Marilyn Williams ordered an appetizer quesadilla for lunch and a to-go box for the leftovers.
There would definitely be leftovers, she said.
"About one section and I'm full," said Williams, of Lansing.
The 52-year-old is adjusting to her new life since receiving gastric bypass surgery on Nov. 22, two days before Thanksgiving. MSU surgeon Dr. Jeff Gauvin performed the surgery, the first in Michigan using robotic surgery arms. Gauvin is an assistant professor and a general surgeon at Lansing's Sparrow Hospital.
The procedure, which is a type of weight-loss surgery, makes the stomach smaller and allows food to enter directly into the intestinal system. For the 9 million Americans who are fighting severe obesity with no success, it offers a last resort.
After losing almost 50 pounds and counting, Williams said she goes out with friends and loves shopping and telling people her age — things she never thought she'd do again after gaining weight as an adult.
"It was as if someone said, 'You will live under a dark cloud the rest of your life, and kids will make fun of you,'" Williams said. "And then a fairy godmother came along, or in this case Dr. Gauvin, waves his wand and says, 'That dark cloud is gone. Go have fun.'"
Exciting technology
When Sparrow Hospital purchased the da Vinci Surgical System almost a year ago, it was mostly used by the urology department, which deals with problems in urinary and reproductive organs. The California-based company Intuitive Surgical produces the robotic arm system. About 275 hospitals own the machine, according to the company's Web site.
Gauvin had bigger plans for the new machine he learned could be used for laparoscopic gastric bypasses. A laparoscopic surgery is a less invasive procedure that requires a series of small incisions, rather than one large one. The surgeon inserts small surgical instruments through the incisions to perform the surgery while watching movements through a fiber-optic telescope.
The gastric bypass surgery has been growing in popularity in recent years, with about 171,000 weight-loss surgeries performed in 2005, according to the American Society for Bariatric Surgery.
Being able to do weight-loss surgery laparoscopically means less pain, fewer chances for complications and faster recovery time for patients, said Gauvin, who is also affiliated with the Sparrow Weight Management Center, 2900 Hannah Blvd. Using a robot for surgery allows him to rest tired hands, reach uncomfortable angles and see inside the patient better, he said.
"There is the potential for the surgery to be safer," Gauvin said.
He enlisted Keith Apelgren, another MSU surgeon, to assist him in bringing the procedure to MSU. Gauvin traveled and trained with the technicians at Intuitive Surgical for a day.
Gauvin also contacted Myriam J. Curet, a surgeon and associate professor at Stanford University, who first developed, described and performed a totally robotic laparoscopic gastric bypass surgery almost two years ago.
Since publishing her findings, Curet has trained a few dozen doctors, including Gauvin, to use the robotic arm system for the gastric bypass surgery.
"We developed the robotic gastric bypass because of its difficulty to learn laparoscopically," Curet said. "There are a lot of limitations that make it very difficult."
Using the robot to perform the laparoscopic procedure provides depth perception and can allow more precision when force is needed to move through thick abdominal walls, Curet said.
It has shortened the learning curve for surgeons who are new to the procedure, she said.
But Dr. Paul Kemmeter, from Michigan Medical P.C. in Grand Rapids, said he doesn't plan on jumping on the robot bandwagon anytime soon. His group has a medical weight-loss program similar to Sparrow's.
Kemmeter, who regularly performs laparoscopic gastric bypass surgeries, said he doesn't see the need to use the da Vinci Surgical System. He said he hasn't tried the robot but learned about it at medical conferences.
He noted the machine has a high cost, about $1.5 million according to its manufacturer, in addition to the price of maintaining it and setting it up before each surgery. He questioned whether using the machine would help a surgeon see more of the procedure since the abdomen is already a large area. He also questioned its convenience.
"I won't use it for gastric bypass surgery because I don't think it would be worth the cost," Kemmeter said. "I don't think it would speed me up. From my patients' standpoint, I don't see many benefits."
Curet said, however, that the robot has been well-received by many patients.
"They like the idea of it being new technology and cutting edge," Curet said. "They are very excited about doing it. Especially for larger patients, there's a real sense of reassurance that we have the technology."
Using robotic arms in surgery could be the wave of the future, Curet said, adding that laparoscopic gastric bypasses could be among the surgeries that benefit the most from the machine.
"We're still trying to figure out where it's clearly better," she said.
For Gauvin, offering a new and easier way to perform the gastric bypass while providing the same health and quality of life benefits to patients is exciting. He's performed a second surgery since Williams' and is planning another one this month.
"They're the most appreciative patients I've ever seen," Gauvin said. "Their lives are completely changed. They are doing things they've never done before."
Making the decision
The bypass surgery is not a quick fix, and it's not for everyone, said Kathy Kacynski, manager of the Sparrow Weight Management Center.
"For some folks, when you're 150 pounds overweight and you're having health problems, you need something that will be a permanent weight-loss change," Kacynski said. "But the surgery's just a tool. You still have to eat less and exercise more."
The post-operative hospital stay is two or three days, and the costs for the surgery can range between $25,000-40,000, she said.
Patients must be severely obese or have a body mass index higher than 40 to qualify for the surgery. In addition, most insurance companies require patients to try between three months and three years of medical weight-loss attempts before a surgery. Patients must return for checkups for five years after the procedure.
Interested patients must be screened medically, psychologically and surgically by the center before they are considered for the surgery, Kacynski said. They meet with dietitians, exercise specialists and nurses throughout the process to ensure they are meeting preparation requirements.
Gauvin also meets with patients and their families before the surgery to ensure everyone is informed about the lifestyle changes and the support patients need in months following the operation. After surgery, patients can only consume liquids and gradually work up to soft and regular foods. They must eat about every two hours because at any one time those who have had the surgery can only eat between two and four ounces of food — about the size of two plastic condiment containers.
The youngest person to have the procedure at Sparrow Hospital was in her early 20s, Kacynski said.
Potential candidates are warned of the necessary dedication, lifestyle changes and possible psychological toll patients experience, especially in their personal relationships.
"We do surgery on the stomach; we don't do surgery on the brain," Kacynski said.
Taking back life
Williams became really concerned about her weight three years ago. Back then, she was taking up to 10 pills at a time for different ailments.
"My doctor told me, 'You're a walking time bomb,'" Williams said, detailing her history with high cholesterol, problems with sleep apnea and being borderline diabetic. "It's called metabolic syndrome. You name it, I had it.
"I said, 'Doc, dieting doesn't work. I don't know what to do.' The only thing left was bariatric."
A year ago, she met Gauvin, who told her she'd be a good candidate for the first use of the robotic arms for gastric bypass surgery at Sparrow Hospital.
But the requirements from the weight management center to receive the surgery made Williams resistant.
"I bucked the whole system," Williams said. "It's set up to be your support system with nutrition, exercise — lifestyle changes — the things heavy people don't want to hear."
In the end, she relented.
Medical weight loss proved unsuccessful, and the center began preparing her for surgery. Williams began a liquid diet the month before surgery.
She entered the hospital on a Tuesday in November and went home that Thursday — Thanksgiving Day — to begin her new life with the gastric bypass.
"You have to eat very slowly," Williams said. "You chew and you chew and you chew to make sure there are no chunks.
"I had to be careful because I didn't feel like I had surgery because all I had were these six little slits in my stomach," Williams said, pinching her fingers together about an inch apart.
Exactly three months out of surgery, Williams feels like a new woman.
She's now down to one pill a day, which isn't related to her weight. Activity is now a regular part of her day, whereas it used to hurt just to walk.
Before, she never enjoyed going out to lunch or shopping, but she said now her 18-year-old daughter has trouble making her leave stores.
Williams loves trying on her old clothing from before her weight gain.
"I told myself I'd lose the weight someday," Williams said. "Everyone who's heavy says that, and then eventually you give up. I was about to throw the clothes away."
She regularly meets for lunch with other gastric bypass patients who she befriended during preparation. They leaned on each other for support throughout the process, she said. They now enjoy healthier lives and have the self-confidence to try new activities, she said.
Williams said she's considering scuba diving lessons.
"If we don't have dreams, we don't have anything," Williams said. "Gastric bypass surgery will give you those dreams; they will give them back to you."
Tina Reed can be reached at reedtina@msu.edu.
