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The Beat Goes On

Robotic bypass surgery shows success in 1-year followup

WEDNESDAY, June 6, 2001 (HealthDayNews) -- One year after having robotic surgery as a part of their heart bypass, all 19 people are in great shape, according to a review of the first North American trial of this type of surgery.

"This is the wave of the future for bypass surgery," says Dr. Ralph Damiano, Jr., chief of cardiac surgery at Washington University School of Medicine in St. Louis, Mo. "What this trial shows for the first time is that robotic assistance can let a surgeon do a procedure with an endoscope [fiber-optic tube with a viewing device on it], where previously it was impossible to hold the long instruments steady when you are working on very small blood vessels."

This is the latest success story in the more than two years of using remote-controlled, voice-guided instruments in various kinds of delicate surgeries. The era was launched in 1998 when Damiano and other surgeons did two heart bypasses in Germany using the Zeus Robotic Micro-surgical System. Damiano is on the clinical advisory board of the company that makes the Zeus system. The same year, another remote-controlled setup called the da Vinci Surgical System, which is not voice-guided, proved its worth in various European hospitals, and last year it received Food and Drug Administration approval to be used in various abdominal procedures in this country.

But the wave of the future may be a bit slower in coming than heart patients would wish. Even though both systems eliminate the tremble and other imprecisions of direct contact with a surgeon, shorten the recovery time and leaves no "zipper" scar from a long incision, the learning curve for the technologies is steep and the cost of the machines is high. For example, the da Vinci costs about $1 million.

Normally, in a heart bypass operation, surgeons cut into the chest, making a 12- to 18-inch incision, then spread the breastbone to get an unobstructed path to the heart in order to replace or detour around a clogged or diseased artery. Endoscopic surgery, on the other hand, only involves three cuts, each about the diameter of a pencil, Damiano says.

Three "arms" are inserted into the holes: one has a camera that sends back 3-D images to the surgeon; the other two hold surgical instruments on "wrists" that mirror the motions of the surgeon, who sits at a nearby console.

"Basically, the surgeon sits at a console five to 10 yards from the operating table, facing a video monitor," Damiano says. "The surgeon grasps two hand instruments, which can be moved like regular [surgical] instruments, and these motions are mechanically relayed to a computer system, which then modifies and digitizes the motion, filtering out any high-frequency motion like a hand tremor. What the computer allows you to do is make easy-to-perform gross motor movements at the console, which are then scaled down by the computer to a microscopic scale."

For this trial, only one artery in each of the patients was repaired using this technology; if more needed to be done, the surgeon did the operation in the traditional manner. All 19 patients were fine after two months, as assessed by an X-ray examination of the blood vessels or chambers of the heart.

The researchers phoned and interviewed the 19 patients and found that they were free of symptoms one year later, Damiano says.

The findings were published in June's Annals of Surgery.

But don't go rushing off to your heart surgeon just yet.

"We are a long way from a demonstration of feasibility to general use, and primarily it's the expense of the equipment," says Dr. Timothy Gardner, chief of CardioThoracic Surgery at the University of Pennsylvania in Philadelphia. "These units cost hundreds of thousands of dollars for a single unit, and they still are in development. I'm sure the company would love to produce more of them, but they are still subject to development costs and U.S. Food and Drug Administration approval."

Gardner says the technology is an advance but "only one possible avenue for heart surgery to take. And we are certainly motivated by trying to make bypass and heart surgery more reliable and less invasive."

"The problem remains that the equipment required and the skill sets required are enormously substantial," Gardner says.

The Zeus system is made by Computer Motion, Inc., of Goleta, Calif.; the da Vinci system is made by Intuitive Surgical, Inc., based in Mountain View, Calif.

What To Do

For more information on robotic surgery, check out the CardiologyLine. For additional information on minimally invasive bypass surgery, visit the American Heart Association.

Or, you can take a look at previous HealthDay stories on heart bypass operations.

SOURCES: Interviews with Ralph Damiano, Jr., M.D., chief of cardiac surgery, Washington University School of Medicine, St. Louis, Mo.; Timothy Gardner, M.D., chief of CardioThoracic Surgery, University of Pennsylvania, Philadelphia; June 2001 Annals of Surgery
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