"Altogether, robotic surgery allow us to work on a smaller scale and more precisely than traditional surgery."

--John Meehan, M.D.

UI surgeons become the world's first to use robotic surgery for several different procedures

Surgeons at University of Iowa Hospitals and Clinics continue to pioneer the use of robotic surgery with several "firsts" involving the revolutionary da Vinci® robotic surgery system.

Surgical teams led by John Meehan, M.D., at University of Iowa Children's Hospital, located at UI Hospitals and Clinics, became the first to use the system for:

• Removal of an adrenal carcinoma (an aggressive, deadly tumor) from a 22-month-old girl. It was also the first time da Vinci had been used to remove an adrenal mass from a child.
• Ladd's procedure (which corrects a condition in which the intestines do not rotate properly and are at risk for cutting off their own blood supply by twisting).
• Removal of a colon from a child (a nine-year-old with colon cancer)
• Surgical removal of the entire colon and rectum with an ileal pull-through in either an adult or a child (in this case a 5-year-old girl).

Meanwhile, UI urologists Howard N. Winfield, M.D., and Badrinath Konety, M.D., are the first in Iowa to use the system for radical prostatectomy procedures, in which a patient's cancerous prostate is removed, and pyeloplasty procedures for treating patients with obstructed kidneys. Also, a surgical team led by Kemp Kernstine, M.D., became the first in Iowa to completely remove a patient's esophagus and affected lymph nodes using the system.

The system allows surgeons to operate without actually touching or even standing over the patient. Instead, the surgeon sits at a computer console that offers a magnified, three-dimensional view of the area to be treated.

The surgeon uses joystick-like controls to manipulate long, narrow, specially hinged surgical instruments that are inserted through small incisions in the patient's abdomen. The remote-controlled instruments can access hard-to-reach areas and turn in ways that would be impossible with normal wrist dexterity.

"Altogether, robotic surgery allow us to work on a smaller scale and more precisely than traditional surgery," says Meehan, who cited 22-month-old Loretta Troyer as an example of a patient who was a perfect candidate for robotic surgery.

The girl's parents, Emanuel and Leona Troyer of Moulton, Iowa, first noticed something was wrong when Loretta developed a cheek rash and a swollen face. When she began sprouting facial and body hair, they consulted their physician in Bloomfield, Iowa. They were subsequently referred to the Ottumwa Regional Medical Center, which in turn referred them to specialists at Children's Hospital of Iowa.

"Lab tests and our examination showed that Loretta had abnormally high steroid levels and a mass in her right adrenal gland," Meehan says. "Because the lesion was isolated to the right adrenal gland, the robot offered a better opportunity to remove the gland without damaging the right adrenal vein, which is very fragile, especially in such a young child."

In the four-hour procedure, Meehan made several small incisions, then inserted a special camera and instruments to remove the tumor, all with the assistance of the computer-controlled precision of the robotic surgical system.

"Using the robot made it much easier to dissect and tie off the very short right adrenal gland vein," Meehan says. "We removed the entire tumor. Even with complete removal, survival is only 30 percent because these tumors age so aggressively. So far, we have not seen see any residual disease, and Loretta is doing very well."

While patients undergoing traditional surgery would have required a week to recover, Loretta's parents took her home after just one day--a typical experience for patients who undergo robotic surgery procedures.

The da Vinci device currently is approved for surgeries involving the abdomen, pelvis, and chest.