High-Tech Healing for the Heart
Nov. 15, 2000 -- If you find yourself in an operating room filled with lasers and robotic surgical tools, you haven't been abducted by aliens. You're probably in a hospital near your own home. These and other high-tech tools promise not only to make heart surgery more effective, but also to make it easier on the patient.
"This will take maybe five years, but there is no doubt it will happen," Stephan Schueler, MD, PhD, chair of the University of Dresden Cardiovascular Institute in Germany, tells WebMD. "We were able to develop a closed-chest bypass procedure that allows the patient to go home with three or four 1 cm chest incisions. Patients stay in the hospital three or four days and then go home. There is no [opening] of the chest, no 30 to 40 cm chest incision to heal."
The device used by Schueler and his colleagues is a computerized robotic machine called the da Vinci Surgical System. At the business end of the system are a tiny camera and two slender instruments inserted through a small cut between the patient's ribs. At the other end, the surgeon sits at a console and views the surgery through a 3-D viewer connected to the camera. His fingers and wrists are connected to sensitive controls that allow him to manipulate the instruments and camera inside the patient.
At a meeting of the American Heart Association in New Orleans, Schueler reported that his team already has used the device to successfully treat 170 patients over the last 16 months.
Other research presented at the meeting shows that a controversial laser surgery actually may work -- although nobody is yet quite sure why. The idea is to treat people with angina -- severe pain caused by blockage of vessels leading to the heart -- by making tiny holes in the heart. The technique was invented as a way to make the human heart work like a reptile heart, which normally bathes itself in the blood that heart tissue needs to survive.
Now it seems that these tiny holes heal in a few days, while the beneficial effects last much longer. So the new, hotly contested theory is that the laser-drilled holes somehow make the heart grow tiny new blood vessels. Hence the name for the technique: transmyocardial revascularization or TMR.
"We have about 80 patients for whom it has been at least five years since their TMR -- some patients are almost 10 years out from the operation," Keith A. Horvath, MD, tells WebMD. "Basically, patients are having significant relief from their angina. Even walking to the end of their driveway or eating a heavy meal was painful. Now people are able to return to work and are doing all those important things they couldn't do before laser treatment." Horvath is assistant professor of cardiovascular surgery at Northwestern University Medical School in Chicago.