World’s First Robotically Assisted Intestinal Bypass Surgery for SMA Syndrome

Wednesday October 22, 2008

LONDON, Ont - London Health Sciences Centre is pleased to announce that the world’s first robotically-assisted intestinal bypass surgery for a patient with superior mesenteric artery syndrome (SMA) syndrome, also known as Wilkie’s syndrome, was performed at the hospital on July 30, 2008.

“This is a very exciting example of how new technology can be adapted to a patient’s unique needs,” said Dr. Christopher Schlachta, minimally invasive and robotic surgery specialist. “Our surgery team has tremendous experience and expertise with robotic surgery which allows us to develop innovative solutions in response to the individual patient, even for a rather rare procedure like this one.”

A traditional intestinal bypass for patients with SMA syndrome requires a one-week hospital stay and involves significant postoperative pain. The patient is typically left with a six inch scar on the upper belly.

By using the da Vinci® robot, Dr. Schlachta, assisted by Dr. Andreana Bütter, pediatric surgeon, and Dr. Shiva Jayaraman, robotic surgery fellow, were able to reduce the patient’s hospital stay to three days with minimal use of pain medication.

The patient herself is an adolescent and came from Children’s Hospital where Dr. Bütter treated her both before and after the surgery.

“When I approached Dr. Schlachta about exploring options for this patient, one of my main concerns was to minimize scarring which was very important to the patient who is a girl of only 16 years of age,” said Dr. Andreana Bütter. “By using minimally invasive techniques, we were able to reduce the scar to only five one-centimeter incisions and she was able to return to normal activity within 1 week. Traditional laparoscopic instruments do not possess the same range of motion and ease of use for intestinal anastomoses like their robotic counterparts. It would have been unlikely that we could have achieved the same result with laparoscopy alone.”

SMA syndrome is a rare, life-threatening gastrointestinal disorder characterized by the compression of the third portion of the duodenum by the abdominal aorta and the overlying superior mesenteric artery. This causes patients to have great difficulty eating and, therefore, digesting food.

Symptoms of SMA syndrome include early satiety, nausea, vomiting, abdominal pain, belching, hypersensitivity of the abdominal area, and marked weight loss. Since patients have difficulty digesting food, they can continue to lose weight which, in turn, increases the duodenal compression, spurring a vicious cycle.

While robotically-assisted intestinal bypasses are performed for other conditions this is the first time it has been used for SMA syndrome.

The patient, 16 year old Nicole Butler is happy the surgery is behind her. “"I was happy that Dr. Bütter took the time to figure out how to minimize the scars. This not only helped with making the scars smaller, but also helped with the healing, so I was able to get out of the hospital faster. So far, I have been great! Now I am able to eat whatever I want without pain, and can go back to school with my friends on a regular basis. I am now enjoying my life a lot more after having this surgery."

Schlachta, who is also medical director of LHSC’s Canadian Surgical Technologies & Advanced Robotics, is confident that the success of this operation opens other venues for surgical therapies. “Since this procedure demonstrates that we can confidently perform a hand sewn intestinal bypass, it will have implications for other advanced gastrointestinal, surgeries including gastric and colon cancer resections.”

Members of the surgical team who contributed to the success of this innovation also included: Dr. Jeffrey Granton, Dave Harrison, Dr. Ravi Kumbharathi, Dr. Kevin Latchford, Amy Lidington, Lisa Reynolds, Reuel Valnecia and Annie Williamson.

Surgical robots have been used in London since 1999 when London Health Sciences Centre (LHSC) acquired its first surgical robot. In 2000, LHSC established CSTAR, Canadian Surgical Technologies & Advanced Robotics, as a research and education program in partnership with Lawson Health Research Institute and The University of Western Ontario.

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Last Updated December 3, 2008 | © 2007, LHSC, London Ontario Canada