Dr. Scott Tully, C'79, and physician assistant Mary Beth Teague, C'95, are the brains behind the da Vinci robot visible behind them in the St. Vincent's Hospital operating room. Photo by Steve Wood
A surgeon improves cancer patients’ outcomes — without laying a finger on them
By Joe Romano
Each year, more than 230,000 American men are diagnosed with prostate cancer. About 30,000 will die of the disease, making it second only to lung cancer as a killer of men in the U.S. Slow-growing and difficult to detect, it is most often diagnosed in men who are 65 or older.
Once a diagnosis is confirmed, there are several possible courses of treatment. Watchful waiting is recommended for some, especially for older patients with less advanced tumors. Radiation therapy, cryotherapy (controlled freezing of the prostate), and hormone therapy all are possibilities. The last option is surgical removal of the prostate.
It is on this front in the war against prostate cancer that Dr. Scott Tully, C’79, is doing battle. Specializing in urological surgery, Tully is a pioneer in a new kind of treatment that, based on his own comparisons, promises his patients a faster recovery, fewer complications, reduced pain, smaller incisions, and a shorter hospital stay.
He does this mostly, perhaps miraculously, without laying a finger on his patient during the procedure. Instead, Tully employs the futuristic da Vinci robot, a $1.2 million marvel, to serve as his hands and eyes during this delicate operation.
The Procedure
The first thing you notice upon entering Tully’s operating room at St. Vincent’s Hospital in Birmingham, Alabama, is the massive da Vinci robot. Covered in clear plastic sleeves, the machine towers over the operating table, sprouting mechanical arms, tubes, and wires as it is moved into the place where it will do its work.
Before it is connected, Tully makes six little incisions, or ports, in the patient’s abdomen. Only about an inch long, these ports are big enough to allow the da Vinci machine — with its arms, high-intensity lights, and cameras — to reach deep inside the body. The abdomen is inflated with gas, lifting the skin above the internal organs, while Tully takes his seat, 10 feet away, at a remote control console. The lights are dimmed, and television monitors on either side of the operating table broadcast a vivid picture from inside the patient.
Now, the real work begins. Tully places his eyes to a viewer reminiscent of an antique stereoscope, where he has a three-dimensional live picture of his work. One real advantage of the da Vinci robot, created by a California firm called Intuitive, is that operating it is truly “intuitive” for a surgeon, says Tully. “You can take a surgeon who has never seen this before, who will sit down at that console, and in 30 seconds be sewing and suturing. That’s because your hand-eye alignment is the same as if you were standing at the operating table, and the instruments do exactly what your hands do at the console.” And, says Tully, the excellent stereoscopic view, which is much better than that afforded by traditional surgery, more than compensates for the loss of tactile sensation.
At the console, Tully delicately guides the robotic arms to the prostate deep within the pelvis. Just reaching the organ takes about 30 minutes. “The prostate wasn’t meant to be taken out,” says Tully. “It’s very difficult to operate on.” But that’s precisely why the robot works so well in this application. “The robot is good for highly complex procedures that you need to do in a limited space. That’s where it really shines.”
Having reached the prostate, Tully begins the most delicate part of the procedure. In fact, it requires such precision, as well as such a degree of coordination with his assistant, Mary Beth Teague, C’95, that he speaks of it as not just medicine, but art. “Coordination between the doctor and the assistant is essential, like a dance,” he says “This is very much a team effort, and it’s very critical for me to have a good assistant at the table to help me see what I need to do. And, she’s a very good assistant.” While Tully gracefully twirls the robotic instruments here and there, Teague — who is using laparoscopic tools — stands at the patient’s side, responding instantly to Tully’s almost inaudible instructions to readjust a light, or to move a fold of flesh.
Even to an untrained eye, the skill that Tully has gained in performing more than 400 of these procedures is apparent. This is the critical juncture in the surgery. Though his overriding concern is the removal of the cancer, Tully must be precise in order to help preserve both his patient’s potency and promote a speedy resumption of continence, both of which are compromised by the operation. Painstakingly, then, he separates the prostate from the tissues and sensitive nerves that surround it, then from the bladder.
Finally, little more than an hour after he sat down at the console, the prostate is placed in a small bag and removed through one of the ports. Tully takes a breather as the prostate is sent to the pathology lab for analysis. If no cancer is detected around the margins of his work, then he can begin closing things up. If it is detected, then he will have to go back and take more tissue to ensure that the cancer is removed.
This time, the lab sends good news. There is no cancer in the margins, and the final part of the procedure, reattaching the bladder and the urethra, can begin. Again Tully and Teague work closely, though at opposite ends of the room, to complete, then test, this re-connection. The instruments are removed, and it is time to close the ports. Only a few stitches are needed, and, frequently, these small incisions heal so well that they are nearly invisible. Tully, who arrived at the hospital before dawn, has a few minutes to rest as the operating room is prepared for the next procedure.
Largely through the work of Tully and his colleagues, St. Vincent’s has become one of the nation’s leading centers for robotic prostate surgery. Tully says he became interested in the procedure because he felt it would provide something better, something less invasive, for his patients. “You’re always trying to pursue excellence as a surgeon. You want to get it a little better, get it a bit more right, every day. I’m trying to do the best I can for my patients.
“Every case to me,” says Tully, “is a battle in and of itself, and I try to fight it out to get that guy the best operation I can on that day. For him, this is the biggest day of his life, and I try to remember that. The challenge is to get it right so this guy has a good result and can get back to his life and put this all behind him. And, that’s the satisfaction of this work. That keeps me going.”
Sewanee and the Doctor
The son of a physician (who works in the same practice group, Urology Centers of Alabama), Tully says that he didn’t necessarily plan on pursuing his father’s profession. “I came to Sewanee,” he remembers, “just to get the best education I could.” But, it wasn’t long before Tully found himself taking up the pre-med track. “It just felt right, it’s in my blood.”
Even after the drive toward medical school became his focus, Tully was still intentional in taking advantage of the broad experiences offered on the Mountain. Though he fondly remembers biology professors Harry Yeatman and Henrietta Croom as his mentors, he speaks with equal enthusiasm about his experiences with English professor John Reishman, history professors Joseph Cushman and John Flynn, and math professor Steve Puckette. He also clearly remembers participating in a benefit walkathon from Chattanooga to Sewanee, led by the late Hugh Caldwell, professor of philosophy. While Tully says he could only make it to the base of the Mountain before his legs just locked up, the 55-year-old professor completed the hike in time for an evening party.
During his tenure on the Mountain, these and other professors, as well as his fellow students and their shared experiences, made an indelible impression upon Tully. “Sewanee was a turning point in my life. I wouldn’t trade those years for anything. I came there and I was raw and green, and in the first year I just busted it. I had to prove to myself that I could do it. It nurtured me and let me grow and I’ll always be thankful for that experience.”
Learn more about prostate cancer and its treatment, including the da Vinci robot, at the Web site for Urology Centers of Alabama.
Joe Romano is the University’s executive director for marketing and communications.
