UI Heart and Vascular Center surgeons perform the first mitral valve heart procedure using robotic surgery

Plagued by fatigue caused by a leaky mitral heart valve, Nancy Ryan's life came down to one thing.

"I wanted to feel better," she says. "I couldn't do anything. I couldn't move off my couch. And that's no life."

Ryan, a 59-year-old resident of Madrid, Iowa, got her wish in early June 2004, but in a totally new way. She became the first Iowan to undergo mitral valve repairs using the da Vinci robotic surgical system.

This alternative approach was offered to her by Jeffrey Everett, M.D., a UI Heart and Vascular Center cardiothoracic surgeon at University of Iowa Hospitals and Clinics.

Robotic surgery allows a surgeon to operate without directly touching the patient. Instead, the surgeon sits at a computer console that offers a three-dimensional view of the area to be treated with magnification up to 12 times that of normal vision. The surgeon uses special hand controls to manipulate long, narrow, specially hinged surgical instruments that are inserted through small incisions made in the patient's chest.

"While we still do the same basic surgery," Everett says, "the robotic system is a great tool that reduces post-surgical discomfort and lessens recovery time."

Traditional mitral valve surgery requires an incision that runs the length of the breastbone--dividing, or splitting, the bone--and a long, often painful recovery.

The robotic surgical system simplifies the process by requiring only one two-inch and several half-inch incisions, and no need to split the breastbone.

Ryan fully appreciated the new approach, saying she felt "100 percent better" almost immediately. She experienced very little pain, and her shortness of breath is gone.

"All of the doctors, the nurses--everyone here--are great," says Ryan, who plans to enjoy the "simple things" in life--her grandchildren, quilting, and reading.

Ryan returned home only four days after her surgery, compared to the typical six- to seven-day hospital stay associated with the traditional technique. In addition, robotic surgery patients usually resume normal activities weeks earlier than if they had undergone traditional open-heart surgery.

Everett expects nearly all mitral valve repairs will eventually be done using the robotic system, and that the next milestone will be using the technology to perform coronary artery bypass procedures.

"Anytime we can give a quality result and with shorter recovery time and perhaps less pain and discomfort, it's certainly exciting," Everett said.

Information about the system can be viewed online at www.uihealthcare.com/daVinci.

Pediatric surgeon uses surgical robot in unique way

Weighing a mere 11 pounds, an Iowa infant has become the world's smallest to undergo a gastric reflux operating using the da Vinci® robotic surgical system.

John Meehan, M.D., a pediatric surgeon at University of Iowa Children's Hospital, located at UI Hospitals and Clinics, offered the Nissen fundoplication procedure via robotic surgery as an alternative to the traditional surgery for repairing severe reflux.

"I felt that the robotic approach offered several advantages," Meehan said. "Our experience in other patients shows that we can take advantage of the technology to do the same procedure, achieve just as good an outcome, and help patients recover faster and get back to eating normally and growing again."

The procedure worked great for Dakota Templeton, a premature twin. Following their births on July 21, 2003, Dakota and his brother, Buddy, received extended care in the Neonatal Intensive Care Unit at University of Iowa Children's Hospital.

Buddy went home first. Dakota went home two months later but then couldn't keep any food down and had trouble breathing. "He was losing weight, and I knew that was not a good thing for a premature baby," said his mother, Felicia Woolwine.

Given his minimal weight, an open operation Nissen procedure would have posed several challenges for Dakota. The open approach involves a lengthy incision on the abdomen as well as an often-painful recovery. Dakota's premature lungs would have further hampered his post-operative recovery.

The da Vinci® procedure was performed in just over an hour with four tiny incisions ranging from one-eighth of an inch to one-half of an inch in length. Using such small incisions results in significantly less patient discomfort, a shorter hospital stay, and a faster recovery overall.

"Typically, children stay in the hospital for three to five days following an open Nissen fundoplication and they can take several weeks to return to their normal activities," Meehan said. "In this case, Dakota was ready for discharge one day after surgery, and was essentially fully recovered in two to three days."

Woolwine said her son is doing well. "His breathing is better, he's starting to gain weight again. I trust what the doctors here tell me, and I'm real happy with how he's doing."

--Tom Moore

Robotic surgery is currently approved for use in surgeries involving the abdomen, pelvis, and chest. UI Hospitals and Clinics was the first hospital in Iowa to use the da Vinci system to perform urological procedures such as radical prostatectomy for removing a cancerous prostate and pyeloplasty for obstructed kidneys.

Nancy Ryan, the first Iowan to receive mitral valve surgery via the da Vinci robotic surgical system, gets a heart anatomy overview from cardiothoracic surgeon Jeffrey Everett, M.D.