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Robotic-assisted surgeries on rise at Legacy Mount Hood Medical Center -



OUTLOOK PHOTO: JOSH KULLA - Dr. Greg Starley sits at the control module of the da Vinci robot. The four-armed surgical robot is in front of him, while a display screen looks over the operating table where a patient would be lying. Dr. Greg Starley, a general surgeon spearheading a boom in robotic surgery at Legacy Mount Hood Medical Center, fell into his niche almost by accident, as part of a surgical career that included six months at the front in Afghanistan.

The Sandy resident said his time saving soldiers gave him the confidence to work on new things such as robot-assisted surgery.

In Afghanistan, “I was only six months out of training (medical school) and I was doing things I’d only read about,” Starley said. “But, if you don’t try, they’re gonna die. It really builds your confidence in your skills.”

After his military service, he landed at Legacy Mount Hood and was approached by a representative of the company that builds the robotic machines who offered him training in the cutting-edge surgery.

Following some initial skepticism, thinking it may just be a fad, the 41-year-old surgeon now calls robotic-assisted laparoscopic surgery “really amazing.” Researching the technique, he found it to be an improvement over both laparoscopic, or minimally invasive surgery as well as traditional, open surgery.

“This was not my plan. I was not planning on making this my thing.” he said. “But ultimately it is great for the community.”

Starley was trained in the state-of-the-art technique in 2014.

“You start with simulations. To get practice you start with games. Then you do the first surgeries on pigs,” he said.

When he came back to Legacy, Starley did three gallbladder surgeries on the first day. The first surgeries are supervised by a proctor for safety.

“They went very well,” he noted.

Starley kept working on the robotic surgery and even found some YouTube videos helpful.

“It wasn’t necessarily fun to learn,” Starley admitted. “In the beginning I was scared to death. But now it is fun to do. It is so much more precise.”

CONTRIBUTED PHOTO - Major Greg Starley, in blue bandanna, operates in an Army field hospital in the mountains of Afghanistan near the Pakistan border. Catching on

The number of robot-assisted surgeries is doubling every year at Legacy Mount Hood. The hospital had 80 of them performed in 2014, 184 in 2015 and 177 in the first six months of 2016. Starley has performed 250 of these.

The hospital now has two machines, worth about $2 million each, one in the hospital and one in the new outpatient medical building. Mount Hood has 12 surgeons who can perform robotic surgery — four urologists, five gynecologists and three general surgeons.

There are many advantages to robotic surgery, Starley said. Because it is less invasive, patients heal faster, they have less pain and use fewer painkillers. The robotic technique reduces the risk of infection in many types of surgeries. Patients also can go home earlier.

The robot is capable of much more finely calibrated movements and can wield smaller instruments than a doctor in traditional open surgery. The machine also absorbs any tremor the doctor might experience doing the fine work on a surgery.

“It makes you more steady and more accurate. If you are suturing a heart valve, those are tiny little bites and it can make them much finer,” Starley said, adding that despite the advantages, “It’s not going to make a bad surgeon good.”

OUTLOOK PHOTO: JOSH KULLA - Dr. Greg Starley has performed 250 robot-assisted surgeries at Legacy Mount Hood Medical Center and is helping other doctors learn the techniques. Robotic surgery is not appropriate for every type of surgical procedure. Repair on some kinds of hernias, removal of gallbladders, some gynecological procedures and colon surgeries are among the most effective for use of robotic surgery.

“This is better than anything I’ve ever seen for inguinal hernias,” Starley said.

Although the complex robotic surgery machine is expensive, the patients don’t pay any more for their operations. And, sometimes robotic can even be cheaper than traditional techniques because some other surgical techniques use expensive disposable instruments that are not necessary with the robot.

Starley is now training surgeons from other hospitals to learn the technique. A doctor from Bend and another one from Anchorage came to Legacy recently to observe Starley at work.

Starley came straight to Legacy Mount Hood from his stint in the U.S. Army. The Army paid for the Idaho native to attend medical school, and he was required to work as a military doctor for four years. He was a major and chief of surgery at Fort Polk near Leesville, La., and spent six months along the Pakistan border in the rugged mountains of Afghanistan.

Starley was part of a forward surgical unit that was first to treat soldiers after they had been hurt.

“We were the front line medical team,” he said. “The soldiers who were injured were flown from the battlefield directly to us.”

The group of doctors stopped the bleeding, stabilized the soldiers and the injured were then shipped to a higher level facility such as one in Bagram, Afghanistan.

“We were out in the boonies. We had plywood walls, a brick ceiling and sometimes we had to shoo the flies off the wounds,” he said.

The facility was a building abandoned by the Soviets years earlier when that country was fighting in Afghanistan. It wasn’t just soldiers who benefited from Starley’s skills.

“We did a lot of humanitarian work too. We provided a clinic once a week for the local residents. We’d help with high blood pressure, heartburn and little kids with hernias,” he said.

CONTRIBUTED PHOTO - Major Greg Starley poses in the operating room of the field hospital in Afghanistan, where he spent six months as the first surgeon wounded soldiers saw after they were injured. Changing lives

Starley’s most memorable local patient was a child whose fingers were fused.

“The family begged us to help him,” Starley said.

But the group of Army doctors was reluctant, since none had ever attempted this type of complicated surgery. Starley researched the operation and contacted a specialist in Dallas, Texas, and discussed the case with him.

Starley and the Army doctors did the surgery and the complex skin grafts in their less-than-optimum conditions. The surgery was a success, giving the child three fingers so he could grasp objects for the first time.

“Those were the rewarding times,” he said.

OUTLOOK PHOTO: JOSH KULLA - Dr. Greg Starley says robotic surgery is less invasive, allowing patients to heal faster and require less pain medication. Starley said he also finds the collegial atmosphere at Legacy Mount Hood rewarding. In the new outpatient building, doctors from different specialties — oncology, surgery, internal medicine and gastroenterology, for example — are all in close proximity and can easily discuss patient care. The hospital provides free soup in the doctor’s lounge as a lure for the doctors to gather and collaborate.

“Everyone gets along and we talk over soup,” he said.

For Starley, robotic surgery is all about the best patient care.

“We want to provide people in Gresham and Sandy and further up the (Columbia River) gorge with the highest-quality medical care without them having to go downtown (Portland),” he said. “People out here want to stay out here.”

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