Open-Heart Surgery on a Closed Chest

Robotic arms make operation less invasive and traumatic

TUESDAY, Nov. 19, 2002 (HealthDayNews) -- Your next heart surgeon may be a robot.

Well, not exactly, but instead of standing over you wielding a scalpel, the surgeon will be sitting at a console, manipulating controls to manage robotic arms that repair a damaged portion of your heart.

And the surgery will be done in what is called a minimally invasive way. Instead of making a foot-long incision in the chest, as is often required for heart surgery, the surgeon will work through four small holes that keep the damage to your body to a minimum.

"This is open-heart surgery without opening the chest," says Dr. Michael Argenziano, director of robotic surgery at Columbia-Presbyterian Medical Center in New York City, who spoke today about the successful use of the technology at the American Heart Association's scientific sessions meeting in Chicago.

Argenziano used Intuitive Surgical Co.'s da Vinci system, which is increasingly available at medical centers in the United States and around the world. "We have sold 132 worldwide and 88 in the United States," says Lyn Thompson, marketing and communications manager of the Sunnyvale, Calif., company.

The system costs $1 million, but Argenziano says it is clearly worth it. "We were able to perform the operation with all the benefits we expected," he says. "There was minimum pain post-operatively and the patients went home a few days earlier than they expected."

European surgeons are ahead of Americans in use of the system because the U.S. Food and Drug Administration (FDA) has stricter requirements for approval, Argenziano says. The 15 operations he did to repair atrial septal defects, in which there is an unwanted opening between the two upper chambers of the heart, are among the results submitted to the FDA to get approval for routine use of the robotic system for that operation. Overall, 10 medical centers are involved in the atrial septal defect work, Thompson says, "and that study is progressing well."

The FDA has just approved use of da Vinci for repair of the mitral valve, which controls the flow of blood between the two left chambers of the heart, and a submission for its use in bypass surgery has been made. "We're hoping for approval for total endoscopic artery bypass [the formal name of the procedure] in late 2003," Thompson says. Approval for atrial septal defect repair could come early next year, she adds.

A benefit for the surgeon is that he or she can sit down during what can be a four-hour procedure, but "we're used to being on our feet," Argenziano says. He'd rather talk about the benefits for the patient that arise from the surgeon's having a better-than-ever view of the operating field.

"Instead of being in the hospital for seven to 10 days, the patient is there for three days," he says. "Instead of a recovery time of six to 12 weeks, it is two to four weeks."

The robotic procedures did take longer than conventional surgery; the heart had to be stopped for an average of 34 minutes, compared to 20 minutes. The reason might be the need for the surgeon to learn how to use the new system, Argenziano says. The average stay in the intensive care unit after surgery was 18 hours, the same as for traditional surgery, and patients did get to go home much sooner.

"This is definitely part of the future," Argenziano says.

What To Do

You can learn more about minimally invasive surgery from the American Heart Association, which also has a page on atrial septal defect and other congenital conditions.

SOURCES: Michael Argenziano, M.D., director, robotic cardiac surgery, Columbia-Presbyterian Medical Center, New York City; Lyn Thompson, marketing and communications manager, Intuitive Surgical Inc., Sunnyvale, Calif.; Nov. 19, 2002, presentation, American Heart Association scientific sessions, Chicago
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