Thursday, May 20, 1999
Robots now fix hearts
Local doctor does no-cut bypass
BY TIM BONFIELD
The Cincinnati Enquirer
Imagine a day when a heart surgeon can do a bypass operation without actually touching a scalpel or clamp or even the patient. For Dr. Randall Wolf, a cardiothoracic surgeon at Christ Hospital, that day is here.
Dr. Wolf is the first U.S. surgeon to complete a remote-control cardiac bypass on a living, breathing patient. He did it in December using a space-age robotic surgery system dubbed “da Vinci.” Next week, he plans to return to Germany to do five more cases.
“This is the big breakthrough for minimally invasive surgery,” Dr. Wolf said. “I actually sit in the room next to the (operating room) to do the procedure. I'm not scrubbed-in or even wearing gloves. Yet you feel as if your hands are actually inside the chest.”
The da Vinci robot is made by a U.S. firm, Intuitive Surgical Inc., which licensed the technology from a company working on a “telesurgery” system for the Department of Defense. Since human testing began in Europe in 1997, more than 200 real operations have been performed with the da Vinci robot, ranging from gall bladder removals to bypass surgery.
Last fall, a photo of a doctor practicing on the new robot made the cover of a Life magazine edition focusing on medical miracles.
Unlike the popular fictional robots in the movies, da Vinci doesn't look remotely humanoid. Instead, the device looks like a smaller, three-armed version of the industrial robots used to assemble cars. Here's how the system works:
For heart surgery, the patient is prepped for an otherwise normal procedure in an operating room with nurses, anesthetists and doctors. But rather than cutting the breastbone and spreading apart the ribs, as needed to do open heart surgery, the team makes three small “ports” between the ribs.
One port allows access for an endoscope, a tiny camera attached to a fiber-optic cable. The other two ports provide access for surgical tools.
Dr. Wolf and other surgeons already use this closed-chest approach to do some bypass operations, which can dramatically reduce recovery time for patients.
However, minimally invasive surgery has limitations that have kept the procedure at less than 5 percent of the 350,000 bypass operations done each year in the United States. Among them: surgeons trying to do finely detailed work using long, sometimes awkward surgical tools; and trying to do three-dimensional work while using a two-dimensional video screen.
Where robot excels
To picture the difference between standard surgical tools and the long laparoscopic ones, try writing by holding a pen by the upper end.
“It is difficult to sew with conventional laparoscopic instruments. It's like threading a needle at the end of a long stick,” Dr. Wolf said.
Enter da Vinci.
The robot, rather than the doctor, holds the tools. The robot never gets tired of holding them steady. And the tools themselves are far more sophisticated than standard endoscopic instruments.
Picture tiny snippers and clamps on pencil-thin rods attached to a “wrist” that can bend back and forth, wiggle side-to-side and rotate in a full circle — actually providing more types and range of movement than a human wrist.
Those robotic hands mimic the motions made by the surgeon sitting at a complex-looking set of hand controls. Actually, the controls are designed to be nearly thoughtless to use: The surgeon moves his hands as if doing the operation and the robot follows along.
The computer controls update the robot's position and response to the surgeon's commands 1,500 times a second, allowing for the delicate, precise movements needed to stitch a bypass graft from inside the chest. In addition, the sensitivity of the tool controls can be adjusted, so that a large movement by the surgeon translates into extremely tiny movements inside the chest.
While doing all this, the surgeon sits at an oversized console peering into an eyepiece that provides high-definition, full-color, magnified, 3-D images of the procedure. The imaging system itself is a technical advance, because most surgical video monitors provide only a 2-D picture.
So far, Intuitive has installed three of its $1 million da Vinci systems in Europe. As testing continues in Europe, Dr. Wolf said the company may install up to three systems in the United States by year's end, possibly one at Christ Hospital.
Dr. Alain Carpentier, a heart surgeon at the Broussais Hospital in Paris, who performed the first open heart surgery using the da Vinci system, said the device “represents a major advance in cardiac surgery.”
“The Intuitive system enhances the precision of our operations and makes it possible to expand the indications of minimally invasive surgery,” he said.
California-based Intuitive Surgical, founded in 1995, is one of several players in the emerging field of medical robotics. Cincinnati-area business people may know Intuitive's CEO, Lonnie Smith, who joined the company in February 1997 after leaving Batesville's Hillenbrand Industries Inc., where he was executive vice president.
In 1997, Dr. Wolf and Christ Hospital were involved in testing the AESOP 2000, a voice-controlled robot made by California-based Computer Motion Inc., designed to maneuver the endoscopic video camera used in minimally-invasive surgery. More than 300 of the $50,000 systems have been sold to hospitals nationwide.
Should robotic surgical equipment prove as reliable as its early successes indicate, many more types of surgery could be minimally invasive. There could be a new era of telesurgery — with the doctor guiding the work from the next room, across town or even thousands of miles away.
Surgery in space In theory, a da Vinci-like device could allow Earth-based surgeons to work on people on the International Space Station, now under construction. Closer to home, such equipment could transform rural health care by making it possible for big-city specialists to do procedures from remote locations — a potentially life-saving benefit for patients too sick or injured to travel.
But what happens if something goes wrong? If communications get disrupted or machinery malfunctions, the robot hands are programmed to stop automatically, Dr. Wolf said. If that occurs, the operating room staff can disconnect the robot and attempt to complete the operation using standard methods, just as doctors do now in the rare event that laparoscopic surgery leads to a serious complication.
That kind of fail-safe can work when the surgeon running the robot is just a few steps away from the patient. But the who-steps-in question remains open for long-distance telesurgery, Dr. Wolf said.
Meanwhile, legal questions remain about whether a doctor will need multiple medical licenses to practice telesurgery in various states and foreign countries.
Once the team completes 60 operations in Europe (30 using the robot vs. 30 not using the robot), it plans to send the data to the U.S. Food and Drug Administration to seek approval to use the robot in the United States.
J.J.'s babies are endless gift to neighborhood
Police shooting called fatal error
Report evokes wait-and-see reaction
Girl, 7, expelled in cap-gun case
Venues remove violent games
What's best for downtown?
Ujima festival gets $150,000 from city
Ohio House backs Commandment monuments at schools
Police deny shooting in raid
Schools awash in charter ideas
Budget bill would erase boundaries
Lawmakers doubt numbers in Kentucky gaming study
Patton seeks higher gasoline tax
Private donor offers bonus reward money
Art makes students' points about violence and abuse
Robots now fix hearts
Contenders in line for shot at Lucas
Writer's images of Ky. haunting
GET TO IT
It's Commonly Jazz series returns to toot its horn
'Take a Stand' helps teens talk about anger, violence
45 arrests after Kings Island 'Grad Night'
Agencies pinched by rising needs
Colerain road will be wider
Council rejects change to intimidation law
County's radio system costs $4.9M
Covington clinic marks anniversary
Covington party ends in slaying
Finan spurns aid plea
Furnish found guilty in killing
Girl's last try for cure fails
Harper competent, could die Tuesday
Hostile e-mails case over
Lebanon manager praised as innovator
Lebanon recall leaves sour taste for many
Meister's attorney won't give up photos
Music room better than ever after fire
Nye urges scrapping proposal
Paint-ball gun brings boy's arrest
Repeat DUI cases target of push for new law
Sisters can pursue claim of fraud against insurer
Tobacco sales to underage dip
TRISTATE DIGEST
Ventura's dismissal request denied
