U of A medical faculty members perform rare surgery
U of A Surgeons Shahzeer Karmali and Dan Birch have performed Canada’s first robotic roux en-Y gastric bypass, a stomach surgery where an operation used a robot from start to finish.
February 3, 2009 - Edmonton-Two surgeons from the Faculty of Medicine & Dentistry and Alberta Health Services in the Edmonton area have performed a rare stomach operation using a robot from start to finish. This surgery is believed to be the first of its kind in Canada.
They were assisted by one of the world's top experts in robotic surgery, who travelled to Edmonton specifically for the purpose.
Shahzeer Karmali, an assistant professor in the U of A's Department of Surgery and a bariatric specialist with the Weight Wise program in Edmonton, and Dan Birch, an associate professor in the department and regional clinical director of the Centre for the Advancement of Minimally Invasive Surgery, performed the procedure on two patients in December.
Also scrubbing in was Karmali's mentor, Erik Wilson, associate professor of surgery and director of robotic minimally invasive bariatric surgery, University of Texas-Houston.
The procedure is called "robotic roux en-Y gastric bypass." It has been performed at only a handful of centres in the United States and nowhere else in Canada.
Robotic surgery is a relatively new advance. Bringing this technique to Edmonton will put the city at the forefront of an emerging medical technology, one that Birch and Karmali would like to see eventually expanded.
Bariatrics is the branch of medicine that deals with obesity. Gastric bypasses are done to treat morbidly obese patients and reduce the health problems that go along with obesity. The stomach is divided into two pouches and the small intestine is rearranged so that the amount of food the patient can eat is reduced and the amount of food that the body can absorb is decreased. This allows the patient to lose large amounts of weight and resolve serious obesity-related health problems such as diabetes, hypertension and high-blood cholesterol.
Birch and Karmali specialize in minimally invasive abdominal surgery, which involves making a small incision and inserting a laparoscope, a tube equipped with a video camera and a light. The surgeon inserts small operating instruments through small keyhole incisions and performs the surgery while watching a monitor. Minimally invasive procedures are the hallmark of CAMIS, a program that is rapidly making Edmonton a leader in these complex surgeries.
Operations done this way result in dramatically better patient outcomes due to faster recovery times. There also is less pain and therefore less need for pain medication and shorter hospital stays. But a gastric bypass requires a large amount of time-consuming and painstaking suturing and stapling so there aren't any leaks. Doing this manually via a laparoscope can be challenging for the surgeon, Karmali says.
However, using a robot to perform this technically intricate procedure reduces surgeon fatigue and may provide a better outcome, Birch says
"The surgeon works with a console controlling the robotic arms. It's like the surgeon's hand is in the body, making it easier to do the sutures and stapling." The device, called the da Vinci robot, is located at the Royal Alexandra Hospital and has been used during other minimally invasive procedures, including urological surgeries.
Birch and Karmali would eventually like to be able to employ the robot more frequently. First, their task will be to prove outcomes and determine whether it can be harnessed for other procedures. "By building on our experience in robotic gastric bypass, maybe we'll be able to carry it over to other surgeries," Karmali said.
