'A Robot Operated on My Hernia'
Tarpon Springs Surgeon Debunks This & Other Myths About Robots in the O.R.

Robotics-assisted surgery has become enormously popular, with physicians around the world performing 1.5 million procedures - from hysterectomies to heart valve repairs - in 2011.

"But myths and misconceptions about robots in the operating room still abound," says physician Dr. Keith Chisholm, MD, a Board Certified General Surgeon on staff at Florida Hospital North Pinellas, (www.fhnorthpinellas.com).

"One is that the robot performs the surgery - 'a robot operated on my hernia,' " says Dr. Chisholm. "Technically, it's not a robot because it can't perform surgery without someone controlling it - it's actually computer-assisted surgery. The surgeon guides all of the movements using finger-manipulated controls."

He and other robotics surgeons use the da Vinci Surgical System, which the U.S. Food and Drug Administration approved for minimally invasive surgeries in 2000. Nine years later, the da Vinci was being used in 80 percent of surgeries to remove cancerous prostates, according to its maker, Intuitive Surgical, Inc.

"The benefits of robotics-assisted surgery are numerous", says Dr. Chisholm, who performs several different procedures using da Vinci and became the first Pinellas-Pasco physician to use it for a single-incision cholecystectomy (gall bladder removal).

"The robotic arms hold miniaturized surgical instruments, so we can get in through very small incisions," he says. "That means there's less chance of infection, less pain, much less scarring and a quicker recovery time. Because the arms have 'wrists' that can rotate more than 360 degrees, we have far more maneuverability than we do with laparoscopic surgery, and we can get into hard-to-reach areas."

"One of the robotic arms holds a magnified 3D high-definition camera, which gives us a much better view of the surgical site than we would have with just our own two eyes."

In a 2013 FDA survey, surgeons experienced with da Vinci said their patients have less bleeding, fewer complications, much quicker recovery times and less time in the hospital - 24 hours on average. Interestingly, those who used da Vinci to remove advanced cancer in the tonsils region of the throat said half of their patients were able to avoid chemotherapy.

What are some other myths and misconceptions?

•  Myth: Robotics-assisted surgery costs much more than traditional surgery.
A study published in July 2013 found that half of the minimally invasive procedures reviewed, including robotics-assisted and laparoscopic surgeries, cost insurance providers less than the same surgeries performed in the traditional manner. Four of the six minimally invasive surgeries also resulted in fewer lost work days - sometimes several weeks fewer.

"The robotics technology is expensive and the whole surgical team has to be trained, which can add to the cost," says Dr. Chisholm. "But there's also a tremendous savings compared with traditional surgery because the patient is out of the hospital more quickly and there are fewer complications."

(Study conducted by University of Pennsylvania health economist Andrew J. Epstein and published in JAMA Surgery.)

•  Myth: Robotics-assisted surgery is riskier than traditional surgeries.
Any surgery has certain risks, but in many ways, robotics-assisted surgeries have fewer overall, Dr. Chisholm says.

"Many times, the robotics-assisted procedures can be done much more quickly, so there's less risk simply because the duration of the procedure is shorter," he says. "You also have the smaller incisions, less bleeding, etc. that reduce the risks."

In addition, the Tampa Bay area is fortunate to have the cutting-edge 2-year-old Center for Advanced Medical Learning and Simulation (CAMLS) operated by the University of South Florida.

"Our surgical teams have easy access to training, practice with simulators and continuing education, so we're extremely well-prepared," Dr. Chisholm says.

About Dr. Keith Chisholm

Dr. Keith Chisholm graduated from the University of North Carolina, Chapel Hill, Medical School and went on to residency training at the University of Florida, becoming an assistant adjunct professor and attending surgeon at the Malcolm Randall VA Medical Center in Gainesville, Fla. He's believed to have performed the first laparoscopic colon resection in the UF surgical department. From laparoscopy to robotics-assisted surgery was a natural advance for Chisholm, who has a private practice in Trinity, Fla., and is among the robotics-certified surgeons with privileges at Florida Hospital North Pinellas, (www.fhnorthpinellas.com).

4 Reasons Why Some E-Cigs Are a Safer
Alternative to Traditional Smoking
CEO Applauds FDA's Proposed Regulations

The Food and Drug Administration is trying to get a handle on new smoking products, including electronic cigarettes, with newly proposed regulations that include banning sales to minors and requiring manufacturers to register all of their products and ingredients with the FDA.

"I like these proposals; the public needs clarity on smoking alternatives because we have 42.1 million adult tobacco smokers [CDC, 2012] who may be able to benefit from them," says Anthony Sarvucci, CEO of American Heritage International, (www.americanheritageonline.com), a company that develops e-cigarettes expressly for adult tobacco smokers who want to quit but have not succeeded.

"The bottom line is that we know how terrible traditional cigarettes are for people, but there has been a vacuum of information about e-cigs, which leads to a great deal of misinformation, some fear-mongering, and even simply making stuff up."

Sarvucci gives four reasons why some e-cigarettes are easily a better alternative.

•  According to the American Lung Association, the average cigarette contains acetone, found in nail polish remover; acetic acid, an ingredient in hair dye; ammonia, a common household cleaner; arsenic, used in rat poison; benzene, found in rubber cement; butane, used in lighter fluid; cadmium, active component in battery acid; carbon monoxide, released in car exhaust fumes; formaldehyde, embalming fluid; hexamine, found in barbecue lighter fluid; lead, used in batteries; naphthalene, an ingredient in moth balls; methanol, a main component in rocket fuel; nicotine, used as insecticide; tar, material for paving roads; and toluene, used to manufacture paint.

•  "Adult consumers of e-cigarettes deserve to know what they're smoking," says Sarvucci, who adds that minors "absolutely should not be smoking or vaping, period." American Heritage's vapor fluid contains water and three food-grade quality ingredients - kosher vegetable glycerin and vegetable propylene and natural flavoring, and the nicotine is derived naturally. "We're the only e-cigarette company for which all of the e-juice ingredients are sourced and mixed in the United States," he says. "Fluid for most other e-cigarettes is sourced and mixed in China and it often contains dozens of ingredients."

•  According to the Centers for Disease Control and Prevention, cigarettes harm nearly every organ in your body and cause dozens of diseases. Cigarette smoke causes more deaths - combined - than HIV, illegal drug use, alcohol consumption, motor vehicle injuries and gun incidents. "We've made significant progress against cigarette smoke in recent decades, but it's not only a problem of the past," he says. Almost half a million Americans will continue to die each year, even though they know the statistics as well as anyone, because they are severely addicted. "Mimicking an authentic smoking experience, like my company tries to do, at least gives these people a better option that's also healthier for the people around them," Sarvucci says.

•  Smokers deserve hope ... In American culture, we have a can-do attitude that is unique to the world, which largely accounts for our influence. We often have a tough time, however, admitting that an individual has a problem that's beyond his or her control. Smoking cigarettes is that problem for more than 40 million of our friends, family and neighbors.

"Look – I wouldn't have gotten into this business if it were to create new smokers," Sarvucci says. "I went this route because, yes, it's a highly profitable space, but it's also an extremely helpful alternative for traditional smokers. If you're a nonsmoker, ask yourself: What would you rather have in your body, a few edible compounds, water and naturally sourced nicotine, or nicotine accompanied by the chemical used to exterminate rats?"

About Anthony Sarvucci

Anthony Sarvucci is the CEO of American Heritage International, (www.americanheritageonline.com), a publicly traded company that manufactures, distributes and sells disposable premium electronic cigarettes. The product uses ingredients that are exclusively sourced and mixed in America, and is designed strictly as an alternative for tobacco smokers and chewers. Sarvucci is past president and co-founder of Prairie West Oil and Gas Ltd. and serves as an investment banking consultant.

Senators' Legislation Will Help Ensure that Rural Residents Have Equal Access to Quality Care

WASHINGTON, D.C.?Today, U.S. Sens. Tom Harkin (D-IA), Al Franken (D-MN), Pat Roberts (R-KS), and John Barrasso (R-WY) introduced a bipartisan bill to help rural communities address the challenges they face when it comes to providing quality health care.

The Craig Thomas Rural Hospital and Provider Equity Act (R-HoPE) would support the efforts of rural health care systems to provide innovative, sustainable health care solutions for patients in rural America. Specifically, the legislation would extend several programs that provide access to hospitals, doctors, and ambulance services in rural areas.

"This bill would be a critical first step toward equalizing Medicare reimbursement between rural and urban areas," said Sen. Harkin, who is Chairman of the Senate Health, Education, Labor, and Pensions (HELP) Committee. "Giving Iowa's hospitals, physicians, ambulance companies, and home health agencies the resources they need to serve the many rural communities around our  state is essential to fulfilling the promise of quality healthcare for every American. States with large rural populations face a significant disadvantage in access to healthcare compared to other parts of the country and this bill will help to ensure that Medicare patients in rural states, like Iowa, will have access to the best service regardless of where they live."

"Providing quality health care to Minnesota's rural communities requires innovative solutions," said Sen. Franken, who was recently named co-chair of the Senate Rural Health Caucus, as long-serving co-chair Sen. Tom Harkin retires this year. "We can't afford to ignore the complexities of health care delivery in our rural communities. Our bipartisan bill will help health providers expand access to quality care, and help ensure that rural residents are afforded the best possible health care regardless of their location."

"The R-HoPE Act recognizes that rural health care providers have very different needs than their urban counterparts and that health care is not one size fits all," said Roberts, co-chair of the Senate Rural Health Caucus. "I am glad we were able to include provisions to get rid of the 'condition of payment' known as the burdensome 96-hour rule, which is particularly troubling for critical access hospitals and in turn, their patients."

"In Wyoming, we understand the unique challenges our rural and frontier communities must overcome when people need medical care. Washington's one-size-fits-all approach to health care simply doesn't serve Wyoming patients well," said Sen. Barrasso. "Our bill will help create an effective and accessible rural health care system by putting our rural providers on a level playing field with other doctors and hospitals across the country.  Most importantly, this bill ensures that folks in rural states like Wyoming have access to medical care as close to home as possible."

You can read a summary of the bill here and download a copy of the bill here. The bill number is S. 2359.

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