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University of Iowa News Release

Release: March 21, 2003

Children's Hospital Of Iowa Performs Pioneering Surgery

Pediatric surgeons at Children's Hospital of Iowa recently used a surgical robot to assist their removal of a tumor in the right adrenal gland of a 22-month-old Iowa girl - the first time the advanced technology was used for such a case.

Emanuel and Leona Troyer of Moulton, Iowa first noticed something was wrong when their young daughter, Loretta, developed a rash on her cheeks and a swollen face. When she began sprouting facial and body hair, they consulted their physician in Bloomfield. They next received a referral to the Ottumwa Regional Medical Center and were in turn referred to specialists at Children's Hospital of Iowa.

John Meehan, M.D. University of Iowa assistant professor of surgery at Children's Hospital of Iowa, determined that Loretta was an ideal candidate for minimally invasive surgery with the advanced technology that uses a surgical robot to assist the surgeon.

"Lab tests and our examination showed that Loretta had abnormally high steroid levels and a mass in her right adrenal gland," Meehan said. "Because the lesion was isolated to the right adrenal gland, we felt that using the robot would better enable us to remove the gland without damaging the right adrenal vein, which is very fragile, especially in such a young child."

In the four-hour procedure, Meehan made several very small incisions and then inserted a special camera and instruments to remove the tumor, all with the assistance of the computer-controlled precision of the robotic surgical system.

"Using the robot made it much easier to dissect and tie off the very short right adrenal gland vein," Meehan said. "We removed the entire tumor. We did not see any residual disease, and Loretta is doing very well."

Another key benefit of the minimally invasive surgical technique in such cases is a faster recovery. Patients who do not receive minimally invasive surgery to remove an adrenal gland instead receive a large incision and must stay in the hospital up to a week to recover. By contrast, Loretta's parents took her home just one day after her surgery.

"We are looking forward to getting back home," Emanuel Troyer said. "Loretta has had great care, and her outlook is good."

The robotic surgical system allows a surgeon to operate with instrument movements that can simulate hand and wrist movements. After the surgeon establishes 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 joystick-like controls to manipulate long, narrow, specially hinged surgical instruments that are inserted through small incisions in the patient. The remote-controlled 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 traditional surgery.

Information about the system can be viewed online at

The technology is currently 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 perform urological procedures such as radical prostatectomy for removing a cancerous prostate.

Children's Hospital of Iowa at UI Hospitals and Clinics in Iowa City is the state's longest-serving children's health care center. More than 100,000 children receive care at the Children's Hospital of Iowa and its outreach clinics across the state each year.

University of Iowa Health Care describes the partnership between the UI Roy J. and Lucille A. Carver College of Medicine and UI Hospitals and Clinics and the patient care, medical education and research programs and services they provide. Visit UI Health Care online at

STORY SOURCE: Joint Office for Planning, Marketing and Communications, University of Iowa Health Care, 200 Hawkins Drive, Room 8798 JPP, Iowa City, Iowa 52242-1009.

CONTACT: Tom Moore, 319-356-3945,