Jan. 29, 2001 -- Robots performing heart surgery? Absolutely! A couple of presentations made this week in New Orleans at the annual meeting of the Society for Thoracic Surgeons (STS) demonstrate that surgery assisted by specially designed robotic devices helps heart surgeons perform less invasive surgery and improve results.
"We've been involved with robotic technology for about four years now," co-author of the first presentation Leslie Wiley Nifong, MD, tells WebMD. "We're trying to figure out a way to operate in the heart through a less invasive approach [to improve patient results]." Nifong is an assistant professor of cardiac surgery and the director of robotics at the East Carolina University Brody School of Medicine/University Health Systems of Eastern Carolina in Greenville, N.C.
At the STS meeting, Nifong and his colleagues reported on patients requiring surgery to repair the mitral valve, located deep within the heart. Normally in heart surgery, the surgeon must cut through the sternum, the bone that runs along the middle of the chest, in order to reach the heart. Instead, Nifong and his team used a technique developed by his colleague, Walter Randolph Chitwood Jr., MD, chair of the cardiothoracic team at Brody, in which the surgery is performed through a 2½-inch incision using specially designed, elongated instruments. This is called endoscopic surgery and is potentially far superior to full open surgery for patients because recovery time is much shorter.
"The incision is too small to use your eyes to do all the work," Nifong says. "So we started putting a camera in there [held and directed by an assistant] and operating from a monitor. We did that for a couple of years, and then the first robotic device came along. Called AESOP and made by a California company called Computer Motion, it is a single robotic arm that's voice activated and holds things for the surgeon. ... The robotic device allowed us to hold the camera steady, and the surgeon was able to control it completely [and precisely]."
Compared to patients who previously had undergone conventional mitral valve surgery involving cutting through the sternum, patients operated on with the endoscopic approach lost less blood and required less time on a ventilator and in the hospital. Furthermore, Nifong says that, "with the robotically assisted cases, we're able to do the procedure in a shorter amount of time. Because of that, that led to patients doing better in the long run." So far, they have operated on more than 150 patients with similar results.
Nifong and his team are now using a full robotic system for mitral valve surgery called the daVinci Surgical System, made by Intuitive Surgical Inc. in California. With this system, tiny robotic arms, controlled by the surgeon from a console several feet away from the patient, actually perform the surgery. So far, they have performed 18 successful operations using this system and plan to continue exploring its pros and cons with the help of surgeons from other medical centers.
"We're able to do the operation now through [an even smaller] incision," Nifong tells WebMD. "And it's given us even more precision because the little robotic instruments that go into the heart, which we control, filter out all of the tremor that we would normally have [if we held the surgical instruments with our hands]."
Nifong's is not the only surgical team taking advantage of robotic technology to perform endoscopic surgery. At the STS meeting, Ralph J. Damiano, MD, heart and chest surgeon at Washington University School of Medicine in St. Louis, previewed the success of his surgical team with a robotically assisted microsurgical system used to perform coronary artery bypass grafting (CABG). In this procedure, a less essential blood vessel from another part of the body is placed in the heart and used to bypass blood flow away from blocked arteries.