July 06, 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
(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 advantages in an August 2005
study published in theArchives 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.