The hours-long wait is agonizing: Every time Mareen and Roy Schimmel glance at the clock, it seems like time is standing still. As their son Kilian undergoes a heart transplant, his brother Jamie is fighting for his life in the intensive care unit.

(Published: June 2021)

Kilian, the somewhat taller and stronger of the 13-year-old twins, first experienced heart pain in 2017, after a soccer practice. His parents thought it was only a persistent cold, but took him to a doctor anyway. The physician opted to refer his young patient to the Fresenius Helios Heart Center Leipzig for a more detailed diagnosis.

“The diagnosis by pediatric cardiology specialists showed Kilian had a genetic heart weakness. We knew we were in good hands at Helios so, at first, we accepted the diagnosis calmly,” said Mareen. As a precaution, the parents took Jamie, who has a slighter build than his brother, to a pediatrician in 2019 for a thorough examination. The blood test, as was the case earlier with Kilian, indicated he also had a genetic heart disorder: In medical terms, a cardiac insufficiency.

This was the start of the family’s ordeal. In May 2020, the parents had to call for emergency assistance after Jamie displayed symptoms consistent with the onset of a stroke. “As before with Kilian, Jamie was transported from Magdeburg to the Heart Center Leipzig, where they implanted a pacemaker with an integrated defibrillator,” said Roy. Shortly thereafter, doctors had to perform the same operation on Kilian.

The sense of security that followed proved to be short lived. The boys’ strength declined steadily to the point that they could rarely walk more than a few hundred meters without taking a break. Doctors at the Heart Center Leipzig placed both boys on the high-priority list for a donor heart.

On the afternoon of February 21, 2021, Mareen got a phone call. “The heart center told us there was an organ available for Kilian. I cannot describe what went through my head when I heard this,” she said. A short time later an ambulance stood at the door. As this was happening, Jamie was already at the heart center, where he had been undergoing extended treatment.

Preparations at the Fresenius Helios hospital began under an established routine. Kilian was prepared for the operation and received anesthesia around midnight. Prof. Dr. Diyar Saeed, Managing Senior Physician for Heart Transplants and Artificial Hearts, and Dr. Marcel Vollroth, Senior Physician for Pediatric Heart Surgery, performed the life-saving surgery. They were assisted by an experienced team of anesthesiologists and nurses. Of the 339 heart transplants performed in 2020 in Germany, 41 were done at the Heart Center Leipzig. “However,” said Dr. Vollroth, “all of them were performed on adults. The last time we transplanted a child’s heart here was in 2010.”

Doctors at the Heart Center Leipzig placed both boys on the high-priority list for a donor heart.

At about 4:30 in the morning, Mareen and Roy received a call that all had gone well. “Professor Saeed told us there were no complications during the operation and that Kilian was doing as well as could be expected,” Mareen said. 

But this good news was dampened by Jamie’s condition. The boy was noticeably declining, weakening drastically to the point where his condition had become life threatening. The reason Kilian and not Jamie had received the new heart was the size of the donor organ. “It was too big for Jamie,” explained Dr. Vollroth. Early on, the parents had ruled out making a decision on which boy should be given priority. “For us, the boys were never in a competition with each other,” said Roy.

To keep Jamie alive, doctors decided to implant an artificial heart. This decision, however, was soon superseded: Out of the blue came word from Eurotransplant, an organization distributing donor organs in eight European countries, that they also had a heart for Jamie. “This meant spooling back to the beginning for the entire operation team,” said Dr. Vollroth. Same doctors, same team and the same professional process. For Jamie, this start to a new life began around midnight and ended nearly five hours later.

“For us, the boys were never in a competition with each other.”

Following eight weeks of hospitalization, the family is together again. The boys have gotten used to their new lives as transplant patients with the accompanying mountain of pills. Visits with friends and relatives will have to wait. Even without the COVID-19 pandemic, the risk of infection would be too great. For now, Jamie must content himself with practicing the guitar and Kilian with riding his bicycle in the yard.

Everybody at the Heart Center Leipzig is both happy and proud of the achievement. It was the first time a situation like this had occurred in a cardiac unit anywhere in the world. The successful transplantations for the twins also had a signal function. “In the future, we will again place emphasis on performing heart transplants for children from about seven years of age,” promised Dr. Vollroth, who can count on continued support from Prof. Saeed.

The robot arms move above the patient’s stomach as if guided by an invisible hand. Monitors on each side of the operating table show an oversized, 3-D image of the stomach’s interior. Two meters (about six feet) away, Dr. Markus Mille sits fully absorbed at the control console.

(Published: February 2021)

His hands are directing the movements of four robot arms: Three of them hold surgical instruments – scissors, forceps and tongs – while the fourth holds the camera that is transmitting the images from inside the stomach cavity. The doctor’s feet, meanwhile, are operating pedals that allow him to coordinate the robot’s actions and engage the individual arms. To get a better feel for what he is doing, he has removed his shoes.

The patient has colon cancer. Dr. Mille, Chief Senior Physician of the General and Visceral Surgery Clinic at Helios Hospital Erfurt under Chief Physician Prof. Dr. Albrecht Stier, starts by removing the tumor and a piece of the large intestine. He then reconnects the large intestine with the small intestine. To make space for the instruments between the abdominal wall and the organs, and perform what is known as a hemicolectomy, carbon dioxide has been injected to expand the stomach to twice its normal size.

Robot-assisted surgery enables even more precision

In a consultation with Dr. Mille at the hospital in Erfurt, in the eastern German state of Thuringia, the patient opted to undergo the operation with the robot. “In cases like this,” the surgeon explains, “we can operate much more precisely with robot-assisted intervention – it’s easier on the patient and we can discharge them sooner from the hospital.” The surgical incisions are at most two centimeters – less than an inch – in length, and leave only small scars.

Using a robot in the operating room also has advantages for surgeons. The robot arms allow supple movements with a greater range of motion. This makes possible a more precise intervention than the conventional minimally invasive surgery, which uses fixed instruments. Surgeons assume a sitting position during the operation, which prevents weariness and back pain. In addition, the expanded monitor display of the area being operated on facilitates recognition of minute, delicate structures such as nerves and blood vessels.

“It is very impressive what can be achieved with the help of a robot. Now I am convinced: This is the future.”

The robot is called the da Vinci Xi, and costs about €2 million ($2.4 million). It is not capable of action on its own, but can perhaps best be described as an extended arm of the surgeon – one capable of neutralizing any shaking or vibrations of the hands. The surgical system consists of three components: The surgeon’s console, a patient cart – where the instruments are installed – and a so-called vision cart, which contains the computer devices that control communications between the components.  

“The first time I heard about operating-room robots like these, I thought they were just some technical gimmick,” says Dr. Mille. “Then I immersed myself in the topic and undertook several study visits. It is very impressive what can be achieved with the help of a robot. Now I am convinced: This is the future.”

Before using the robot for the first time on a patient, the surgeon underwent weeks of comprehensive preparation with multiple training courses and study visits. Using computer simulation, he learned how to move the robot’s arms correctly, then traveled to a special robotics training center in Belgium to use the da Vinci Xi for the first time on a model.

“Stepping up to the operating table and just starting, which you may know from before, doesn’t work here,” Dr. Mille explains. “You must learn systematically how to handle the technology and deal with the different way of operating, and then train intensively.” The surgical team that works with the medical robots also received special training.

Use of robot-assisted surgery is growing

The colon surgery was Dr. Mille’s 88th surgical procedure using the robot. One operation that remains vivid in his memory was the removal of an 85-year-old patient’s esophagus: For this complex surgery, Dr. Mille – in a first in Thuringia state and at Helios – deployed the robot twice during the same procedure, once on the stomach and then in the chest area. Eight days later, the patient could leave the hospital.

In addition to General and Visceral Surgery, the robot is being used at Helios Hospital Erfurt in Gynecology, Thoracic Surgery and Urology. It can assist in surgery on various organs in the stomach, chest areas and pelvic areas, such as the lungs, liver, uterus or prostate.

Surgery is also being performed with da Vinci surgical systems at several other Helios hospitals, including in the German cities of Wuppertal, Schwerin, Krefeld, Duisburg and Aue. This is part of a larger trend in medicine: According to the manufacturer, more than 7.2 million operations were carried out with this surgical system in 2019.

Following the birth of her son Joona in April 2018, Lea Zerbe is certain: “I want to become a midwife.” It is a courageous decision that comes from the heart. She leaves her old job and, after her paternity leave ends, begins studies to become a midwife.

(Published: July 2020)

Lea had always been torn between two main interests: “On the one hand I love everything creative; culture and music – on the other hand I have always been a people person.” After her pregnancy, the 28-year-old made up her mind. “People are more important.”

Upon leaving high school, her outlook was a little bit different. Lea considered several career paths before deciding on a curriculum of cultural studies and business administration at the University of Lüneburg in northern Germany – opening the door to a career in the world of culture. “Even then I knew that it probably wouldn’t be permanent,” she recalls. “I’m not an office person. I want to work with people as much and as closely as possible.”

With her studies completed, she found work organizing music and film festivals, but it fell short of her expectations. “I had played with the idea of becoming a professional midwife for a long time, but I couldn’t really come to grips with it until I got pregnant,” Lea says, thinking back to the time when she not only was carrying new life, but was also ready to try something new. Lea wanted to know everything about the development of a child, churning through book after book and taking courses. Pregnancy was a beautiful experience for her, during which she learned more and more about the midwife profession.

The shortage of midwives in Germany is a big problem. For that reason, expectant mothers are advised to look for a midwife right from the onset of pregnancy, in order to secure someone who can lend support in the early stages. Even if this is often a time of great joy, there are also uncertainties and complaints; nausea, for example. And should it come to a tragic situation like a miscarriage or infant mortality, a midwife can lend support and make the necessary arrangements.

“Through my own pregnancy, I saw how important the work of a midwife is, and how good it feels when someone is there to help the expectant family along,” Lea says. And this ultimately led her to apply for a trainee position at Helios Mariahilf Hospital. The dual study program lasts four years and culminates in a Bachelor of Science degree. Together with two other trainees, she is learning how to best accompany women before, during and after birth.

The profession is multifaceted, with many options for trainee midwives to find employment in an area that suits them. The duties of a midwife extend well beyond those which are visible in a hospital. Births, naturally, are at the center of what midwives do. However, their duties can cover the entire spectrum from family planning through the woman’s pregnancy and on to postnatal care.

Midwives can perform the same precautionary examinations as gynecologists during pregnancy – with the exception of ultrasound. Midwives also help with the complaints and burdens that can result from a pregnancy. In addition, they prepare expectant mothers and their partners for the birth, and make home visits to advise on supplementary foods and breastfeeding in the days following birth. Some midwives also teach, explaining the stages of pregnancy and birth as part of sex education for primary-school students.

Lea is optimistic about her future as a midwife. “In school, they always talk about the supreme discipline of birth, but I think it is the complete package that is important. I simply want to be there for women in this most special time in their lives.”