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Unity hosts first critical access hospital robotic surgery in state

December 20, 2023 - Todd Morgan, Walsh County Record

Unity Medical Center (UMC) in Grafton continues to break ground and be a leader in care and innovation when it comes to critical access hospitals, otherwise known as rural hospitals.

As many people already know UMC has been named one of the Best Places to Work the last two years by Modern Healthcare magazine, an independent organization that focuses on the healthcare industry and is considered a leading publication in the medical industry.

So, it’s not a stretch to say that UMC in Grafton/Park River is a leader in rural healthcare, not just in North Dakota but perhaps nationwide. Recently, the hospital acquired an Intuitive daVinci Surgical System, which is an incredibly high-tech machine that uses four thin robotic arms guided by the surgeon to perform surgical procedures. The robotic instruments have a wider range of motion than the human hand. Intuitive Surgical, the current market leader in robotic surgery systems, reports that more than 12 million robotic surgery procedures have been performed and more than 60,000 surgeons around the world have been trained on its da Vinci systems.

Last week, UMC CEO Alan O’Neil announced that the hospital performed its first two surgeries on Monday, Dec. 11, using the daVinci system.

“As far as we know, with information from the vendor, which is the market leader in this technology, these were the first robotic surgeries performed at a critical access hospital in North Dakota.”

Dr. Michael Bittles, general surgeon, performed the surgeries. Bittles was recently hired by UMC in partnership with First Care Health Center in Park River and Pembina County Memorial Hospital in Cavalier to perform surgical procedures.

Bittles worked as a paramedic before going to medical school in Indianapolis, Indiana. His initial eight years of practice were with a large provider network in northern Indiana. He then moved to rural Nebraska where he worked with critical access hospitals much like those in rural northeast North Dakota. He then moved back to Indiana in 2019, where he was working at a larger hospital prior to the move to North Dakota.

Bittles was familiar with robotic surgeries, having used the equipment extensively prior to relocating to North Dakota.

“When the surgeon is performing the surgery, they are positioned at the control monitor which is stationed a few feet away from the patient. The control monitor completely controls the robot which is positioned directly above the patient,” O’Neil said.

It is commonly known in the medical community that robot-assisted surgeries are less invasive in terms of incision sites. Overall, there is less blood loss and associated trauma. The daVinci’s vision capabilities give the surgeon a highly magnified, crystal-clear, 3D view while operating, so they can see the fine details of the surgery through very small, precise incisions.

“That means quicker recovery time and less chance of infection because you have a much smaller surgical site,” O’Neil said. “Patients recover sooner, there is less pain, less scarring and fewer complications. It’s just a lot more precise in the hands of a skilled surgeon. It’s definitely the industry trend now.”

One key point – robotic surgeries are performed by surgeons, not robots. But instead of conventional hand-held tools used in laparoscopic surgery, which involves incisions, and a more open surgery, in which the surgeon enters the body through an incision, the doctor uses the machine. The surgeon controls the machine’s tools remotely by using a console with hand and foot controls while viewing the surgical site through a high-definition monitor that provides a three-dimensional image of the procedure.

O’Neil has high regard for the support they have received from Intuitive, including sending all UMC surgical staff to Minneapolis hospitals for upfront training and the fact Intuitive provides an onsite support team that oversees the first several surgeries performed at UMC with the daVinci. He also gives credit to the surgery team at Unity for learning the system quickly.

“Surgery manager Kristen Pastorek deserves a lot of credit for getting her team up to speed and trained in a very short time because they’re busy with other cases day in and day out.”

Industry data states approximately 644,000 robotic surgeries were performed in the United States in 2021, and that figure is expected to approach 1 million by 2028. Millions more have taken place worldwide.

UMC intends to have a little fun with a naming contest to give the robot a name in the near future.


The first surgical robot, PUMA 560, was used in a brain biopsy procedure. This procedure took place in 1985 as robotics began to be implemented to reduce movement due to hand tremors.

By the late 1990s, engineers had developed three different systems that combined laparoscopic technology with surgical robots. These systems were the daVinci, AESOP and Zeus.

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