Surgeons at Allegheny General Hospital (AGH) have performed the region’s first minimally invasive, robot-assisted weight loss surgeries. 

The first procedure, a gastric banding (LapBand) surgery, was performed on a 375-pound man from Bellevue on December 15, 2008. The second procedure, a complex gastric bypass revision, was performed on a Pittsburgh woman on December 17, 2008. Both surgeries involved use of the hospital’s da Vinci Robotic Surgical System.

A state-of-the-art technology that is revolutionizing the field of minimally invasive (laparoscopic) surgery, the da Vinci System utilizes 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 remotely 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 minimizes the possibility of human error.

Doctors at the West Penn Allegheny Health System (WPAHS) have been using the technology since February, 2008 to perform prostate cancer surgery and an assortment of gynecological procedures.   Surgeons from the AGH Minimally Invasive Surgery Center are now expanding the robotic surgery program to include weight loss procedures as well as surgeries of the pancreas, esophagus, adrenal gland, gall bladder and kidney.

According to Joseph Colella, M.D., Director of AGH’s Division of Bariatric Surgery, weight loss surgery in particular was a natural extension of the 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. 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 laparoscopic surgery and robot-assisted surgery, weight loss procedures can be performed through just a few small incisions. The precision perfect arms of the advanced robotic technology, however, offer easier access to some of the more inaccessible areas in the body, explained Miro Uchal, M.D., Director of AGH’s Minimally Invasive Surgical Center.

“While performing the complex gastric bypass 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. Colella 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.”

Gastric banding involves placing an adjustable silicone band around the upper part of the stomach to significantly reduce its size and restrict calorie intake. Squeezed by the silicone band, the stomach becomes a pouch that can only hold about one ounce of food. A plastic tube that runs from the band to a device just under the skin in the abdomen allows saline to be injected or removed to tighten or loosen the band’s grip.

“For morbidly obese patients, weight loss surgery can be a life-saving operation. Although results vary, gastric banding on average leads to a 40% reduction in excess weight. In addition to 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. Colella said.

Gastric bypass is an even more complex reconfiguring of the digestive system in which surgeons permanently divide the stomach into a smaller pouch and redirect the path of the small intestines to it.

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. Colella and Dr. Uchal expect that a growing number of these procedures will be done with the da Vinci System.

Dr. Collela and Dr. Uchal also performed West Penn Allegheny’s first robot-assisted laparoscopic cholecystectomy, or gallbladder removal surgery, on December 15. More than 500,000 people in the U.S., undergo gallbladder surgery each year when the formation of gallstones leads to attacks of pain and nausea.

WPAHS acquired da Vinci Systems for both its AGH and West Penn Hospital campuses and is now home to the region’s most comprehensive robotic surgery program with 14 specially trained surgeons and more than 200 surgical procedures performed this year.