UNMC/NHS perform world's first urinary diversion with robotic surgical system
by Walter Brooks, UNMC public affairs
Surgeons at UNMC/NHS successfully performed the world's first ileal conduit urinary diversion using a
combination of the da Vinci Surgical System (computer assisted laparoscopic arms) and traditional
The combined technique now offers significant quality of life enhancement -- with greatly reduced pain
and recovery time -- for thousands of patients needing urinary diversions for various diseases affecting
the urinary bladder.
On Sept. 4, a team of five surgeons, led by K.C. Balaji, M.D., UNMC associate
professor, section of
urologic surgery, performed the complex ileal conduit urinary diversion on Frank
Holmead, an 83-year retired architect from Sidney, Neb.
The medical team included George Hemstreet, M.D., Ph.D., UNMC chairman of urologic
surgery; Paulos Yohannes, M.D., Creighton University assistant professor
in the division of urologic surgery; and Dmitry Oleynikov, M.D., and
Corrigan McBride, M.D., UNMC assistant professors in general surgery
and co-directors of the Minimally Invasive Surgery and Robotic Initiative.
About the surgical procedure
The ileal conduit urinary diversion procedure consists of using a 6-inch section
of bowel to connect the two ureters (the tubes that drain urine made
by the kidneys) on one end, and turned into a stoma for external drainage
through a stoma bag on the other end. Although urologists all over the
world perform this procedure, almost all urologists are only trained
in the open method -- making large incisions to allow the surgeons hands
inside the body to do the intricate maneuvers.
"The primary reason most patients suffer permanent loss of bladder function is
due to bladder cancer,"
Dr. Balaji said. "There are 50,000 cases of bladder cancer diagnosed in America
each year now and at least 5,000 or more of these cases result in the complete
removal of the bladder."
Creighton University's Paulos Yohannes, M.D., and UNMC's George Hemstreet, M.D.,
Ph.D., and K.C. Balaji, M.D., participate in Thursday's press conference.
Holmead's bladder was severely scarred during radiation treatments for prostate
cancer 20 years ago. He suffered from side effects for 15 years that included
progressive incontinence due to irreversible damage to the bladder and external
sphincter from the radiation, recurring bladder infections and constant wetness
due to urinary incontinence necessitating two or three layers of adult diapers
every day. The treatment options
In the last six months, Holmead was hospitalized for multiple urinary infections,
spasms and bleeding. Holmead and his wife, Phyllis, sought a second opinion from
Dr. Balaji with regard to further treatment options. Dr. Balaji believed that
instead of removing the entire bladder, an ileal conduit urinary diversion would
produce the same symptomatic relief without the added risks of bladder removal
in an elderly patient.
"Dr. Balaji made it clear from the beginning that this would be a new surgical
method," said Phyllis
Holmead, Frank's wife for 33 years. "His communication with Frank and I was outstanding.
He never dodged or evaded a single question. He never talked down to us. He described
in detail how he planned and rehearsed the surgery. And what really meant a lot
to our family was that Dr. Balaji -- during the 10 hours of surgery -- repeatedly
called me in the waiting area and updated us on what was being done and how everything
On the leading edge
Only a handful of medical centers even do traditional laparoscopic urinary diversions.
The UNMC/NHS commitment to use the da Vinci Surgical System in diverse surgical
procedures puts the medical center on a competitive footing to become the regional
center -- if not national destination point -- for the world's least invasive
urinary diversion procedure, Dr. Balaji said.
"Without the da Vinci, this would have been a lot harder to do -- especially
the intricate suturing that has to be done inside the closed body," Dr. Balaji
said. "The team effort was incredible. Dr. Hemstreet
was very supportive of the procedure, involved in the planning process from the
beginning and attended the surgery. Dr. Yohannes, the outstanding laparoscopic
urologist, brought great expertise from Creighton throughout the entire procedure.
Drs. Oleynikov and McBride also assisted in the planning processes, did a lot
of the clinical laboratory work in advance of the surgery, and Dr. McBride did
excellent work on the bowel resection for the conduit.
"This is the kind of collaboration that allows all of us to pursue new procedures
and continue to build up Nebraska as a national competitor -- if not leader --
in increasing areas of medicine."
Holmead didn't even have a recovery period in intensive care, a routine expectation
for such an invasive surgery after traditional methods. He went to a regular
room and left the hospital in three days. He was taken off intravenously administered
pain medication within 24 hours of surgery. Instead of a several inches long
abdominal incision required under the traditional method, Holmead had four small
incisions -- each less than a half-inch long -- where the da Vinci robotic arms
were inserted. Phyllis Holmead said her husband had no bruising whatsoever at
the insertion points and now it just looks like he has "a couple of extra navels." In
less than a week, Holmead was changing his own stoma bag and showing outstanding
"I feel fine," Holmead said. "At my age and condition, this wasn't about making
some kind of radical change in my life. But it really means a lot to just be
finally free from pain and recurring infections. And I no longer have to wear
diapers for the first time in years."
Date Published: Friday, September 20, 2002