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Dr. Jon Dangerfield sits next to the robotic instrument used to remove a mass in Brooke Conlin's abdomen. Dangerfield operates the "arms" of the robot while viewing an enlarged version of the surgical target on a screen. The new technology has meant greatly reduced recovery time in patients. Photo by Michael Smith, Sanford Photography
Dr. Jon Dangerfield sits next to the robotic instrument used to remove a mass in Brooke Conlin's abdomen. Dangerfield operates the "arms" of the robot while viewing an enlarged version of the surgical target on a screen. The new technology has meant greatly reduced recovery time in patients. Photo by Michael Smith, Sanford Photography

Robotic technology in the OR: Grand Forks woman has cysts removed by da Vinci SI robot

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news Dickinson, 58602
Dickinson North Dakota 1815 1st Street West 58602

GRAND FORKS -- Last fall, Brooke Conlin of Grand Forks had three massive cysts in her abdomen -- one was half the size of a football, the others were each as big as a grapefruit.

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She had no idea they were there.

The 29-year-old had noticed unusual back pain, which she thought might be caused by sciatica, discomfort that originates in the sciatic nerve, or possibly colitis, an inflammation of the large intestine. She'd had experience with these conditions.

Consulting with doctors, ultrasound testing revealed the cysts.

"We didn't see it coming," she said.

She learned the cysts were the result of endometriosis, the growth of cells from the lining of the womb (uterus) in abnormal locations.

She was referred to Dr. Jon Dangerfield, an obstetrician-gynecologist at Sanford Health in Fargo, who also practices at the health system's clinic in East Grand Forks, Minn. Conlin was relieved when he told her "right away" that the cysts were not cancerous, she said.

She had two options to remove the cysts, she said: undergo traditional surgery, which would involve cutting open the body, or have a surgical procedure using robotic technology only available in this area at Sanford Health in Fargo.

Robotic surgery requires incisions, about 1 inch long, through which instruments, including a camera, are placed. Carbon dioxide is pumped into the cavity to the camera to capture and convey the internal "landscape."

The surgeon operates on the patient using computerized equipment that he controls and manipulates at a console about 10 feet from the patient.

With the view provided by the 3-D, high-definition camera, he uses various tools -- to pinch, cut, cauterize, remove tissue -- as he watches his progress on a screen.

"The view is so wonderful," Dangerfield said. "It's better than if I had opened her up."

With this technology, he is able to move tools around in awkward places and operate "at weird angles."

'da Vinci SI'

Conlin elected to have the robotic procedure because "it was a less-invasive surgery, the recovery time would be much shorter and, because of the smaller incisions, you're not all scarred up.

"It was kind of a no-brainer," she said.

From the time of her first visit with Dangerfield to her surgery, three weeks later, the cysts grew. There was no time to waste.

Conlin's parents, Lynn and Dave Roche of Grand Forks, were concerned "that I was going to be alright," she said. Her father "was a basket case."

She arrived at Sanford Health in Fargo early Dec. 14 with her husband, Tom, and had surgery the same day.

In the operating room, Conlin recalls her first glimpse at the robot, "da Vinci SI." It's the third generation of this type of equipment that was originally launched in 2001, Dangerfield said.

"It was a big silver thing with these arms, or tentacles," she said.

After one night in the hospital, she was released. If she had undergone the traditional surgery, "it would have meant a stay in the hospital for three or four days and a significantly longer recovery time, about six to eight weeks," Dangerfield said.

"She would have had a large vertical incision because of the size of the masses (inside her), probably 12 inches long."

With robotic surgery, the risk of infection is reduced, he said, and it's been estimated that pain is decreased by 80 percent.

Robotic surgery

Dangerfield began performing robotic surgery about four years ago, after more than a year researching the technology.

"Sanford in Fargo was one of the first 15 places in the world to use da Vinci," he said. "It's now used in several thousand locations around the world."

Instrumentation is so sophisticated and precise that a skilled surgeon can use it to peel the skin off a grape, Dangerfield said. One of his colleagues can do origami, the ancient Japanese art of intricate paper-folding, using the technology.

The da Vinci technology has been adopted by other Sanford surgeons in the fields of obstetrics-gynecology, heart and lung surgery, and urology, he said.

In robotic surgeries, Dangerfield relies on a team of assistants who make sure the patient is positioned correctly and safely and is properly prepared for surgery. During surgery, an assistant can handle tasks such as suctioning through an incision.

Dangerfield is "excited" about how the technology has opened new horizons in surgery, he said. "I'm like a kid in a candy store. Now, there are all these things I can do."

The only problem, though, is that "people feel too good too fast.

After traditional surgeries, which required deep and longer incisions in the body, "most patients didn't feel like moving for four to six weeks," he said. After robotic surgeries, "patients want to go jogging the next week.

"I have to tell them they need to take time to heal," he said.

Transition

At Sanford, "the staff overall was exceptional," Conlin said. "I had such a great experience through the whole thing."

Had she undergone a traditional surgery, the trauma to her body and the required recovery time "would have been like having a C-section," she said Dangerfield had told her.

Instead of a large scar, Conlin has five marks "that look like lines," measuring a little more than an inch, on her abdomen, she said.

Not that noticeable, but "I won't be wearing a string bikini."

The stitches that closed the incision were internal, "came to the surface and eventually dissolved," she said.

Arriving home after the surgery, "the first day was probably the hardest," she said, "making the transition to home and back to bed."

The next week, she was determined to go out Christmas shopping, despite Tom's concerns.

"I had two more gifts to get," she said. The shopping left her tired, "but I wasn't in pain."

The couple were able to go to Williston, N.D., to celebrate the holiday with Brooke's in-laws.

"We definitely would not have been traveling" if she had undergone the traditional surgery, she said.

Smooth recovery

She's still "on an adventure with Sanford," she said.

Because her endometriosis was severe, she and Tom will be unable to conceive naturally, she said. They plan to explore alternative paths to parenthood with fertility specialists at Sanford.

Conlin is on a medication that treats the endometriosis and prepares her body for the next step toward becoming a mother.

The medication "puts my body into a pre-menopausal state, so I'm having hot flashes -- at 29 -- at night," she said with a laugh. "If that's the worst thing, that's fine.

"I know I'll have to have a hysterectomy at a young age," she said, but she hopes to have one or two children before that becomes necessary.

The robotic technology can also be used for hysterectomy, she said.

Dangerfield recommends that women faced with the prospect of having a hysterectomy with surgery that opens the body consider getting a second opinion.

When given the option of having robotic surgery, some patients are fearful, Dangerfield said. "I think it's just the fear of the unknown. ... They think the machine is doing the work.

"I tell them it's an instrument that allows us to do the work. I'm still doing the surgery. It's instrumentation that makes it easy and much better for the patient."

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