Patricia Horn can't remember a time when she wasn't heavy.
"I've always struggled with weight. I've been on diets all my life," said the 49-year-old Camrose, Alta., resident.
But nothing has worked, so the morbidly obese woman recently agreed to be the guinea pig for a state-of-the-art bariatric procedure being offered in Edmonton: robotic-assisted gastric bypass surgery.
While this complex type of weight-loss operation is already done in the United States, it's the first time one has been performed in Canada.
A few weeks later, Ms. Horn's physicians are already seeing the results they wanted: she had no complications and a faster recovery time than she would have had with conventional gastric bypass surgery. And she's losing weight.
Bariatric doctors in Edmonton are hopeful that the innovative and less invasive procedure will help attract patients (about one-quarter of Canadian adults are obese), medical talent and resources to the city for this growing and still relatively new area of medicine.
Daniel Birch, who was behind the computer console during Ms. Horn's four-hour operation at the Royal Alexandra Hospital last month, said the robot is an invaluable aid to a surgeon.
"Doing this type of surgery has always been physically demanding," said Dr. Birch, who is medical director of Edmonton's Centre for the Advancement of Minimally Invasive Surgery.
A gastric bypass, a procedure that shrinks the stomach and allows food to bypass part of the small intestine, requires a lot of suturing because of the size of the patient and the area operated on. As a result, it can leave the surgeon tired, Dr. Birch said.
Suturing is a key area in which the robot can step in and help. "That's what the robot does well and probably does best," Dr. Birch said. "And of course it doesn't get tired, or sore arms or shoulders."
But the robot can't do everything, such as suction or place clips on bleeding tissue, so at least one surgeon must be in the operating room at all times while another controls the computer console. The operating surgeon must also prep the patient by creating the gastric pouch, which limits the amount of food that can be consumed.
A study that recently appeared in the Journal of Robotic Surgery found that robot-assisted surgery significantly lowered the risk of gastrointestinal leaks, a rare but serious complication.
Also, doctors have reported reduced patient recovery time because only small incisions are required.
On the downside, robotic-assisted gastric bypass surgery currently takes longer to perform than a conventional procedure, Dr. Birch said. However, he expects those times to come down as surgeons gain more experience.
Also, the technology is not cheap and the operations are more expensive than conventional ones. The robotic equipment (a U.S.-made da Vinci Surgical System) used in Edmonton for gastric bypasses and urological surgeries costs $4-million. The bill was shared between the province and the Royal Alexandra Hospital Foundation. Still, robots are increasingly being used in operating rooms across Canada for all types of procedures, including prostatectomies, pelvic surgery and hysterectomies.
For bariatric procedures, there is a long waiting list across the country: so long that many patients turn to private clinics and pay out-of-pocket for the procedure.
Ms. Horn is a single daycare worker, so that wasn't an option. "I couldn't afford to pay for it myself."
She waited two years to get into Edmonton's Weight Wise clinic, one of the few holistic, medically based clinics for obese patients in Canada. The clinic currently has about 1,700 patients from across Western Canada.
After receiving several months of counselling and other services, Ms. Horn was chosen to receive the robotic-assisted gastric bypass.
Before entering the operating room last month, she weighed 148 kilograms. Since the surgery, the 5-foot-9 woman has dropped two pant sizes and 12 kilograms.
"I have so much more energy now," Ms. Horn said.
