Robots to assist in heart surgery

Last June, surgeons in France performed the first successful closed-chest coronary bypass operation. Instead of cutting open the patient's chest and breaking apart his breastbone, surgeons did the operation through three tiny half-inch holes between the patient's ribs. Twenty-four hours after the operation, the patient felt so good that he refused pain medication.

Seventy-five cardiac operations and dozens of other minimally invasive surgical procedures have been successfully completed by French surgeons using the $850,000-system designed by Intuitive Surgical Inc. in Mountain View, Calif. Hospitals in Germany and Belgium have begun using the system.

On Wednesday, Ohio State physicians joined officials from Intuitive Surgery in announcing a partnership that will make the Columbus campus the site of the first Food and Drug Administration-approved American clinical trial using the device.

Mimics a surgeon
The system mimics all or some of the movements of a surgeon's shoulders, elbows and wrists. A surgeon makes three tiny incisions and inserts thin tubes to tunnel to the operating area and protect the other body tissue. He then inserts three arms into the tubes. One is for an endoscope, a camera that provides a 3-D view. Two others hold tiny artificial wrists to which a variety of tools - scalpels, scissors, needle - can be attached.

The surgeon sits at her own computer workstation several feet from the operating table and moves instruments that control the ones inside the patient. The instruments inside the patient mimic the motion of her hands so accurately that she can sew up a coronary artery as thin as a thread. The system removes any hand tremors. The surgeon watches her progress on a screen that enlarges the artery in 3-D to the size of a garden hose.

"It's important to remember that the surgeon is still the one who is doing the procedure and the one who is in control," explained Randall Wolf, a cardiac surgeon from Christ Hospital in Cincinnati. Wolf, who has trained in Europe using this equipment, will join the Ohio State faculty in August. "This is a tremendous advancement in minimally invasive surgery that is aimed at improving the quality of life for patients," he said.

Promising but limited
Endoscopic surgery was revolutionary when it was developed more than a decade ago, but it has serious shortcomings. Some surgeries were considered too complex or risky for this approach, explained Pascal Goldschmidt, professor of cardiology and director of Ohio State's Heart and Lung Institute. "Physicians were reluctant to use this approach when the risk of bleeding was high."

Also, the instruments are too cumbersome to use in complex operations, such as heart, bowel and spinal surgery. Using an endoscopic instrument is like poking a pencil through cardboard and writing on a piece of paper behind it. The surgeon's motions are reversed. She has to move the instrument down for the tip to move up, or left to move the tip to the right. Because the instruments are stiff, there's no wrist movement. Cutting on organs isn't a problem. But sewing them up can't be done.

Sixty patients requiring a single vessel coronary bypass are expected to be enrolled in the Ohio State trial.

"This approach offers significant advantages to cardiac patients," said Robert Michler, chief of cardiothoracic surgery at Ohio State who received training in Europe using the new system earlier this year. "Eventually, we expect to see a heart patient receive surgery one week and then return to work the next."