Smallest patient to receive surgery to correct an abdominal disorder using an advanced surgical robotic system

After spending more than seven months in the hospital following his premature birth, the parents of Dakota Templeton were hopeful that his worst medical challenges were behind him. Unfortunately, those hopes were not realized.

Dakota and his twin brother, Buddy, were born on July 21, 2003. Both boys received advanced care in the Neonatal Intensive Care Unit at the Intermediate Special Care Nursery in Children's Hospital of Iowa at University of Iowa Hospitals and Clinics in Iowa City. After four long months, their parents, Felicia Woolwine and Buddy Templeton of Clinton, were delighted when young Buddy was able to leave the hospital. Finally, three months later, Dakota followed his brother home.

Before long, Dakota's mother noticed that something was wrong. "He had problems eating and couldn't keep anything down," Woolwine said. "He would throw up, and he had trouble breathing. He was losing weight, and I knew that was not a good thing for a premature baby."

Dakota was not gaining weight properly. He had severe reflux that would not respond to medical therapy. He needed a procedure called a Nissen fundoplication, in which surgeons wrap the top part of the stomach -- called the fundus -- around the esophagus. This helps prevent food from escaping the stomach back up the esophagus.

At only 11 pounds, an open operation Nissen procedure would have posed several challenges for Dakota. The open approach involves a lengthy incision on the abdomen as well as an often-painful recovery. Dakota's premature lungs would have further hampered his post-operative recovery.

John Meehan, M.D., a pediatric surgeon with Children's Hospital of Iowa, offered Dakota's family an alternative approach. He proposed using the da Vinci robotic surgical system to help perform the operation.

"I felt that the robotic approach would offer several advantages for Dakota," Meehan explained. "Our experience in other patients shows that we can take advantage of the technology to do the same procedure, achieve just as good an outcome and help patients recover faster and get back to eating normally and growing again."

The procedure was performed with four tiny incisions ranging from one-eighth of an inch to one-half of an inch in length. The entire procedure took just over an hour. Using such small incisions results in significantly lessened patient discomfort, a shorter hospital stay and a faster recovery overall.

"Typically, children stay in the hospital for three to five days following an open Nissen fundoplication, and they can take several weeks to return to their normal activities," Meehan said. "In this case, Dakota was ready for discharge one day after surgery, and he was essentially fully recovered in two to three days."

At only 11 pounds, Dakota was the smallest child in the world to have this operation performed using the da Vinci surgical robot.

"Dakota is doing real good," his mother said. "His breathing is better, he's starting to gain weight again. I trust what the doctors here tell me, and I'm real happy with how he's doing."

The da Vinci robot is a complex instrument that allows a surgeon to perform minimally invasive surgery. 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 special hand controls to manipulate long, narrow, specially hinged surgical instruments that are inserted through the small incisions in the patient.

The complex 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 standard laparoscopic surgery and even traditional open surgery. 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 was the first medical center in Iowa to use the da Vinci system to repair a mitral valve in the heart and to perform urological procedures such as radical prostatectomy for removing a cancerous prostate and pyeloplasty for obstructed kidneys.