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Release: Aug. 5, 2002

Patients to benefit from advanced robotic surgery at UI

The meaning of "a surgeon's touch" is about to change for some patients cared for by University of Iowa Health Care surgeons. The recent addition of a da Vinci Surgical System will result in less tissue damage during surgery, reduced postoperative pain and quicker healing for patients treated with the minimally invasive robotic device.

Acquiring the sophisticated technology is a key step in establishing the University of Iowa Minimally Invasive Surgery Center, said Howard Winfield, M.D., UI professor of urology and co-leader of the new clinical initiative along with James Maher, M.D., UI professor of surgery.

The da Vinci system allows a surgeon to operate without actually putting his or her hands on the patient. Instead, after establishing access into the body cavity, the physician 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 joystick-like controls to manipulate long, narrow specially hinged surgical instruments that are inserted through small incisions in the patient. The remote-controlled instruments can be used in hard-to-reach areas and turned in ways that would be impossible with normal wrist dexterity. Altogether, these advantages allow the surgeon to work on a smaller scale and more precisely than traditional surgery.

"It's a kinder and gentler form of surgery," Winfield said. "The technique causes less tissue damage than traditional instruments such as scalpels and retractors and allows patients to recover faster and with less pain. Patients and surgeons alike will increasingly want these benefits of minimally invasive surgery, and the new center will help us meet that need."

The clinical initiative received slightly more than $1.8 million to purchase the da Vinci system, fund a research nurse-clinician and a part-time video technician and develop a surgical suite designed for the advanced technology. Information about the system can be viewed online at www.uihealthcare.com/daVinci.

The device currently is approved for use in surgeries in the abdomen, pelvis and chest. In addition, UI Hospitals and Clinics will be the first medical center in Iowa to use the da Vinci system to do urological procedures such as radical prostatectomy for removing a cancerous prostate.

Although the number of subspecialties using the new technology currently is limited, use of the robotic technique soon will quickly expand into new areas, including reconstructive surgeries, Winfield said. To that end, the collaborative minimally invasive center brings together UI experts in general surgery and engineering as well as disciplines such as anesthesia, cardiology, gastroenterology, gynecology, cardiothoracic and vascular surgery, orthopaedics, radiology and urology.

"We wanted to create a center where all surgical disciplines can interact and exchange ideas related to minimally invasive surgery care, research and education," said Winfield, who also is a staff physician with the Veterans Affairs Medical Center in Iowa City.

Winfield, Maher and Jeff Everett, M.D., UI assistant professor of surgery in the cardiothoracic division, learned to use the da Vinci device earlier this year. The surgeons said the robotic surgery will allow them to do things they never dreamed possible.

"I can take a cut vessel and put it back together using very, very tiny sutures." Winfield said. "The magnification system makes it seem the size of normal sutures, yet I can use miniature suture material that I otherwise wouldn't be able to handle with my own hands."

Maher said he was impressed with how the system mimics the motions of the fingers and wrists, yet because of its scalability allows the surgeon to extend a normal 90-degree turn of the wrist into a 180-degree turn.

Maher said he would use the system for operations such as transhiatal esophagectomy, used primarily in cancer cases to remove the esophagus. With traditional surgery, the treatment requires a nearly eight-inch chest incision, which sometimes causes broken ribs and a painful recovery.

"This new technique will be a lot better for the patients needing this type of cancer surgery, Maher said. "Another significant use likely will be in cardiac surgery for coronary artery bypass and valve replacements without sternotomy, which is opening the breastbone down the center. Eliminating the need for that type of incision will be quite helpful to patients, reducing pain and disability."

Traditional laparoscopic surgery also involves small incisions through which instruments are inserted and contributes to speedier and less painful recoveries. However, unlike the da Vinci system, it does not offer the same visual and dexterity advantages and is limited to certain types of

surgeries. For regular laparoscopic procedures, the physician remains by the patient's side, watching images on a two-dimensional screen and using non-hinged (or non-wristed) straight instruments.

"The problem with these long instruments, even though they are inserted through small ports, is that any little bit of tremor you have in your hand is amplified by the length of the instruments," Maher said. "In contrast, with the da Vinci robotic technique and tools you have more wrist action, and the robot filters out through its computer any tremor you have in your hand."

Winfield and other UI and visiting colleagues will help train general and specialist surgeons in minimally invasive surgical techniques for kidney diseases at a UI conference Aug. 23-24. The event primarily involves hands-on training of physicians and nurses in how to perform laparoscopic surgery and how the robotic system is becoming part of this minimally invasive approach.

The da Vinci surgical technique may be more expensive to perform than traditional surgery primarily because of preoperative equipment set-up. However, because patients recover more quickly, hospital stays and postoperative nursing care costs will be reduced. And with shortened recovery times, patients can return to work, family and social activities more quickly.

Winfield also foresees that the center will launch various research projects such as comparing the perioperative characteristics and wound healing of patients treated with the da Vinci system and those treated by traditional surgical methods.

Maher added that as the robotic instrument develops, improvements will come along with it.

"The exciting challenge for all of us is to learn to use the technology in the best possible way," Maher said. "We won't be using it for routine surgeries such as gallbladder removals but for more complicated and precise forms of surgery that are difficult to do laparoscopically.”

University of Iowa Health Care describes the partnership between the University of Iowa Roy J. and Lucille A. Carver College of Medicine and UI Hospitals and Clinics and the patient care, medical education and research programs and services they provide. Visit UI Health Care online at www.uihealthcare.com.