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Robotic ViKY helps perform a single-incision hysterectomy at MetroHealth Medical Center.

CLEVELAND, Ohio — On the eve of her hysterectomy, Paula Millerwas asexcited about making medical history as she was being freed fromtheexcruciating pain and nauseaofher menstrual period.

The37-year-old mammogram technician would the next dayhave her uterus removedby a surgeon at MetroHealth Medical Center who shehad just met buttrusted immediately: Dr. Kevin Stepp.

“It’s amazing the technology they come up with, that I’m going to be part of medical history with him,” said Miller, who also works at MetroHealth. “It’s very exciting.”

Stepp wanted to remove the organthrough a single incision inMiller’s belly button — something he haddone dozens of times before — but this time with the help of a robotic system called ViKY. The system would enable him to perform the surgery by himself — without theusual one or two assistants.

The surgeryalso was exciting for Clement Vidal, chief executive of EndoControl of Grenoble, France, the maker of ViKY (which is a French acronym that describes the way the devicefunctions). Vidal wanted to watchhow used his company’s technology so he could tellother surgeons how to use it.

It would be the first timeViKY wouldbe used anywhere in the world to bothguide thelaparoscopic video camera and light that”see” inside Miller’s abdomen, as well as position her uterus duringsurgery.

Dr. Kevin Stepp

Surgical robotsenable surgeons to goplaces inside the body where their hands andhand-heldinstruments don’t fit.With robotic devices, surgeons can navigatea blood vessel,repaira heart valve from the inside and remove a uterus (through the vagina) by working through one small incision in the belly button.

Robotic technologiesalso are cool.Dr. Miranda Bailey, a surgeon on ABC’s Gray’s Anatomy television show, acted like a kid in a candy shop when fictional Seattle Grace Hospital got its first multi-station DaVinci Surgical System. DaVinci has made the roundsat medical conventions, attracting lines of doctors who want to try the system that operates something like a video game.

DaVinci is a sophisticated surgicaltechnology made by Intuitive Surgical Inc. that enables surgeons to operateremotely — they sit in front of a computer screen and use a console of levers and buttons to move instruments that operate on patients who are located several feet away.

ViKY looks nothing like DaVinci. Rather, the French company’s device looks more like a medical instrument-holder on a circular base.

That’s okay withStepp, assistant professor atCase Western Reserve School of Medicine,who found the device by keeping track of the search term “single-incision laparoscopy” in his Google Reader.Stepp likes ViKY partly because he cando surgeryat the side of his patient,usingthe robotlike a coupleextra pairsof hands.

ViKY also is a bit of a David-and-Goliath story. The devicewas born in 2000 in a laboratory at Grenoble University, Vidal said. “And in 2005, we decided to transfer it to the industry,” he said.

“So, there are all sorts of little startups that are trying to come up with better robots,” said Stepp, who also is fellowship directorof minimally invasive surgery and urogynecology. “Just like when you bought an IBM computer in the 1960s, it was big as a house and cost twice as much, but now, I have one on my hip.”

One of two things usually happen to these surgical robot start-ups.”They either get bought up by Intuitive (the maker of DaVinci),” or theystart making their ownheadway, he said.

The global market for surgical robots each yearis about $1 billion, Vidal said. Intuitive Surgical, maker of DaVinci, dominates that market, accountingfor more than 90 percent of sales, he said.

The first of fourViKY components — anendoscope holder — was CE Mark approved forsale in Europe in 2007, Vidal said. In December, the U.S. Food and Drug Administration approved ViKY for sale in this country.

Unlike daVinci, ViKY issimpler, smaller and specialized to do certain surgical tasks, Vidal said. ViKY also costs a fraction of daVinci, which can do many more surgical jobs. “The DaVinci is $1.7 million for the old version, and $200,000 a year to maintain it,” Stepp said. “All said and done, the four components of the robotic [ViKY] system should cost around $150,000 or $170,000.”

Stepp used ViKY’s endoscope holder three monthsago. Today, he also will use the system’s second component — a uterus manipulator. The surgeon has no financial relationships with EndoControl.

Hebegins surgery by fixing two ViKY units to rails on the operating room table. One unit is positioned above Miller’s belly button, the other just outside her vagina.

Using foot pedals,Stepp can move the units holding the laparoscopic camera and light and the uterine manipulatorinor out, upor down, and rightor left.Surgical technicians who usually operate the camera or move the uterus during surgery stand nearby, arms crossed, watching.

A half-dozen MetroHealth surgeons walk in and out of the operating room to watch their colleague perform his first laparoscopic hysterectomy by himself. Stepp asks questions of Vidaland gives himfeedback on how the devices work throughout the surgery.

Stepp and his partner, Dr. Rob Pollard, have performed about 45 single-incision hysterectomiesover the last year. For women who can’t have their uteruses removed vaginally,”this is absolutely the least invasive way to do it with just a single incision through the belly button, he said.

Inexpensive surgical technologies like ViKYalso could lower health care costs.”For example, each component of this device certainly costs less than what you would pay a surgical tech over the course of a year,” Stepp said.