Surgeon Michelle Toder, on a recent Monday morning, sat at a boxy control console in the corner of a surgical suite on the first floor of Eastern Maine Medical Center in Bangor. She peered intently through the goggles-shaped eyepiece at a three-dimensional digital image of Amy Webb’s small intestine.

Several feet away in the center of the room, Webb, an obese 31-year-old band teacher, wife and mother of two who lives in Houlton, lay fully anesthetized and draped for surgery on a steel table. A gleaming white surgical robot with multiple jointed arms hunched over her like an enormous praying mantis.

Six slender steel tubes protruded from Webb’s abdomen, giving the robot surgical access to her digestive tract. A tiny camera already was in place inside her belly, beaming high-definition information to Toder’s console as well as to two other monitors beside the table, where Toder’s gloved and gowned assistants were working.

Tapping a footpad to adjust the camera’s focus and angle, the surgeon used the console’s hand controls to manipulate the robot’s delicate instruments into the glistening pink mass of Webb’s organs and tissues. Gently pushing and tugging at key structures, she identified essential landmarks before beginning Webb’s gastric bypass procedure.

The $1.5 million da Vinci Surgical System robot has been a valued operating room partner at EMMC for close to two years. By allowing surgeons to do their work laparoscopically – through one or more small incisions rather than through a single large one – and by allowing the precise, tremor-free use of scaled-down surgical instruments, the robot reduces pain, bleeding and complications from abdominal surgery. Recovery time also is shortened.

EMMC’s robot so far is used primarily for weight-reduction procedures such as Webb’s gastric bypass, also known as bariatric surgery.

Bariatric procedures result in dramatic and rapid weight loss by reducing the size of the stomach and restructuring the digestive tract to allow fewer nutrients – and calories – to be absorbed. While EMMC’s bariatric surgeons still perform traditional “open” abdominal procedures as well as nonrobotic laparoscopic ones, Toder said she uses the robot as often as possible.

She prefers its highly refined maneuverability to standard laparascopy’s more limited control, which “is like doing surgery using chopsticks.” She also appreciates the comfort of sitting at the remote console rather than hovering over the patient and said the true-to-life image afforded by the robot’s camera technology is a big improvement over the mirror image she must use when performing a standard laparoscopic procedure.

“It’s a tremendous tool,” she said.

The robot is just one of many tools in use at EMMC’s surgical weight loss program, which was recently designated a “center of excellence” by Surgical Review Corp., a nonprofit organization that promotes quality of care in bariatric surgery. It’s a coveted distinction; with hundreds of hospitals nationwide performing gastric bypass procedures, only about 60 have been so recognized.

Out of the five hospitals in Maine that offer bariatric procedures – EMMC, MaineGeneral Medical Center in Augusta, The Aroostook Medical Center in Presque Isle, Maine Medical Center in Portland and Downeast Community Hospital in Machias – EMMC’s program is the only designated center of excellence.

For weight loss surgery patients, the prestigious designation means safety, reliability and support, according to Lynn Bolduc, coordinator of EMMC’s three-year-old Surgical Weight Loss Program. Furthermore, she added, it’s likely that in the near future most insurance companies will cover only procedures performed at centers of excellence.

“People have been very concerned about doctors hanging out their shingles [to perform gastric bypass procedures] without providing appropriate follow-up care,” she said.

Because the procedure itself is inherently risky and effective only when patients make a lifetime commitment to complying with a strict diet and exercise plan, Bolduc said, patients must be prepared carefully and encouraged to participate in support groups and other services after their surgery. Some obese people may be rejected as surgical candidates if they seem incapable of making sustained lifestyle changes, she added.

When inspecting a facility for center of excellence designation, the Surgical Review Corp. reviews all aspects of care, Bolduc said. At EMMC, this includes the mandatory months-long lead-up that provides extensive nutritional education, a psychological evaluation, family support and other preparation.

Surgeons’ credentials are examined closely, including education, training and certification as well as the number of procedures they do each year. Staff must be trained for sensitivity in meeting the specialized physical and emotional needs of obese patients, and the use of obesity-friendly equipment and supplies, such as oversized gurneys and hospital gowns, is a must. There must be evidence that the facility enjoys the strong financial support of the hospital administration.

In addition, Bolduc said, the inspectors evaluate the success patients experience in dropping weight and keeping it off compared to national norms.

Nationally, 60 percent to 75 percent of bariatric surgery patients will succeed at losing at least half of their excess weight and keeping it off for five years or longer. EMMC’s center has been offering the surgery for just three years. Bolduc said that of the patients who have agreed to be tracked, about 75 percent of those who had their surgery in 2002 and 68 percent of those from 2003 have kept off at least half their excess weight.

And while national statistics show that between one in 100 and one in 200 patients will die during weight loss surgery or within 30 days afterward, just two of the roughly 700 cases at EMMC have died, or one in 350.

The surgical robot was just the icing on the center of excellence cake; without it, EMMC’s program already met all of the credentialing standards and more, Bolduc said.

“We could have all the latest and greatest technology, and still have horrible infection rates,” she said. “The examiners were very impressed that we had the robot, but it’s really just another tool for the surgeons.”

Dr. Dennis Shubert, a retired Bangor surgeon who helped establish the EMMC surgical weight loss program and now heads an initiative to establish a statewide health plan, said Thursday that surgical robots nationwide have been shown to cut down on errors in the operating room. Even for relatively common, low-risk procedures such as gall bladder removals, “it reduces complications and improves the surgeon’s skill,” he said.

But robot-assisted surgery takes longer than standard procedures, tying up physician time and operating room space. “So while there’s a clear improvement in safety, it may not be worth the cost” for low-risk procedures, Shubert said. For high-risk bariatric operations, the robots are likely to prove a more justifiable expense. The only other da Vinci robot in Maine is at Maine Medical Center in Portland, he said.

Back home in Houlton, Webb said recently that she was up and around and feeling terrific. The hospital discharged her just two days after her Nov. 28 surgery, and though the first few days were uncomfortable, she already has been able to resume many of her usual activities. Two weeks after her surgery, she already had lost more than 17 pounds.

Webb said she’s doing her best to comply with her postoperative diet orders, which consist of several servings of Instant Breakfast, Jell-O, custard or strained cream soups a day. She’s supposed to take 30 minutes to consume 8 ounces of this liquid diet at each sitting.

Webb admitted to filching a single, delectable Goldfish snack cracker – but just one, and she made it last two minutes. A few days later, she nibbled at the filling of a pie a friend made.

“I had hoped that after the surgery I wouldn’t even want to think about food,” she said ruefully, “but unfortunately, all the bad stuff still smells really great.”