Pittsburgh, PA (Vocus) July 10, 2009
A Washington County woman is recovering well today after undergoing a new, robot-assisted weight loss surgical procedure at Allegheny General Hospital (AGH). Malinda Eustis, 52, of Canonsburg, is one of just a handful of bariatric patients in the region to benefit from the advanced technology since AGH launched its robotic surgery program in 2008.
A state-of-the-art device that is revolutionizing the field of minimally invasive laparoscopic surgery, the da Vinci Robotic Surgical System features robotic arms equipped with surgical instruments that are remotely controlled by surgeons sitting at a console in the operating room.
Originally developed by NASA for operating on astronauts in space and used by the Department of Defense to operate on soldiers in the battlefield, the da Vinci System allows surgeons to see targeted anatomy through a high resolution, three dimensional endoscopic camera. The System's robotic arms exceed the natural range of motion of the human hand and are designed to minimize the possibility of human error.
Doctors at the West Penn Allegheny Health System (WPAHS) are now using the technology to perform an assortment of surgical procedures, including prostate cancer surgery, gynecologic surgery and surgeries of the pancreas, esophagus, adrenal gland, gallbladder and kidney.
According to Miro Uchal, M.D., Director of AGH’s Minimally Invasive Surgery Center Education Program and Director of the hospital’s Division of Bariatric Surgery (http://www.pabariatricsurgery.com), weight loss surgery was a natural extension of the robotic program considering the complexity of the procedure and the growing demand for it in western Pennsylvania.
The National Institute of Diabetes and Digestive and Kidney Disease estimates that nearly one third of U.S. adults are now considered obese, and the number of people classified as morbidly obese – defined as having a body mass index of 40 or higher - also continues to rise exponentially - from 3% in 1988 to more than 7% in 2006.
Obesity is linked to a number of serious health problems, including diabetes, heart disease, high blood pressure, arthritis, sleep apnea and stroke.
With both conventional and robotic laparoscopic surgery, weight loss procedures can be performed through just a few small incisions. The precision perfect arms of the robot, however, offer easier access to some of the more inaccessible areas in the body, Dr. Uchal said.
Ms. Eustis underwent a complex bariatric procedure at AGH on May 11 in which Dr. Uchal converted her from one form of bariatric surgery, called vertical banded gastroplasty, to a Roux-en-Y Gastric Bypass, which is considered the gold standard of weight loss surgery.
“When performing Ms. Eustis’ revision, I found the patient’s abdomen was frozen with adhesions [scar tissue that had formed after her previous surgery] and that nothing but fibrous tissue was covering the area of interest. Yet, with the unrestricted range of motion of the robot’s ‘fingers’ I was able to separate vital organs layer by layer without any injury to the patient and virtually no blood loss,” Dr. Uchal said.
Dr. Uchal said that da Vinci offers distinct advantages to both the surgical team and patients.
“The da Vinci System greatly improves our ability to confront even the most complicated obesity cases with a minimally invasive approach, providing surgeons with superior visualization, dexterity, control of the instruments and ergonomic function,” he said. “With this technology, we are better able to afford patients a proven surgical treatment that results in fewer complications, shorter recovery time and less post-operative pain.”
In normal digestion, food passes through the stomach and enters the small intestine where nutrients are absorbed. Gastric bypass involves significantly reducing the size of the stomach to limit a patient’s food consumption and bypassing a sizable portion of the small intestine.
“We essentially construct a mini-stomach by permanently dividing the stomach, creating a pouch that can hold only a few bites of food. The intestines are then cut approximately one and a half feet beyond the stomach and attached to the pouch. This reconfiguring of the digestive system provides both a restrictive and malabsorptive method to the weight loss,”Dr. Uchal said.
More than 150,000 such operations are now performed annually in the United States.
“For morbidly obese patients, weight loss surgery can be a life-saving operation. Although results vary, gastric bypass on average leads to a 65% reduction in excess weight. When combined with healthy life-style changes that patients are encouraged to pursue following surgery, this procedure enables us to resolve or greatly improve 80 to 90 percent of a patient’s weight-related health problems,” Dr. Uchal said.
A number of clinical studies have demonstrated the advantages of robotic gastric bypass, Dr. Uchal said.
Reporting in the September, 2008 Journal of Robotic Surgery, surgeons from the University of Texas Medical School showed that robotic surgery significantly reduced a patient’s risk of developing gastrointestinal leakage from the procedure, a rare but serious complication.
Researchers from Stanford University noted additional potential advantages in an August 2005 study published in the Archives of Surgery. They found that the robotic system made the surgery quantitatively easier to perform and reduced the median surgical times by approximately 30 minutes.
Dr. Uchal stressed that gastric bypass is generally recommended for patients who are severely obese and/or those who are experiencing a reduced quality of life from health problems related to their weight.
Designated as a Bariatric Surgery Center of Excellence by the American Society for Metabolic and Bariatric Surgery, AGH surgeons annually perform more than 400 weight loss procedures. Dr. Uchal expects that a growing number of these procedures will be done with the da Vinci System.