CONTACT: TOM MOORE or
Joint Office for Planning, Marketing and Communications
8788 John Pappajohn Pavilion
Iowa City IA 52242
Release: Aug. 5, 2002
Patients to benefit from advanced robotic surgery at UI
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
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.