.

The Pulse: Is this something that patients should ask for? If their urologist doesn’t offer minimally invasive or laparoscopic surgeries, what should they do?

Hansen: It is a patient issue. Patients should ask for second opinions on the best treatment options, and that doesn’t mean going to Denver or Salt Lake City. A lot of people just don’t realize that we offer it in Casper.

I get some urologists who do refer to me, but there are a lot that do not. They either just remove the entire kidney, or they do an open surgery. You cannot say that is substandard care, but I do not think even our own hospital recognizes how much further apart we have set ourselves than the vast majority of the care that is getting performed.

I think it is appropriate for any patient in any situation to ask for a second opinion if they feel that it would benefit them. It is okay for a patient to ask for a second opinion. I have patients who do that. We all have patients who do it.

It’s OK to ask your doctor: “Is this something that can be done in a less invasive way?”

The Pulse: How many different procedures are you able to do on the da Vinci?

Hansen: The question anymore is, “What don’t we do on the da Vinci?” There are not very many abdominal surgeries that we are not doing with da Vinci and/or robotically.

Take a prostatectomy: You end up being able to do a better dissection because you can see better. You end up doing a better anastomosis because you can see better. You can actually perform the surgery better robotically than you can open.

Some people would debate that. This is not a hard and fast thing, but in my experience, I think you can actually get better outcomes doing it robotically. There is a fair amount of literature that suggests you can. Definitely, you can do it with a better recovery. If your surgeon said “Let’s take out your gallbladder laparoscopically versus doing an open gallbladder,” every person would choose a laparoscopic gallbladder.

The Pulse: What are the advantages of having these procedures in Casper as opposed to traveling out of state?

Hansen: One of the huge advantages is follow-up. You have a physician who is committed to taking care of you long term. Many of my patients have found it frustrating that they have gone elsewhere and then realized that there is really not much follow-up. These physicians are kind of like, “just go back and see whomever.”  That is probably one of the biggest advantages as there is much better follow-up care long term, not just immediately.

I still respect the fact that the patients need to do what they are comfortable with. I do not believe I lose very many to outside facilities. Most of them are very comfortable with the care we are providing. I know the hospital is very focused on that. I think I have more in-migration than out-migration. I get many more patients referred into me than I have leaving, by a huge number.

I do think there are patients who we never see to begin with because they do not know what we can do here. The biggest area that is true in is pediatric urology. That is probably education that needs to go on at the level of the pediatricians.

The Pulse: What trends do you see coming in urological medicine?

Hansen: There have been so many advances, mainly related to the da Vinci robots. When I started here, for example, we were doing all kinds of open procedures. Now, the number of open procedures has been cut down to just a trickle.

The biggest advancements are going to continue to be learning to do things minimally invasive with better outcomes. That will still be the trend. Cystoprostatectomies are getting done robotically. That is probably something that we would bring in.

The other thing is that I think that there is going to become better screening for cancer. Two big areas in urology, other than minimally invasive, would be better cancer screening and detection so that we can differentiate who to treat and not to treat. New organs at some point, they are already in the process of developing things like bladders and that now. There will come a point when we use tissue that is grown in the lab to implant surgically.