Infant who became the smallest to undergo robotic surgery is recovering

IOWA CITY, Iowa (AP) _ Amber Vairo has grown two inches and gained nearly a pound, and the three tiny scars on her belly have all but vanished _ along with any doubts she'd survive a complex surgery

Monday, March 14th 2005, 8:20 am

By: News On 6

IOWA CITY, Iowa (AP) _ Amber Vairo has grown two inches and gained nearly a pound, and the three tiny scars on her belly have all but vanished _ along with any doubts she'd survive a complex surgery to fix a life-threatening condition.

Last month, at just 5.6-pounds and six days after birth, Amber became the smallest patient in the world to undergo robotic surgery of any kind, according to her doctors at the University of Iowa Hospital and Clinics.

She was born with a hole in her diaphragm, the abdominal muscle that is critical to breathing and forms a wall between the chest and abdomen.

The condition, called congenital diaphragmatic hernia, can be fatal because the hole allows the intestines to migrate into the chest, putting pressure on the heart, lungs and spleen that can stunt organ growth or shut them down altogether.

``All signs are that she is recovering and will be just fine,'' said Amber's mother, Nicole Hines, who brought the infant home for the first time last week.

``She is gaining about an ounce a day and eating every two or three hours. It was all very stressful for a while. But I'm very glad with the way things went.''

So are doctors.

The little girl suffered from a particular type of congenital diaphragmatic hernia, according to Dr. John Meehan, who led Amber's surgical team. Known as a Bochdalek hernia, it affects about one in 3000 babies and has a 25 percent mortality rate, Meehan said.

Other children's hospitals have used robotics to fix diaphragm hernias, but those cases involved older patients with a different kind of hernia, hospital officials said.

Typically, surgeons use laparoscopic methods in such cases, extending their reach through tiny incisions with thin, long rods. But the rods are inflexible and allow little range of motion.

In Amber's operation, surgeons made three incisions, each no wider than the diameter of a ballpoint pen. Two provided a pathway for the robotic arms; the third for a pair of cameras providing a three-dimensional view.

``Was this life saving? Yes,'' Meehan said. ``But I think what is also interesting is this is a new way of treating a severe medical problems in newborns. We didn't invent a new operation here, but just used a different technique to get it done.''

The surgery lasted two hours.

``I started to worry about what could go wrong,'' said Hines, 26. ``I was very stressed, and paced and worried and drove my mother nuts. At one point I just had to stop myself, say my prayers and realize everything was going to be fine.''

Last fall, Meehan's team performed robotic surgery on a 5.7-pound boy. Meehan, however, said there are limits with the robot, and it's unlikely the benefits could outweigh risks to using it on a smaller person.

``Amber's size is about the limit of what we can do with the device,'' he said.

There are about 150 robotic systems nationwide.