Robotics, The Next Frontier In Operations, Heart Surgery

November 12, 1997

ORLANDO, Nov. 12 -- Robots are being tested as a new way to help surgeons perform heart operations, according to researchers who spoke here today at the American Heart Association's 70th Annual Sessions.

The robots control miniature instruments such as scissors, needle holders, graspers and a camera through 5 or 10 millimeter (about one-quarter inch) incisions, or ports.

"This is a potentially revolutionary technique for surgery," says Ralph J. Damiano, M.D., chief of cardiothoracic surgery at Penn State Geisinger Health System and Hershey Medical Center, Hershey, PA.

Damiano and his colleagues are testing the technique for assisting in bypass surgery, one of the most common heart procedures. In this procedure a blood vessel from another part of the body is used to construct a detour around the blocked area of the coronary artery that feeds blood to the heart. Normally a 12- to 18-inch incision is made. In minimally invasive bypass, the procedure can be performed through incisions that are about four- to eight-inches long.

Once developed and perfected, the robotic port-access technique might allow mini coronary bypass surgery to be performed with "just small puncture wounds," about three milllimeters in size, says Damiano. "Individuals would have a very short hospital stay and a return to work sooner. And there wouldn't be as much scarring."

In their presentation today, researchers report the testing of the bypass procedure in 10 pig hearts. All bypasses were successfully completed, says Damiano.

During the procedure, the surgeon sits before a screen several feet away from the operating table, viewing the heart on a television monitor. Large handles are used by the surgeon to control the instruments. The handles are interfaced with a computer that processes and maps every movement. This is translated down to the robotic arms and surgical instruments.

"You are holding the handles, which are electronically interfaced with a microprocessor that translates your motions to the robotic arms," says Damiano. "The advantage here is that the robotic arms can hold things absolutely steady. The motion is filtered to eliminate tremors. In addition, the physician can scale his motion so that large movements of the controls produce fine movements in the patient."

In one port, a voice-activated camera is inserted over the heart that shows real time pictures of the heart on a large screen. Two other probes are inserted on either side and robotic surgical instruments are passed through the probes. As the robotic arms dissect the mammary artery, which is used for the graft, the surgeon can watch every move on a large screen. The camera is voice activated and coded for simple commands.

The camera responds to simple voice commands, says Edward R. Stephenson, M.D., cardiothoracic fellow at Penn State Geisinger Health System and co-investigator of the study. "By saying 'left' the camera moves a certain distance to the left. If 'move left' is said, it continuously scans to the left. If 'return' is said, the camera moves to its original position."

This system allows use of the same needles and suture material employed in traditional surgery.

Presently, the surgeons involved in the new technique are performing only coronary bypasses using the mammary artery in the chest. However, in the future they may be able to take a section of the artery from the arm, insert it into the chest via a port, and then use robotics to sew it in place, according to the researchers.

As minimally invasive heart surgery has expanded, significant limitations have been encountered because of the lack of adequate precision with standard instruments. But robotics eliminate many of these problems by allowing the precise movements required to complete bypass surgery, says Damiano.

Initially, the robotically assisted microsurgery will be used only for individuals who have blockages in one of their coronary arteries and only when the heart is stopped (while the heart-lung machine keeps the blood oxygenated). In the future, the technique could be performed on a beating heart.

Co-authors of the study are Mark A. Jayawaut, M.D., cardiothoracic fellow, Medical College of Virginia, and Sachin Sankholkar, engineer, Computer Motion Inc.
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American Heart Association

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