Neil Thornbury (Host): Welcome to Pulse & Perspectives, where we dive into the latest innovations in healthcare that are making a real difference in the lives of patients in our community. I'm your host, Neil Thornbury, CEO of TJ Regional Health. In today's episode, it's my pleasure to welcome Jamie Wilkerson, our Chief Nursing Officer here at TJ Regional Health, and Jamie brings a wealth of clinical leadership and a passion for advancing patient care through innovation.

Together, we will be exploring how robotics is transforming the way we approach surgery and even specialized areas like pulmonology, urology, and surgery, making procedures safer, more precise, and less invasive for our patients. Please join me in welcoming Jamie as we discuss how these robotic technologies are shaping the future of healthcare right here in our community. So, welcome, Jamie.

Jamie Wilkerson, RN, MSN, MBA/HCM: Pleasure to be here, Neil. Thank you for having me. Excited to talk about our innovative robotics here at TJ Regional.

Host: That's great. So, let's just jump into the first, the Ion robotic platform. And if you will, I know that's a mouthful, but if you will, just give us an explanation of what is the Ion and what's the general use of the Ion robotic?

Jamie Wilkerson, RN, MSN, MBA/HCM: Yeah, absolutely. So, what the Ion is it's a robotic bronchoscopy. This is something that Dr. Mahmoud-- he is our critical care pulmonologist-- that he was very adamant about bringing this to TJ, ultimately to keep patients here.

So Neil, in a short version, basically what it is in a normal bronchoscopy, you can only go down in the lung field so far, right? You can't reach those outer segments, those peripheral nodules. So with the Ion, what we're able to do is we can reach all 18 segments of your lungs now. So if you're a patient, you go into the room, Dr. Mahmoud controls the robot. And if you have a nodule peripherally, he can actually get it from a one-stop location in a sense. So, he can put the tube down, he can get the biopsy. We actually have Pathology that's in the room partnering with him that, once that biopsy is out, gets it over to Pathology to where now sometimes patients actually have a diagnosis before they even wake up, which is pretty cool, which is the old-fashioned way of what we did prior to this. To get a biopsy on a peripheral node, you would have to go externally. So when you go external like that, your risk increase, pneumothorax, chances of bleeding and what have you. So, we were either doing it that way or we were sending the patients hour and a half north to get this completed.

So, we've been doing this now for a little over a year, but proud to have it here. Because it's the early diagnosis of cancer, right? We want to get the community members staged at a lower stage if they do have cancer. So then, we can then progress them throughout our continuity of care with oncology or whatever that may be.

Host: Yeah, I think, I really should have started with this, because I think one of the questions I would have, and I think a lot of consumers have is let's just talk about robots in healthcare, whether that's going to be for pulmonology and lung and, again, being able to get further into the lung and seeing better, even going into surgery in places like that. So, if you're a consumer, what does the robot do? I think, there's some misconceptions out there of, what does the robot do? Is a robot going to actually do the procedure? Or how does that work? And why is it better in healthcare?

Jamie Wilkerson, RN, MSN, MBA/HCM: I think the ultimate goal with that, Neil, is we're looking to get as minimally invasive as we can. We want the patients to go back to their home as soon as they can. We want them to be able to have a procedure done with less complications, right? So, what a robot does is it's the most innovative care that we can deliver to them, right? So, we're practicing at the best scope that we can. And we're seeing a lot of that as we recruit newer docs as they come in, right? When they're going through the residency, this is all that they're practicing on. So, the robot, it's not that the doc hits a button and they stand away, right? The doc is still manipulating the robot fully. The Ion specifically is able to use an ultrasound and some CT guidance put together just to make the accessibility for Dr. Mahmoud to hit that nodule a lot easier. And then again, you're reducing the amount of time that patients have to come in to get procedures done. So, we're old school, if you had a bronchoscopy, you would go down, you would see a nodule you couldn't get, then the patient would have to come back in to get that procedure done. So, it's not only more minimally invasive. It's smarter care, because patients are able to go home quicker with less trips to the hospital.

Host: I completely agree. I think that's really the neatest part of the technology or some of the neater parts of that technology from my perspective is just what you said, it's great precision. These are high def cameras that allow the surgeons to see things that the naked eye wouldn't see in prior surgery before robotics. It keeps hands super stabilized. It is less invasive. It is, I think, again, very precise on the motions and the areas that they're working in. And then, ultimately, it's less pain, smaller scars, faster recovery, a lot fewer complications. So, it really is from a quality, safety, recovery-- it's just better care that's a lot more precise. And I think that's what robotics has brought to healthcare and to our organization that, again, just the benefits for the consumer are so much better. So much better.

So now again, just to kind of go, because we've got several to talk through, tell me a little bit about aquablation. Again, this is another robotic treatment that we're doing here in the hospital. I feel like we've been doing that for almost over a year now. So, share a little bit about what that is. And from the consumer standpoint, how's that beneficial?

Jamie Wilkerson, RN, MSN, MBA/HCM: To your point, Neil, we started this back in February of '24. This was something that our current urologist, Dr. Wiatrak, was very interested in. He was hearing about it, seeing it at conferences. We didn't have hardly anybody around us that was invested in the technology.

So basically, what aquablation is, it's for men who have any kind of urinary tract symptoms, whether that's retention, whether that's incontinence. As we get older, we're going to run into that. But this isn't just for the 90-year-old. These symptoms can start early on in age. So, basically, what the aquablation is it's a robotic system, right? Something through AquaBeam that uses realtime images along with ultrasound. But the cool thing with aquablation, you don't use any heat, it's all a water source. So, all you're doing is you're using the robot with high pressure water that basically takes your prostate tissue and cleans that up.

The old way of doing this was something called a TURP, right? So, patients would have to stay in the hospital for extended stays. It serves the same purpose, but it's just an older way of doing it. With aquablation, patients stay in the hospital less than 24 hours now and with less side effects. When it comes to men with sexual functions or preserving their previous urinary tract symptoms, it's a quick fix and it lasts a long time.

Host: The aquablation technology has advanced urology and prostate care and prostate treatment decades ahead now. Tell me a little bit about what's the recovery and what are the outcomes, aquablation versus kind of the traditional TURP overall after the procedure, how's the quality of life?

Jamie Wilkerson, RN, MSN, MBA/HCM: So, very rapid symptom relief with aquablation and you got durable results. A lot of times, these last over five to 10-year period, you may have to come back in and see urology, but it lasts a long time. What you're going to see is you're going to see improvement of urinary flow. Men are not going to have to get up so many times in the middle of the night to use the restroom. That's the number one thing that you hear. I've got a family member that recently had this done, and he was amazed. He said, "I was getting up to use the restroom four times a night, and I haven't gotten up since I had the procedure." That's enough for him to be excited and share his story. But what aquablation sets you aside is it doesn't use the thermal approaches to have that collateral damage from a tissue standpoint. When you're just using water pressure to clean up that prostate, your recovery time is, literally, you might stay in the hospital overnight, but you're going to be out of here first thing in the morning. And the only reason you're staying in the hospital is just for us to look at you and just to make sure that risk of bleeding and other things that may occur. But it reduces a lot of your downstream combinations with BPH when you're looking at bladder damage, kidney issues, kidney stones that occur when the prostate starts swelling.

Host: It really is amazing technology. You just said it, recovery time is very reasonable and the outcomes are fantastic. And if I could go out there and tell every man this, we do not do very well with health sometimes, but there are so many things of just minor screenings that would help prevent so many issues. But if you hear any of the symptoms or think, "Man, if I got something that I would just have a question about," you got to ask the question and come see us." Because, again, they're very non-invasive screenings that can say, "Hey, yeah, you may have something." And if you do, there's non-invasive robotic surgeries that can get you right back into great health within days. Obviously, everybody needs to be advantageous in trying to be proactive with their health. But this is a real game-changer for a lot of men's health as we move forward. Really amazing care.

So, switch gears real quick. Now, go to the next robot that's the newest for us as it relates to procedures. And this is a robot that we call ROSA. So, tell us a little bit about ROSA and what ROSA is and what's happening with ROSA.

Jamie Wilkerson, RN, MSN, MBA/HCM: ROSA is something that actually we've got three cases completed this month. So, this is the new service for us. We had the opportunity to partner with Dr. Neginhal when he came in, he was a big advocate of robotic knees. He's one of the first entrepreneurs of a lot of this getting going.

But basically, what a robotic knee is it takes out the manual component of it, right? So, it's a robotic-assisted tool for total knees. What does that mean for somebody that's coming here and says, "Okay, I want to use a robot and compare it to use of a standard approach." Big thing it does is it improves your implant positioning to where it's almost like your contour was prior, right? That's what Dr. Neginhal will tell you when you ask him, What's the benefits of doing this robotic need versus doing it the way that we've done it for years? He's a big component of talking through, you're going to have a shorter hospital stay. He gets his patients up and walks them immediately post-surgery, and he wants to walk them a long distance, but he also wants to send them home the same day. That's a totally new approach if you think about total joints.

I can remember back in the days to where we would do a knee, the patient would stay in the hospital a week, right? So, that cushions itself down to now you do a knee in the morning, we'll get you out of here by lunch. That's what it's coming to. So, the ROSA, again, anytime you're using a robot, your patients are going to experience less pain, less muscle trauma, potential for less bleeding. So, it takes a lot of the manual approaches out of that, and then it allows the physician to focus in on what they do best, right?

Host: As a health system, we were very fortunate to go out and procure Dr. Neginhal for this area. Somebody that's been doing knees and the ROSA and the robotics for over a decade. So, a lot of experience that he brings to this area. And I'll tell you the proof's in the pudding as it relates to just ask the patients, go see what the patients are saying. If you go to our Facebook page, that will link you to a lot of what some of the patients that we've had go through this procedure. They've gone on Facebook and shared their experience in a lot of different ways in the recovery time. And it's been pretty amazing when you see some of the, cases that have come in and some of the challenges that Dr. Neginhal has faced so far. But you're right, the specific alignment that a robot allows and to be able to get somebody out of here within a day, an afternoon and not have nearly the pain even right after the surgery. And one I can think of that the patient said, "I just don't even have the pain that I had prior to surgery and I just got out."

So, a pretty amazing technology. Something that I would, again, recommend everybody to go out there and look. It's quick care, it's safer, better, faster, and really accurate.

Jamie Wilkerson, RN, MSN, MBA/HCM: I just want to hit one more point on that, Neil. It's kind of funny using my family as Guinea pigs for a lot of these new services, but I'm excited about it, right? So when we have something, I'm sending them right in to see the doctor. I had a loved one that got robotic knee surgery done as well, and completely life-changing. And he was scared to have the surgery. You know how men are, we don't want to go in and get cut on. So, he ultimately came in, got it done, went home the next day. And within a couple weeks, he was out walking in the driveway, just, "Why didn't I get this done 20 years ago?"

So, I think we are very hesitant about healthcare just as a whole. But I think these robotics changes the gears a little bit. It's less invasive. I'm not going to have to stay in the hospital. I'm not going to have to be away from home. So, that's a difference.

Host: And then, let's jump real quickly into what I expect to arrive at our hospital here in the next few weeks, is a robot called the da Vinci. Again, that's the company that produces that robot for us. It's used a lot in general surgery. But tell us other places and uses and, if you will, the pros that it's going to bring to our patients here.

Jamie Wilkerson, RN, MSN, MBA/HCM: Yeah. The D5 from Intuitive is a very unique robot. They say that this robot is 10,000 times more powerful than their most recent robot. I can't even fathom what that means. But in a sense, I've got the luxury of being able to navigate through what it looked like getting it here.

So, from a surgery standpoint, you can do about anything with this robot. We're looking a lot on hernia repairs, colons, getting into some urology cases, GYN, potential for bariatrics. So, it's a whole gamut of potentials, bringing it here to TJ. Benefits of this robot, it's truly the most minimally invasive surgery component that you can have when it comes to less tissue trauma.

Neil, I've talked to you about the force feedback on that, and I think you actually had time to get on there and play on it too. But truly, what that does, it allows the physicians to sit there and then feel the instrument tips on there. And the robot will mark the depth that it wants you to cut, and it will not let you cut any further. So from a tissue damage, it doesn't allow the physician to extend past where their intent is. It's pretty cool.

Host: I was fortunate to be able to go up and try to do some tests as a, again, non-surgeon, non-physician, just a consumer that was in the market looking for this, for our surgeons who were advocating for it, and I just wanted to put my hands on it to see what it would be like and what's it feel like and look like if I'm a patient. It is nothing short of amazing and I've been in healthcare a long time. It really is from a safety, quality, just accuracy, precision, it's just amazing, really. So, the level of accuracy and effectiveness in those surgeries with this device will be it's taking leaps and bounds forward in healthcare for safety and quality, and that's what we're all about.

So, very excited about the da Vinci. I know our physicians are very excited to get that tool in here and be able to start adding that to their already super skills. So, it should be a great addition to the team here. Gosh, we've talked about four really in themselves are their own conversation. But give me your overall thoughts on the robots and where we're at and what kind of impact they're having on our patients in their community.

Jamie Wilkerson, RN, MSN, MBA/HCM: Yeah. I just think it's exciting. It's exciting as we try to strategically plan where TJ's going and the investments. I mean, If you look at it from a financial standpoint, we've made the decision to invest over $4 million in the last 18 to 24 months just in the robotic program. But what that's doing, Neil, it's keeping patients local. That's something that we talk about. I don't want to drive an hour for care if I can try to get it done at our local facility.

So, from a quality standpoint, you hit on that a lot. It feels good for me in my seat to know that we are investing in technology that is truly going to give the best outcomes for patients in the community. So not only do they not have to go nowhere, they can have the confidence in knowing that they're going to get the best outcomes. That's what makes me sleep a little bit easier at night, just because I can confidently speak about them and know that it's truly doing great for the community. That's what's exciting for me, Neil.

Host: Yeah. And I would agree with that. I would tell anybody when you're in healthcare and you're working in the healthcare systems in all the different departments, all the different physicians, it can become very complex. And sometimes communication is challenging at best. So, to be able to bring that level of technology into the area, into the region, to be able to touch patients and get high quality, great outcomes, and then also be able to work with patients who we know, because again, every patient, as I say, that comes into our building today, I either know them or I know somebody who does know them. And for us, it's personal because that's exactly who we want to take care of. So, it really is a wonderful thing to be able to do in this level of care in this community. And I think that's really what robots have done and they've allowed our physicians to, again, enhance their already very talented abilities. It's been a win-win for everybody. Truly, it has. Any last thoughts?

Jamie Wilkerson, RN, MSN, MBA/HCM: No, that's good. I appreciate you having me on. You know how excited I am about the investment that we've made into robots. I just wanted to thank you for the opportunity to get on here and talking through it.

Host: Absolutely. Well, thank you for joining us on Pulse & Perspectives. I'd like to extend a very sincere thank you to Jamie Wilkerson for sharing his insights on robotics in surgery. We're fortunate to have this level of innovation as well as Jamie's leadership guiding our healthcare system forward.

To our listeners, if you or your loved one are considering a surgical procedure, ask your doctor. Ask about whether the robot-assisted surgery may be an option. These advancements are designed with one goal in mind, and that's better care, better recovery, and better outcomes for you. If today's conversation resonated with you, please subscribe to the podcast platform. Share the episode. I'm Neil Thornbury urging you to keep your pulse on the future, your perspectives wide open. And until next time, stay informed, stay proactive, and stay well. Thank you.