Operating with 'da Vinci' Precision:
Craig Albanese, M.D.

Lan Pham holds her 4-month-old son, Daniel, nearly a month after surgeon Craig Albanese, M.D., used the da Vinci robot to repair a blockage in the infant's liver.

SPRING 2004 - When little Daniel Pham underwent complex liver surgery at Stanford Medical Center last January, one member of his surgical team was nearly seven feet tall and had three arms. Guided by surgeon Craig Albanese, M.D., who sat at a video console nearly 10 feet away, a giant robot known as da Vinci assisted in the unprecedented five-hour operation.

Daniel was born with a blockage of the duct that delivers bile from the liver to the small intestine. Left untreated, it results in severe jaundice and liver failure. To start the complex repair procedure, the surgical team made several small incisions in the baby's abdomen, then carefully inserted a thin telescope and two slender robotic arms tipped with tiny surgical instruments. Then, by manipulating joysticks and foot pedals connected to the robotic arms and scope, Albanese was able to zoom in for 3-D views, remove the obstructed duct and then suture it to the small intestine -- a complicated technique knows as the Kasai procedure. When the operation was finished, baby Daniel was left with just five little scars on his tummy, each small enough to be covered with a Band-Aid.

Albanese, who joined Packard nearly two years ago as director of pediatric surgery, is a pioneer in the use of minimal access surgical techniques to treat infants and even fetuses with congenital abnormalities. But he says this new da Vinci robotic system takes the art of minimal access surgery to an even higher plane. "It’s so fine and precise; it's wonderful," the father of two raves about the robotic device. Compared to traditional surgical tools, he says, "It's the difference between a little scooter versus a Porsche Carrera."

The surgical team poses for the camera in a quiet moment before surgery. From left to right: Claire Abrajano, P.N.P., Craig Albanese, M.D., Rosette Reyes, R.N., David Le, M.D., and Tom Krummel, M.D.

Albanese says the robotic system is ideal for long, complex procedures, in part because it’s so comfortable to use. The surgeon can stay seated throughout the operation, resting head and arms on the console. Da Vinci's camera can produce three-dimensional images of the patient’s internal tissues up to 10 times their normal size, and its slender arms can firmly grasp and rotate tiny cutting and sewing instruments 360 degrees -- just like a human hand and wrist, only steadier.

For the small patient, the benefits of such minimal access surgery are huge. Besides the lack of scarring, minimal access allows children to eat, drink, and get out of the hospital much faster, and with far less pain medication. In Daniel's case, that meant more time at home in San Jose with his twin baby sister. "It was a very long day," his soft-spoken father Loi recalls of the operation, "but I am happy now." As his relatives in Vietnam assured him, "In America, they can fix almost anything."