November 19, 2002
IL (AHA) – For the first time in the
United States, open-heart surgery was performed without opening
the chest, in more than a dozen patients, researchers reported
in preliminary results presented at the American Heart
Association's Scientific Sessions 2002.
procedure, surgeons remotely maneuver robotic arms from a seat
in front of a console away from the patient. Instead of opening
the chest and cutting the skin and muscle to view the area,
surgeons make four holes (8 to 15 millimeters each) through
which robotic arms are inserted. The robotic arms include one
with a camera-like device to transmit the image to the console.
The other arms are fitted with operating instruments.
this new procedure to successfully repair the hearts of patients
with atrial septal defect (ASD) or patent foramen ovale –
conditions in which people are born with an opening between the
heart's two upper chambers. This opening allows some blood from
the left atrium to return to the right atrium, instead of
flowing through the left ventricle, out the aorta and to the
body. It's repaired either by plugging the hole with a patch or
suturing the hole closed.
surgery traditionally requires that surgeons make a foot-long
chest incision to cut patients' breastbones in half.
"We wanted to
know if it was possible to operate inside the hearts of these
patients without making any incisions," says Mehmet Oz, M.D.,
director of the Heart Institute at Columbia-Presbyterian Medical
Center in New York. "Not only did we show that the operation is
feasible, but we demonstrated it in more than a dozen patients."
During 12 months,
15 patients (ages 22 to 68) underwent ASD repair using the
robotic technology, called the Da VinciTM system.
equipment is costly, this is definitely part of the future,"
says Michael Argenziano, M.D., lead author of the study and
director of robotic cardiac surgery at Columbia-Presbyterian.
"Patients are going to insist on it despite the expense because
it's cosmetically superior and allows for much faster recovery.
For certain procedures, like the ASD repair, it's already
proving to be a worthy alternative to conventional surgery."
found that robot-assisted endoscopic heart surgery takes a
little longer than the traditional technique, but that might be
attributable to the learning curve necessary to use the new
approach. The heart was stopped for 34 minutes on average,
versus about 20 for traditional surgery. The time needed on a
cardiopulmonary bypass machine was also slightly longer.
Patients in the
study had no major complications. In 14 cases, imaging tests
confirmed that the defect had been successfully closed. One
patient required a repair five days later. Surgeons did this
through a three-inch incision (a mini-thoracotomy). The average
length of stay in the intensive care was 18 hours, which is
about the same as for the traditional approach. The average
hospital stay was three days – two to four days shorter than for
a traditional operation.
advantages of this minimally invasive surgery are faster patient
recovery, less pain and dramatically less scarring than
traditional open-heart surgery," Argenziano says.
to work and normal activity about 50 percent faster than those
who have the open procedure, he says. Quality of life measures
also revealed the robotically treated patients had improved
social functioning and less pain compared to patients undergoing
traditional surgical approaches.
Doctors are also
using the robotic technology to repair mitral valve defects
through incisions in the side of the chest.
"What makes the
totally endoscopic ASD repair a significant advance is that it
is the first closed-chest open-heart procedure," Argenziano
also principal investigator of several Food and Drug
Administration-sanctioned trials of robotic cardiac surgery
including one in which it is used for closed-chest coronary
artery bypass surgery (CABG). Earlier this year, the Columbia
team performed the first totally endoscopic CABG in the United
wonderful surgical cures for heart disease in that they're very
effective and long-lasting," Oz says. "However, they're also
very traumatic. So, we're evaluating a technology that might
provide us with the same wonderful results without the trauma."
facilities nationwide offer the Da VinciTM technology, and
researchers at about four other centers have been specifically
trained to perform ASD closure, the researchers say.
Takushi Kohmoto, M.D.; Mauricio Garrido, M.D.; Jaina Dimitui,
R.N.; James Beck, perfusionist; Linda Mongero, perfusionist;
Hadar Hermoni, B.S.; and Craig R. Smith Jr., M.D.