Advanced Robotics
in Cardiac Surgery Provide Minimally Invasive Bypass
November / December 2002
Penn Cardiac Care at the Hospital of the University of Pennsylvania
is the only hospital in Philadelphia and one
of only
12 in the nation participating in an FDA clinical trial to
determine the safety and effectiveness of totally endoscopic
coronary artery bypass (TECAB) surgery via an advanced robotic
surgical system.
Multiple general surgical, urologic and gynecologic robotic
applications are already widely practiced, but technical limitations
of endoscopic equipment have precluded the wide spread application
of minimally invasive approaches in cardiac surgery. "Technological
advancements in cardiac surgery in recent years have allowed
fewer invasive approaches to cardiac surgery to become feasible,
but the development of computerized surgical robots that are
applicable to delicate heart surgery is a revolutionary breakthrough,"
says Y.
Joseph Woo, MD, director of the Minimally Invasive and
Robotic Cardiac Surgery Program at Penn. "By virtually transporting
the surgeon's eyes and hands into the patient's body, the
robotic system allows the surgeon to perform complex heart
surgery without ever having to open the patient's chest."
In the operating room, one surgeon controls Intuitive Surgical's
da Vinci™ Surgical System from a viewing console, while
a second surgeon works alongside the patient, making three
tiny chest "stab holes" for the robotic arms and endoscope.
With the high-resolution, three-dimensional camera system,
the operating surgeon has a full view of the patient's heart
and can perform the bypass operation with the robotic arms.
"Attached to the robotic arms are sleek, small-caliber, multi-jointed,
surgical instruments that precisely replicate the operating
surgeon's wrist and hand movements. The computer enhances
the surgeon's hand movements and provides greater range of
motion than humanly possible," explains Dr. Woo, who is one
the nation's few surgeons trained to use the robotic system
for bypass surgery.
"Our investment in the robotic system and in the extensive
training of our surgical and nursing team was driven by the
potential to improve patient comfort and enhance our expertise,"
says Timothy J. Gardner, MD, chief of cardiac surgery for
the University of Pennsylvania Health System.
Cardiovascular disease is the leading cause of mortality
and the leading diagnosis for hospital admission in the United
States and coronary artery bypass grafting is the most commonly
performed cardiac operation. Traditionally, heart bypass surgery
requires an eight to 10-inch median sternotomy, placing the
patient on the heart/lung machine, a five-day hospital stay
and a lengthy recovery at home. In contrast, TECAB requires
tiny incisions that cause minimal trauma and results in less
blood loss, pain, scarring, and lower risk of infection, while
decreasing length of hospitalization and improving recovery
time.
In addition to bypass procedures, clinical trials have been
completed for totally endoscopic mitral valve and atrial
septal
defect repair. Once approved by the FDA, these procedures
will be available at Penn. The full impact of surgical robotics
may not be realized for another two or three years, but future
applications may include arrhythmia ablation, transmyocardial
laser revascularization and heart failure therapy. Dr. Gardner
noted, "As demonstrated by our new robotic program, Penn
Cardiac Care is committed to providing the most comprehensive,
technologically
advanced cardiac care in the region and will continue to
pursue similar developments that hold great promise for
both patients
and surgeons alike."
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Referring Physicians: To speak with a Penn physician
or refer a patient, contact PennHealth through the secure online
referral form or by calling
1-800-789-PENN
(7366). |
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