Dr. Michael Irish’s youngest surgical patient was just 5 days old when Irish successfully operated to remove a cyst near the newborn’s heart.   

Irish performed the bulk of the three-hour procedure across the operating room from the patient, seated at a console from which he maneuvered robotically controlled instruments, guided by a tiny camera that, with the instruments, were inserted through a small incision in the child’s chest.  

A pediatric surgeon with Blank Children’s Hospital, Irish has performed 33 such robotically assisted operations since the high-tech system was installed two years ago at Iowa Methodist Medical Center, which like Blank is an affiliate of Iowa Health-Des Moines.  

“We began with the big patients and gradually made our way down to newborns,” said Irish, whose 5-day-old patient was the youngest in the world to be operated on by robotic surgery last October.   

Blank earlier this month hosted an international symposium in which leading surgeons doing robotically assisted procedures met in Des Moines to discuss techniques. One result of the conference will be a centralized database for surgeons using the robotic systems to share information.   

“We see (robotically assisted surgery) as one of those quantum leaps in health care,” said David Stark, chief operating officer for Iowa Health-Des Moines. “It’s the kind of service that a level-1 trauma center and tertiary care center should be providing.”

Iowa Methodist was the first hospital in the state to invest in the technology, which is now also used at the University of Iowa’s Carver School of Medicine.   

Stark said Iowa Health’s board of directors is supportive of adopting new technologies early to allow its hospitals to better acomplish their missions, and that the medical staff also pushes for what they see will become the standard for care.   

The system represents about a $1 million investment for Iowa Health, which funded the bulk of the cost from its foundation. Blank and Methodist are not charging patients any more to use it than they would pay for any other non-invasive surgery.

“We feel strongly about the technology and that it’s an investment on our part, not on anyone else’s part,” Stark said. “So we never even entertained charging more for it.”

Benefits of the robotically assisted surgery for patients include shorter hospital stays, less pain and quicker recovery times, he said.

“The longer-term piece is that this is a technology that is going to have more applicability in more service lines down the line, such as cardiology and urology,” Stark said. “We’re looking at how this going to position us for five, 10 years down the line.”

Irish said the robotic system is well suited to more complex procedures that require more dexterity than is possible with conventional minimally invasive means.

“The very small (5-day-old) baby we operated on, we removed a cystic mass,” he said. “That could have been done thoracoscopically, or with a chest incision, but it could be performed with more precision with the robot. Also, there are some surgeries requiring a very delicate touch that may be done better by robot.”   

The technology, known as the da Vinci system, provides the latest capabilities in performing what is known as minimally invasive surgery, but with better control through the use of tiny robotic arms and an endoscope, a camera that provides three-dimensional images from inside the patient’s body. The da Vinci system’s control console translates the surgeon’s hand, wrist and finger movements into minute movements of the instrument tips, which are positioned inside the patient’s body.

“There’s no time delay to this whatsoever,” said Irish, who said the endoscope gives him a 3-D view inside the body. “That’s an important aspect to this, because it tells you how far you can push or manipulate something and know how far you have to go.”

Irish, who trained for 10 years to become a pediatric surgeon before joining Blank in 2000, said hospitals will need to perform more procedures with the technology to determine whether it’s truly more effective than more conventional techniques.

“There are many advantages, but whether we can transfer those from the micro (level) to the macro remains to be seen.

Out of the 33 patients he’s operated on using the system, three have had complications, but none that wouldn’t be typical for that type of surgery, he said.

“I think the importance of this for any medical center in actively embracing technology is very basic: it translates into the best, state-of-the-art care for our patients,” Irish said.

“The most important thing is that we understand this is new technology and that we move forward safely. This is not something you put in your medical center and say, ‘I’m going to start hitting home runs with this.’”

IOWA HEALTH TO OFFER HIGH-TECH RADIATION TREATMENT

Some hospitals are lining up to buy the latest version of a technology that pushes the success rate for treating some brain tumors into the 80-90 percent level.   

The John Stoddard Cancer Center at Iowa Methodist Medical Center plans to purchase a system that provides near-pinpoint delivery of radiation for treating tumors. Known as stereotactic radiosurgery, the non-invasive procedure allows tumors to be treated while exposing far fewer healthy cells to radiation.

“We’re currently in the evaluation phase with medical staff and the board of directors about what (company’s) technology we should adopt,” said David Stark, chief operating officer for Iowa Health-Des Moines, which operates Iowa Methodist. “This will be a key advancement in cancer care that we’ll be able to do right here in Des Moines.”

The system will be used on children and adults with primary brain tumors as well as tumors from cancers that have spread from elsewhere in the body. It can also be used to control benign tumors before they grow large enough to cause damage.

With the new technology, “we can hit just the tumor with a 1- to 2-millimeter margin,” said Dr. Joseph Rhoades, a physician with the cancer center’s radiation oncology department. “What we’re seeing is less side effects, less effect on memory.”

The image-guided therapy constantly monitors the procedure to ensure the radiation is hitting only the intended treatment area, he said.

The systems, which cost in excess of $1 million, are in high demand, and it will take up to a year to get one once it’s ordered — with payment required upfront, Rhoades said.

Iowa Methodist will be the only medical center in the state outside of the University of Iowa to have the system.

“We’ve been sending our patients there,” he said, “but they told us, ‘We can’t keep up,’ so they told us to go ahead and get our own.”