| |
Closing open-heart surgery:
Doctors are using robots to take cardiac care to the next level
By LAURA BEIL Medical Writer
It might look like an elaborate video game, but the joysticks don't command busty, karate-kicking women.
Instead, these controls are made for doctors who want to perform operations with robots - an expanding field that some believe to be the future of cardiac surgery.
Federal regulators just this month cleared robotic surgery for a type of heart valve repair. And last week, researchers announced the results of the first study in the United States of "closed" open-heart surgery - performed with a robot, through incisions no wider than drinking straws - to repair a birth defect in the heart.
That research suggested that robotic surgery, where surgeons manipulate willowy mechanical arms threaded into the chest, could return patients to their normal lives faster than traditional operations.
Another study is under way with a more ambitious goal: closed-chest coronary bypass surgery. This is bypass surgery in every respect, "but we've skipped the minor detail of a foot-long incision," said Dr. Michael Argenziano, director of robotic cardiac surgery at Columbia University College of Physicians and Surgeons in New York City.
In West Texas, surgeons in Odessa are already performing closed-chest coronary bypass operations using a robot.
"I think that the robot probably operates better than the human hand," said Dr. Sudhir Srivastava of Odessa Regional Hospital.
In Dallas, both Medical City Dallas Hospital and Baylor University Medical Center have robot surgery machines, though neither hospital performs closed-chest operations with them yet.
Patient benefits
By eliminating major cutting and the need to crack bones in the chest, doctors aren't just trying to render their patients more attractive on the beach. Without a slash through the chest wall, patients are spared a good deal of postoperative pain, have a lower risk of getting an infection and spend substantially less time recovering, Dr. Argenziano said.
The blood vessels themselves don't feel the nips and tucks. "It's the incision the patient feels," Dr. Argenziano said.
But the surgery using a robot has drawbacks. It takes longer to perform, and the machines can cost about $1 million. Also, many surgeons aren't comfortable operating with no sense of touch. Doctors who direct mechanical fingertips instead of their own must be acutely attuned to the visual cues on their screens. Not every surgeon is at ease at the helm of a robot.
"It transfers the pain of surgery from the patient to the doctor," Dr. Argenziano quipped.
During robotic surgery, a doctor sits in front of a screen - a three-dimensional view on the latest machines - and wraps his or her hands around the controls. Like a virtual reality game, the instruments move with the surgeon, while a tiny camera transmits the image back to the operator.
"I don't even think about the fact that I'm not in the patient's chest," Dr. Argenziano said.
In many ways, the robot instruments are superior to human senses. The magnification on the screen is more powerful than the magnification of typical surgeon's glasses, and delicate robot-held instruments, unlike the human ones, never tremble.
"It is a huge potential benefit," said Dr. James Edgerton of the Cardiopulmonary Research Science and Technology Institute, based at Medical City. U.S. doctors perform coronary bypass surgery more than 500,000 times each year. Dr. Edgerton has performed bypasses with a robot, though none yet without opening the chest.
Greater advantages
Studies suggest that closed-chest operations offer advantages beyond that of even the most minimally invasive current techniques. Last week in Chicago, during the American Heart Association's annual Scientific Sessions, Dr. Argenziano and his colleagues described a study of 17 patients who had closed-chest heart surgery to fix a birth defect called an atrial septal defect, which leaves an opening between the heart's two upper chambers. In all cases but one, the defect was repaired.
The hospital stay was considerably shortened. On average, people stayed in the hospital about three days, compared with a normal stay of five to nine days, the researchers said.
Also, patients were able to return to their normal lives in about half the time.
As heart surgery goes, atrial septal defect repair is a relatively simple procedure. Dr. Argenziano is now heading up a nationwide study at many sites, including the hospital in Odessa, using the robot for closed-chest coronary bypass operations that involve one blood vessel.
He has already performed five closed-chest coronary bypass operations. Dr. Srivastava in Odessa has performed almost twice that many.
"I feel great. No pain at all," said Domingo Anaya, who had closed-chest robotic bypass surgery by Dr. Srivastava on Nov. 11. He went home the next day, and is already taking short strolls in his neighborhood.
Dr. Srivastava doesn't think machines will ever completely replace a surgeon's hands. "There will always be some percentage of cases that will have to be done traditionally," he said, for patients with certain complications. But he predicts that eventually, robotic operations will become more common than surgery by the human hand.
'Clearly evolving'
While some doctors can imagine all kinds of Star Trek scenarios - a surgeon sitting at the controls, beaming commands over high-speed Internet lines, operating on someone in another country - those kinds of possibilities are futuristic fancy for now.
Still, "the instrumentation is clearly evolving," Dr. Edgerton said.
Dr. Argenziano agrees that the technology will improve, and so will the price, as more surgeons become interested in robot surgery. "We still call this the Model T version," he said.
E-mail lbeil@dallasnews.com
|
|
|
