"There are so many procedures for children that can be done with minimally invasive surgery. The kids are recovering so much faster, and they're doing much better overall."

--John Meehan, M.D.

Seventeen-year old Marcus Grafft was just pleased to know that he would finally see some relief from the swallowing discomfort he had been experiencing for the past three years. And the teen-ager didn't mind being a part of a major medical breakthrough at University of Iowa Children's Hospital either.

Grafft, a high school senior-to-be, joins several other pediatric patients who have undergone robotic surgery with the da Vinci Surgical System®, making them some of the first in the nation to receive advanced pediatric surgeries with the system.

"We're making leaps and bounds here," said John Meehan, M.D., assistant professor of pediatric surgery, who performed Grafft's surgery. Using the da Vinci system, Meehan corrected Grafft's swallowing disorder with a minimally invasive procedure, resulting in less postoperative pain and a shorter hospital stay.

But Grafft's speedy recovery pales to the time he spent enduring the discomfort. Over a three-year period, he gradually experienced pain while swallowing. "He felt like his food was catching on something," said his mother, Rita. But the growing teen-ager still managed to eat even though a disorder in his lower esophagus was making it difficult for food to move down and into his stomach.

Eventually, Grafft's discomfort became so severe that he was hardly able to tolerate solid foods. At a visit with Scott K. Nau, M.D., a pediatrician with Cedar Rapids Pediatrics and a 1978 graduate of the UI Roy J. and Lucille A. Carver College of Medicine, Grafft learned that he was experiencing classic symptoms of achalasia, a disease rarely seen in children. The condition occurs when muscles in the esophagus fail to relax.

Because of this rarity, Grafft was referred to University of Iowa Children's Hospital, located at University of Iowa Hospitals and Clinics, where he was evaluated by Warren Bishop, M.D., a pediatric gastroenterologist. Bishop reviewed Grafft's options and ultimately decided surgery would provide the most permanent treatment for the young patient.

When Meehan was recommended as Grafft's surgeon, the da Vinci robotic system seemed ideal. "The area involved is focused and easy for the robot to get to," said Meehan.

Introduced last fall to UI Hospitals and Clinics, the da Vinci Surgical System is the only FDA-approved robotic surgery device for use in surgeries in the abdomen, pelvis, and chest. The system is used for both pediatric and adult procedures by a growing number of surgeons at UI Hospitals and Clinics.

Robotic surgery resembles laparoscopic surgery, which uses long, rigid, telescopic instruments called laparoscopes to access body cavities through small incisions. However, the da Vinci system represents a major advancement over standard laparoscopic surgery, which offers limited depth perception and less precise motion control and mobility.

The da Vinci system's instruments can be controlled in ways that would be impossible with normal wrist dexterity. "There's so much more mobility," said Meehan, comparing the da Vinci's ability to extend a normal 90-degree turn of the wrist into a 180-degree turn.

During the surgery, Meehan sat at a separate console operating tiny joystick-like controls to manipulate the surgical instruments on the robot. The console offers a three-dimensional view of the body cavity compared to the two-dimensional view available in laparoscopic surgery.

In addition to its many technical advantages, robotic surgery also benefits patients by shortening their recovery time. Following his Wednesday surgery, Grafft spent only one night in the hospital compared to a five-day stay typical of the traditional open surgery and was back to school on Monday.

"It was amazing," Rita Grafft said. "We're certainly glad that this was available."

As a national pioneer in using robotic surgery for pediatric patients, Meehan shares Grafft's enthusiasm. "There are so many procedures for children that can be done with minimally invasive surgery. The kids are recovering so much faster, and they're doing much better overall," he said. "It's the way of the future for all types of surgery."

Questions about the use of robotic surgery in pediatric patients should be addressed to John Meehan, M.D., directly via e-mail at john-j-meehan@uiowa.edu, or call UI Health Access and ask for Dr. John Meehan in pediatric surgery. Physicians seeking consultation or referral should e-mail Meehan or call UI Consult.

Ever more common

While John Meehan is helping lead the way in robotic surgery for pediatric patients at Children's Hospital of Iowa, other surgeons at UI Hospitals and Clinics are also using the da Vinci system to perform an increasing number of procedures in various areas.

• In urology, surgeons are using the da system for removing cancerous prostates (radical prostatectomies) and to clear obstructed ureters (pyeloplasties).
• Thoracic surgeons are using the system in the removal of the thymus gland and esophagus, while heart surgeons are gaining experience with the system in preparation for more complex procedures in the future.
• In general surgery, the system is being used for gastrointestinal procedures to correct gastroesophageal reflux (Nissen fundoplication) and to treat achalasia (Heller myotomies).
• Gynecologists are beginning to use the system to remove fibroid tumors from the uterus (myomectomies).