CNN's Dr. Sunjay Gupta on da Vinci Surgery

Researchers laud robot-guided heart surgeryBy Debra GoldschmidtCNN Medical UnitTuesday, November 19, 2002
CHICAGO (CNN) -- Robotic heart surgery using the da Vinci Surgical System has many advantages for patients and doctors, according to research presented to cardiologists at the annual Scientific Sessions of the American Heart Association on Tuesday.
Surgeons from New York Presbyterian Hospital presented the outcomes of 17 patients after having a heart defect -- called atrial septal defect -- repaired using the robot for assistance.
Of the 17 patients, 16 of them had their hearts repaired in a totally robotic operation. One patient required additional repair five days after the first surgery. The average length of stay in the hospital after the surgery was three days compared with seven to 10 days for traditional surgery. None of the patients experienced major complications.
The robotic technique requires four puncture wounds, each an inch in diameter. Surgeons use pencil-sized instruments to operate on the heart. They sit several feet away from the patient at a console where they see inside the patient on a monitor.
Lead researcher, Dr. Michael Argenziano said the success rate "proved we can do this surgery in a closed chest approach." The alternative is the traditional technique of cracking the chest -- done by a long incision, cutting the bone, and then splitting the ribs.
"The main advantage is that these patients were able to recover quickly." he said.
Patients recovering from the traditional approach usually have several inactive weeks before they're able to resume regular activity, but patients who undergo robotic surgery only spend a couple of days recovering from local wounds. Argenziano was amazed when one of his patients was able to pick up her toddler the day after her surgery.
Compared with other minimally invasive heart surgery approaches, robotic assistance allows surgeons to have better control over the surgical instruments and a better view of what they are doing.
However, there are disadvantages -- time being one of them. Robotic-assisted surgery takes nearly double the amount of time that a typical open-heart surgery takes. That means a patient is under anesthesia longer and nurses and other staff must also work longer hours.
The cost seems to be a disadvantage as well. In the short term, hospitals pay millions of dollars for the robot and the disposable instruments needed.
But Argenziano argues that although the robotic-assisted surgeries cost about $2,000 more per operation, in the end the cost comes out about even because patients are out of the hospital sooner.
Money is saved after surgery on nursing care and pain medications, he said, in addition to the societal benefits from faster recovery.
The procedure is still experimental under a U.S. Food and Drug Administration clinical trial; therefore, the robot's manufacturer picks up any costs that exceed the normal cost of heart surgery.
Seven other patients have undergone the procedure at other centers as part of the trial.
Argenziano said they've had no trouble finding patients willing to try the experimental surgery because of the faster recovery time. He added that the surgeons can have the patient's chest open in one minute's time should they suddenly need to convert to traditional surgery -- something they haven't had to do.
In another trial, Argenziano and other surgeons are using the robot to perform closed-chest coronary bypass surgery.
Last week the FDA gave approval for the robot to be used for mitral valve repair surgery. This is the first robotic heart surgery to be granted clearance by the FDA.
The da Vinci Surgical System is made by California-based Intuitive Surgical Systems. There are 132 systems in hospitals worldwide and nearly 100 are in U.S. hospitals.
Source>http://archives.cnn.com/2002/HEALTH/11/19/heart.robots/index.html