Diabetes Dramatically Improved-Pat Dittilo Shares in an Email

I received this Email from Pat Dittilo last week and she has agreed to share this with all of my readers. She said would like to encourage as many as possible. Here is what she shared:

Dr. Myers,

Hope you are doing well in your new position. I wanted to give you an update on my status since you and I have talked several times about the surgery and diabetes. I had a robot assisted gastric bypass by you in October of 2010, about 18 months ago. I was your 13th or 14th robotic case. I had type 2 diabetes diagnosed about 5 years before my operation and was on oral medicine as well as 10 micrograms of Byetta that I had to inject three times a day in addition to injecting 105 units of long acting insulin twice a day.

You may remember that my diabetes was out of control – my A1C was 11.7 and while I haven’t had it tested recently, my last A1C was 7.1 six months ago, (i will be having it checked again soon). I wanted to let you know that my sugar level yesterday and today were 94 and 89 and I am not taking any diabetic medication. I am so pleased and happy about my decision to have the surgery and even more pleased that you were here to do that for me. I have maintained my weight at 138 for over a year and I feel awesome. In addition to not taking any medication for my diabetes, I also no longer take medication for my blood pressure like I was before and my sleep apnea is completely gone. I’m 55 (almost 56) and I feel like a kid again. I have more confidence than I’ve ever had in my life.

It’s funny that so many people are more aware of the results of the surgery for those who have diabetes and the media attention it’s getting. Almost weekly I see something in the news about how people with diabetes are no longer dependant on insulin or completely cured. I can’t tell you how wonderful it is to wake up every day and not think about having to take those shots. I can eat without worrying about injecting the Byetta 30-60 minutes before I eat and how it made me sick to my stomach sometimes.

Thank you again for everything you did for me – I never thought I would feel so good again. Living my life without drugs and machines is a blessing, not to mention going from a size 18-20 to an 8-10!

God Bless you and your family. You are truly an Angel in many people’s lives.

Pat Dattilo

Why Robotic Bariatric Surgery?

Using a robot to perform a Roux en-Y gastric bypass brings significant value to patients.

I had performed at least 800 gastric bypass operations laparocopically without q robot before I began to perform this operation with the help of a surgical robot. The robot does not perform the operation but helps me perform the operation with more precision and with allowing me to see better.

I compared the last 100 gastric bypass operations I performed without a robot to the first 100 gastric bypass operations I performed with a robot. I found the following:

1). It took more time to perform the robotic operations. On one hand this is not surprising since I had performed so many laparoscopically and had the opportunity to decrease the time it takes me to perform the operation in that way. On the other hand it will take time for me to continue to to improve on the time.

2). Most patients in the robotic group left the hospital the day after the operation while most of the patients that had a gastric bypass operation without the use of the robot left the hospital after 2 days.

3). The patients in the robotic group had less bleeding. in fact only one patient in the robotic group received even 1 unit of blood whereas 5 patients in the non-robotic group received blood and they each received an average of more that 2 units of blood. I believe this is because I can see better, perform the operation with more precision and with the help of the robot I am able to perform some of the connections with sutures instead of staples.

4). There was no increase in complications with using the robot even though these were my first 100 operations.

Although it took a lot of patience and effort to learn to perform a gastric bypass with the surgical robot, I believe it was more than worth it.

Today most gastric bypass operations are performed laparoscopically without a robot. There is nothing wrong with having an operation in this manner and in fact this would be the choice for most surgeons. However, the robotic approach is being used by more surgeons and in my practice I have shown that I have even less complications when I use the robot.

If you have questions please let know and I will be happy to do my best to answer them.

Testimonial Robotic Gastric Bypass

Tom Cocran had a robotic gastric bypass operation 4 months ago. He is 6 ft 4 inches tall and weighed 356 lbs. He lost 60 lbs in the Fresh Start Bariatrics program prior to surgery. He has now lost a total of 114 lbs. He no longer has type 2 diabetes with a normal HbA1c. He is no longer on diabetic or blood pressure medicine. He also no longer is on his CPAP machine for sleep apnea.

Tom shared this at the Fresh Start Seminar on April 16, 2011.

Patient Testimonial after Robotic Gastric Bypass on How Her Pain is Controlled

Jill Ehrhart had a robotic Roux en-Y gastric bypass just 9 days ago by Dr Myers at Fresh Start Bariatrics at Riverside Methodist Hospital in Columbus, Ohio. She explains what she experienced and how her pain is controlled after her operation.

Robotic Gastric Bypass

Kathy Tells How Her Type II Diabetes was Resolved with a Robotic Gastric Bypass

Robotic Bariatric Surgery and Improvement in Pain

The results of our first 50 robotic gastric bypass operations have now been completed. The most dramatic difference we have noted is that our patients who have had robotic operations are much more comfortable following surgery and are leaving the hospital the day after surgery in the vast majority of cases.

At the live bariatric surgery seminar I gave last Saturday,as usual one of our patients volunteered to share her journey through our program. She had lost 135 lbs over the last year and is clearly doing very well. However, one thing she said took me by surprise. She explained that she experienced considerable pain at the one incision in the left side of the abdomen for several days after her operation. The reason this was surprising to me is that I remembered how much discomfort this particular incision caused many of our patients and that I have not heard this at all for the last several months since we have been using the da Vinci Robot.

This is a remarkable change. Previously we made an incision a little over an inch in size that allowed the passage of a fairly large circular stapler into the abdomen. This required the spreading of the muscles at this location which caused much more pain than the small incision we use with the robot.

Using the robot allows me to perform the connection between the gastric pouch and the Roux limb with two rows of stitches instead of using a circular stapling device. Of course the stitches, which we call sutures, are easily passed into the abdomen without any additional abdominal openings. In fact we have been able to decrease the number of incisions from five incisions we previously used and now use only four smaller incisions.

The result is much less pain and the ability to leave the hospital the day after surgery.

It is a privilege to be the only bariatric surgeon in central Ohio using the da Vinci Robot to perform the gastric bypass operation and to be one of the very few surgeons in the country to use the da Vinci Robot routinely to perform a Roux en-Y gastric bypass. It is wonderful to work Riverside Methodist and have the privilege to use today's most advanced technology to improve the lives of so many people.

Robotic Surgery Update

We have now completed our first 44 robotically assisted gastric bypass operations. I am pleased to report that our patients are doing well. We have had no leaks and no transfusions. Most patients are now going home the day after surgery. Surgical pain is much less and patients seems to be pain free on their first office visit after surgery at 1 week after the operation.

We have needed to dilate one patient who developed a narrowing between the gastric pouch and the Roux limb of the small intestine.

We now are completing the operations in 2 hours.

Update on Robotic Bariatric Surgery at Fresh Start

This is just a quick update on our robotic gastric bypass operations. We have now completed 23 Laparoscopic Roux en-Y Gastric Bypass operations with robotic assistance. We have had no complications from the robotic portion of the operation and the only complication was the infection from the non-robotic small intestinal connection that we reported in the previous update. The robotic portion has reduced in time from 2 hours to 45 minutes and most patients are now going home on the day after surgery. Overall I am delighted with our progress to date.

Results of the First Eleven Robot Assisted Gastric Bypass Operations at Fresh Start

Left: Dr. Myers, Right: Mike Palasek, CRNFA, Robot, named "Bow Tie" center





Over the last few weeks I have been privileged to several Robotic Assisted Laparoscopic Gastric Bypass operations. I am very pleased with the initial results and I would like to share them with those who follow this blog.



Number of operations performed 11

Converted to open operations 0

Number of incisions required 4, which is 1 or 2 incisions less (2 5 mm ports and 2 12 mm ports)

Total lentht of incisions decreased by 50%

Discharged day after operation 50%

The length of time required to perform the operation has improved from 3 hours 30 minutes to 2 hours 20 minutes.


In addition, we have noted the patients have much less pain in the hospital and denies any pain at the 1 week visit.

One patient was rehospitalized for an infection not related to the robotic assistanc and they are improving nicely.

Overall patients are doing very well. I will keep you informed of further progress.

Early Results from Our First Robotic Gastric Bypass Operations

“It’s amazing”, Robyn Blake told me in the office today. She is just one week from her robotically assisted laparoscopic Roux en-Y gastric bypass and she is thrilled with her results. ‘I only took one pain pill a day for the first 2 days after I was discharged from the hospital.”

“The results are not subtle,” Mike Palasek, CRNFA who assisted with each of these operations told me today. “The patients who had their operation robotically are having much less pain.”

We have now completed our first four robotically assisted gastric bypass operations. Both are doing very well. Two of these patients went home the day after their operation instead of two days later. The patients appear much more comfortable the day after the operation.

Overall I am very impressed with these very early results. There are only 4 incisions and these are smaller and healing well without a drain or staples.

I agree with Robyn, the results are amazing.

Update on the Use of the da Vinci Surgical Robot

Last Tuesday, September 14, 2010, I was privilegded to perform 2 gastric bypass operations with the assistance of the da Vinci surgical robot. Although it is always challenging to begin to use new technology, both patients did well and one left the hospital after only one night stay.

The following is an exert from an email sent out by a representative of the company that makes the da Vinci robot to some of the Medical staff at our hospital. I thought you might be interested in this anouncement:

"OhioHealth has established itself as a leader in robotic surgery and Dr. Myers has established himself as a leader in bariatric surgery. This is another application where da Vinci is helping surgeons deliver minimally invasive surgery to a broader base of patients every day. Dr. Myers gave the following reasons for using the da Vinci for his gastric bypass procedures:

1. Stronger anastomosis
2. Patients are less likely to bleed
3. Less incisions - reduced from 5 to 4 with about 50% reduction in incisional "footprint"
4. Less pain at trochar sites
5. No need for largest incision to pass circular stapler

Dr. Erik Wilson from the University of Texas Medical School at Houston proctored Dr. Myers with the use of the dual console da Vinci Si system."

This important device will be able to help make this operation even safer and better. I will have the oportunity to use the robot to perform a gastric bypass for three more patients in the coming week.

Learn more about the da Vinci robot at www.IntuitiveSurgical.com

Preparing to Perform Robotic Assisted Bariatric Surgery

Preparing to Perform Robotic Assisted Bariatric Surgery

My wife and I were at my parent’s home last weekend. Our conversation included my plan to begin performing robot assisted bariatric surgery. They asked a great question, “How have you been training to use the robot?”

I thought you might be interested in my response.



First, it is important to remember that I have been performing the Laparoscopic Roux en-Y Gastric bypass for over 7 years and have performed nearly 800 of these operations.

Second, I plan to begin by performing only a part of the operation using the robot.

Third, using new advanced technology to perform this operation is much like an experienced professional pilot training to use a new airplane to fly a familiar air route.

As you might imagine Riverside Methodist Hospital has a pathway each surgeon is required to complete to become credentialed to perform operations with the assistance of a robot. I have exceeded the requirements and followed the following 10 steps in the path to preparation:

1). Observed two operations performed by Dr. Michelle Toder in Bangor Maine in July 2010 and was very excited by the capability of this remarkable instrument.

2). Informed the hospital of my interest in robotic surgery

3). Reviewed about at least 8 hours of video of the operation performed using the robot

4). Observed an operation with Dr. Burges at Riverside

5). Completed an all day training session performing several operations with a certified instructor

6). Logged at least 8 hours of independent practice on the robot

7). Choreographed each step of the operation with the operation room staff during a mock operation

8). Received temporary privileges to perform robotic surgery from Riverside credentials committee

9). Obtained consent from the first 2 patients to perform their operations using the robot

10). Arranged for Dr Erick Wilson, a very experienced robotic surgeon from Houston, Texas, to be present in the operating room during the first two operations using the robot as my “proctor” or supervisor tomorrow, (9/14/2010)

Now I am ready to get started! Maybe I should watch “Top Gun” once again before we start the operations!

Robotic Surgery Holds Great Promise for Bariatric Surgery Patients.

As many of you know, qver the last several weeks I have been observing robotic surgery, logging time practicing on the newest robot and doing a lot of planning for my first robotic gastric bypass operation scheduled on September 14th , just a little over two weeks from now.

Today I spent the entire day training in the robotic laboratory at Good Samaritan Hospital in Cincinnati, Ohio. It was an intense day with many hours in the console of the robot performing several operations, learning to “dock” the robot to the ports and instruments and learning much more about this elegant and sophisticated machine.

The training will continue nearly each day in preparation for the first operations but everything is progressing very smoothly.
I must say, I believe the da Vinci Robot is very likely to bring considerable value to my gastric bypass patients. I am even hopeful that many will be able to go home the day after surgery since I believe I will be able to decrease the incision “footprint” by about 50% and there should be even less discomfort involved with this operation.

Congratulations to Intuitive Surgical, Inc. for many improvements in the newest model of the da Vinci robot!

Posted by Stephan Myers, MD, FACS, bariatric surgeon, Columbus Ohio

Robot and Bariatric Surgery

When using the Da Vinci Robot to perform bariatric surgery I begin the operation at the operating table placing the robotic scope and instruments as I would in a standard laparoscopic operation. I then sit at a consol in the same operating room and thereafter all robotic movements of instruments are controled by me.

The veiw is much better because I can see in 3-D since the scope is a binocular scope. Also most of the instruments are "wristed" alowing me to reach angles that are not possible with standard laparoscopic techniques. If I need an instrument to be changed the first assistant and scrub nurse are continuously at the side of the patient and they will remove one instrument from the robot and attach another at my command. Interestingly, the robot "remembers" exactly where the previous instrument is located within the abdomen and placed the instrument in the same location only a short distance from the previous point to protect the patient from any possible injury.

The placement of stitches is more exact and I am able to see much better with the robot than with other techniques.

I am very pleased Riverside Methodist Hospital presently has 2 of these advanced robots with a third to be installed by mid-September.

Written by Stephan Myers, MD, FACS, bariatric surgeon in Columbus, Ohio.

Da Vinci Robot and Bariatric Surgery

I have been pondering the possible place for the Da Vinci Robot in bariatric surgery for a few years. Although it is an expensive device, (about 2.5 Million dollars per robot), I am now convinced there is very real value for bariatric patients and their surgeons.

First, he patient is likely to benefit by having less incisions decreasing from four ¾ inch incisions and one 1 ¼ inch incision to two ¾ inch incisions and two ½ inch incisions. This alone should decrease pain and shorten recovery time. In addition the robot “remembers” the point each device passes through the abdominal wall and pivots at this point decreasing the trauma to the abdominal wall tissues thus decreasing pain even more.

Second, the surgeon can see better since the view is a 3 dimensional view instead of the 2 dimensional view with standard laparoscopy. The better the surgeon can see the safer the operation. Who wouldn’t like there surgeon to see as well as possible during their operation?

Another issue is the reduced wear and tear on the surgeon. Operation on persons of size is physically demanding and allowing the robot to take the physical load while the surgeon is guiding every move of the robot while sitting comfortably at the console may add years to the length of a surgeons career.

Two weeks ago I spent the day in New England with Dr. Toder who performed 2 gastric bypass operations that day. It was clear to me that using the Da Vinci robot would be of benefit to our patients.

Riverside presently has 2 robots and they will be installing the third and most up to date robot in the operating room I usually use to do bariatric surgery operations by the middle of September 2010.

Over the next 6 weeks I will be training on this new instrument. I am hoping the robot will reduce the number of days a patient stays in the hospital from 2 days to one day.

I will post regular updates as we make this transition to this advanced technique to keep you informed.

Innovation in surgery keeps life exciting for Dr. Myers

I am sitting in the Reagan National Airport before leaving Washington, DC to return home to Columbus, Ohio after attending the 12th World Conference for Endoscopic Surgery.

As I reflect on my 25 years as a surgeon it is amazing to me how much the techniques of surgery have changed. The principles of tissue healing and infection control still are basically the same but how we do what we do is very different.

When I completed my surgery residency in 1985 nearly all operations were done through large incisions in the abdomen. The only laparoscopic operations were tubal ligations and viewing the pelvic organs. In 1989 a major revolution began to occur as surgeons began to use the laparoscope to do abdominal operations. First I learned to perform gallbladder operations laparoscopically then I, as well as many other general surgeons, learned to do other operations using minimally invasive techniques such as groin hernias, abdominal wall hernias, colon operations and stomach and small bowel operations.

Nearly 7 years ago I began to do bariatric operations and as I began I applied the laparoscopic approach pioneered by Dr.Allen Whitgrove from San Diego who reported the first in human laparoscopic Roux en-Y gastric bypass in 1995.
Now, although I restrict my practice primarily to bariatric surgery, even complicated revisions and bowel resections and other complicated operations are done with minimally invasive techniques. Today I can go months without doing an operation through a larger incision.

There are other skills we are acquiring as well to enhance the practice of surgery. For instance yesterday I learned to do video editing so I will be able to present digital videos of procedures to my patients, to other surgeons and to the public. Since nearly every operation I do is projected in High Definition on several TV screens in the operating room, it is a simple matter to record this digital information to be edited for later use. I would never have thought this would be an important part of a surgeon’s life but it is beginning to be so just like using the internet to communicate in forms such as this blog.

Today I spent the morning practicing on a new edition of the Da Vinci Surgical Robot. The new edition is very interesting and may bring additional value for our patients in less pain and quicker recovery. It may also be less wear and tear on their surgeon!

These 25 years have been an exciting ride with new innovations nearly every year and it continues even to this very day.

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