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[DPRG] Fw: Open-heart surgery without opening chest (robotics)

Subject: [DPRG] Fw: Open-heart surgery without opening chest (robotics)
From: warm38 at juno.com warm38 at juno.com
Date: Sat Nov 23 07:40:02 CST 2002

Remote Operated Robot


http://www.jsonline.com/alive/news/nov02/97270.asp
 
 
Heart surgery without the saw
Device allows bypass operation without opening chest
By JOHN FAUBER
jfauber at journalsentinel.com
Last Updated: Nov. 19, 2002
Chicago - Like a mechanic who does engine repair work
without lifting the hood, surgeons have performed
nearly two dozen open-heart surgeries with a
revolutionary robotic device that alleviates the need
to open the chest.
 
Robotic Bypass


Graphic/Alfred Elicierto 
A Revolution in Heart Surgery


Nintendo Effect?

A bit of applause for video games?
The closed-chest surgical technique was ushered in by
a group of younger heart surgeons, many of whom grew
up playing the games.
"This is really a change in culture," said Mehmet Oz,
director of a New York heart institute.


And as early as this week, a St. Luke's Medical Center
surgeon, who is among a small group of doctors using
the device, expects to do the first closed-chest
coronary artery bypass operation in the Midwest.
Earlier this month, the hospital did its first two
opened-chest bypass surgeries with the device as trial
runs for the upcoming closed-chest surgery.
 
Doctors reported Tuesday on the results from about 17
patients who underwent closed-chest, open-heart
surgery using the da Vinci system, which uses robotic
arms that are inserted in the chest via four holes
about the width of a pencil.
 
Normally, heart surgery requires using a saw to cut
through the sternum to create a foot-long incision.
Such incisions can leave patients with pain, are
subject to infection, add to hospital stays and
recovery time, and are cosmetically undesirable.
 
The device's primary disadvantage is that surgeries
take longer, which means patients must spend more time
hooked up to heart-lung machines. However, the time is
expected to decrease as surgeons become more
proficient with the device.
 
So far, U.S surgeons have used the device to do 23
operations to repair the hearts of patients with
atrial septal defect, a condition in which people are
born with an opening between the heart's two upper
chambers. The condition is repaired with a patch or by
sewing the hole closed.
 
In addition, about 14 closed-chest bypass operations,
such as the one that is expected to be done at St.
Luke's, have been done in the last year, said Michael
Argenziano, director of robotic cardiac surgery at
Columbia-Presbyterian Medical Center in New York and
the first U.S. surgeon to do a closed-chest bypass
operation.
 
The study's results were presented at the American
Heart Association Scientific Sessions 2002.
 
The device also has been used for heart valve repairs.
 
Ushered in by a group of younger heart surgeons, many
of whom grew up playing video games, robot-assisted
heart surgery may still be in the Pac-Man stage, but
it is quickly headed toward Nintendo status.
 
"This is really a change in culture," said Mehmet Oz,
director of the Heart Institute at
Columbia-Presbyterian Medical Center in New York.
 
While the technology is being pushed by younger
doctors, some longtime surgeons who have tried the
device at trade shows can perform basic procedures
such as tying knots within 15 minutes, Argenziano
said.
 
"Although the equipment is costly (the robots cost
about $1 million), this is definitely part of the
future," Argenziano said.
 
The da Vinci system, designed by Intuitive Surgical,
allows the surgeon to sit at a computer control
console about 10 feet away from the patient.
Technically, the device is not a robot, because its
arms are operated in real time by the surgeon. The
surgeon's fingers are placed in Velcro rings and
connected to master controller. When the surgeon's
fingers move, the robot arms move. Another arm is used
to operate a 3-D camera.
 
St. Luke's closed-chest bypass surgery will be part of
a clinical trial in which 125 closed-chest procedures
will be conducted in hopes of getting Food and Drug
Administration approval for the purpose. The device
already is approved for use in heart valve surgery.
 
One of the advantages of the device is that it
provides three-dimensional magnification that is up to
10 times greater than in conventional surgery. The
device also has a computer program that can correct
for any tremors in a surgeon's hands so,
theoretically, it can be more precise.
 
But the real advantage, according to advocates, is
that it avoids having to cut through a patient's
breastbone.
 
It means that patients can leave the hospital in three
days rather than six days and that they can return to
normal activity in two weeks rather than six weeks.
 
"When people realizethey can have their bypass without
their chest being opened, there will be more of it,"
said Daniel O'Hair, the St. Luke's surgeon who will do
the hospital's first closed-chest procedure.
 
For now, closed-chest bypass surgeries involving only
a single blood vessel are being performed, but the
goal is to use the device to do multivessel bypass
surgery.
 

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