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


For Immediate Release:
October 22, 2008

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(LONDON, Ontario) –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 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.

How it works: The da Vinci® Surgical System manufactured by Intuitive Surgical http://www.intuitivesurgical.com/index.aspx consists of a surgeon’s console, a patient-side cart with four interactive robotic arms, a high-performance 3D HD vision system and instruments that work like wrists. The surgeon, guided by a high-resolution, enhanced three-dimensional image of the surgical field, manipulates master controls on a console to operate the robot’s arms. The dexterity of the robotic arms allows the surgeon to be even more precise than could be done manually or with traditional minimally invasive instruments. The system is designed to scale, filter and seamlessly translate the surgeon's hand movements into more precise movements of the EndoWrist® instruments. There are eight daVinci® robots in Canada, including two in London.

About London Health Sciences Centre
London Health Sciences Centre has been in the forefront of medicine in Canada for over 130 years and offers the broadest range of specialized clinical services in Ontario. Building on the traditions of its founding hospitals to provide compassionate care in an academic teaching setting, London Health Sciences Centre is home to South Street Hospital, University Hospital, Victoria Hospital and Children’s Hospital, two family medical centres, and Lawson Health Research Institute - a joint research initiative with St Joseph’s Health Care, London. As a leader in medical discovery and health research, London Health Sciences Centre has a history of over 30 international and national firsts and attracts top clinicians and researchers from around the world. As a regional referral centre, London Health Sciences Centre cares for the most medically complex patients including critically injured adults and children in Southwestern Ontario and beyond. The hospital’s 10,000 staff, physicians, students and volunteers provide care for more than one million patient visits a year. For more information visit www.lhsc.on.ca

For more information contact:
Mitra Foroutan
Corporate Communications and Public Relations
London Health Sciences Centre
519-685-8500, ext. 74772

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Call LHSC Switchboard at 519-685-8500 and ask to page the communications consultant on-call.