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New Robotic Bypass Surgery a Success

Patient, with fewer scars and risks, says he feels 'good'

FRIDAY, Jan. 18, 2002 (HealthDayNews) -- The first U.S. robot-assisted coronary bypass operation that required no chest incision was successfully performed this week at Columbia Presbyterian Medical Center in New York City.

Arthur Barrett, 70, of Cedar Grove, N.J., looking tired but alert at a press conference today at the medical center, said he felt "good" after the surgery, which replaced a an almost completely blocked major artery in his heart.

Asked if he thought about being the guinea pig for this operation as the first person to have it, he said, "I thought about it." But he added he and his wife, Cathleen -- who was with him at the press conference, along with two of their four children -- gained confidence from the surgeons who explained the procedure to them.

"I felt like I took the least invasive way to go," he said of the seven-hour procedure.

The surgery on Jan. 15 was conducted entirely by robotic arms that worked on his heart through two pencil-sized holes that had been punctured in his chest. The arms were guided by surgeons at a nearby computer console. A third hole was inserted for a small camera that allowed the surgeons to see what they were doing.

Normal coronary bypass surgery, the most common open-heart surgery done in this country, requires an eight-to-10-inch incision in the chest, an incision that cuts through the breastbone and chest muscle so that surgeons can do their work. Such incisions have always added considerable time to a patient's recovery period.

"This is a significant milestone to minimize the trauma of surgery," said Dr. Craig Smith, chief of cardiothoracic surgery at Presbyterian and one of the surgeons involved in the procedure.

With no chest incision, there will be less pain for the patient, less chance of infection and dramatically less scarring, he added.

"We expect recovery time in the hospital to be two to three days vs. five to seven days [with the chest incisions]," said Dr. Michael Argenziano, director of robotic cardiac surgery at the hospital, who was another of Barrett's surgeons.

Barrett was chosen for the surgery because he had only one artery that needed repair, Smith said, and one artery is the limit for the robot's use at this time. Barrett had had a stent inserted in the artery four years ago, but it closed, leaving the artery 99 percent blocked.

Argenziano and his fellow surgeons trained for more than a year to use the robot, performing 50 operations on animals and parts of operations on humans to familiarize themselves with the "3,000 to 4,000 steps to do it."

Argenziano said that at first he was uneasy using the computer instead of his own hands. But he added, the "surgical immersion" training was so thorough that when he "dropped" a utensil while training on the computer, he instinctively pushed his chair back as though a real instrument might be dropping in his lap.

The operation is part of a clinical trial, sanctioned by the Food and Drug Administration, for the hospital to test the surgical robot in three different types of heart operations: repairing the mitral valve; closing a hole between two chambers of the heart, and the coronary bypass operation.

Last July, surgeons performed the first successful operation -- called atrial septal defect repair -- using the robot and no chest incision in closing the hole between two chambers of the heart.

The first experimental robot heart surgery was done in this country in September 1999. This robot, developed by scientists at Stanford University and manufactured by Intuitive Surgical of Mountain View, Calif., is called the da Vinci Surgical System. It was approved by the FDA in July 2000 for use in such abdominal surgery as gall bladders and colon surgery, and in July 2001 for prostate surgery. The da Vinci is already used in Europe for heart bypass procedures.

Columbia Presbyterian and 10 other medical centers will perform 125 coronary bypass operations as a part of the current FDA trial.

Argenziano expects these operations will take place over the next 14 months, but could not say when the FDA might finally approve the robot's use in the three coronary operations. The FDA approval system includes three phases, each of which is reviewed, and FDA approval times vary widely. This phase tests the safety of the procedure.

In the meantime, Barrett, who will turn 71 on Jan. 25, said he was looking forward to a big birthday party, golf, and visits from his six grandchildren.

What to Do: For information about heart procedures that are minimally invasive, you can visit the American Heart Association. The site also has thorough information about other heart operations.

SOURCES: Interviews with Michael Argenziano, M.D., director of robotic surgery, Columbia Presbyterian Medical Center, New York; Craig Smith, M.D., chief of cardiothoracic surgery, Columbia Presbyterian Medical Center; Arthur Barrett, heart patient, Cedar Grove, N.J.; photo courtesy Columbia Presbyterian Medical Center
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