Thoroscopic surgery robots now FDA-approved for use in United States hospitals

Richmond 06 March 2001On March 5th, 2001, Dr. Marc Katz performed the nation's first U.S. Food and Drug Administration approved robotically assisted thoracic surgery using the da Vinci surgical system at Henrico Doctors' Hospital in Virginia. The system was cleared for thoracic surgical procedures on March 2nd, and prensently allows cardiac surgeons to perform minimally invasive "thoroscopic" procedures. These are procedures performed in a patient's chest cavity. Henrico Doctors' Hospital was also the first facility in the United States to perform laparoscopic surgery with the da Vinci system in July of 2000.

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"This is the first step toward our goal of total endoscopic, or closed-chest, coronary artery bypass surgery", commented Dr. Katz. "Using minimally invasive techniques with this robotic system, we can significantly reduce the trauma to the body which is associated with open chest cardiac procedures." During Dr. Katz' intervention, the internal mammary artery, or IMA, was harvested for use in a coronary bypass. The IMA is a blood vessel located in the chest cavity, and in about 90 percent of all coronary bypass operations, it constitutes the best available conduit for surgical bypass to major arteries of the heart.

"Typically when performing this procedure, we must make a large sternotomy incision through the patient's chest bone", Dr. Katz stated. "Using retractors, we lift open one side of the chest cavity, similar to raising the hood of a car, so that visualisation and harvesting of the IMA is possible. This often causes severe trauma to the chest wall, resulting in fractures to the ribs and severe muscle and tissue damage which sometimes makes the use of the IMA impossible."

However, with the da Vinci system, only three small ports were placed in the side of the patients' chest, each no more than a 1 cm in diameter. Using an endoscope and two surgical instruments, the IMA was harvested for use in the surgery. "By using the da Vinci system, we can now perform this surgery with minimal chest wall trauma, resulting in much less pain and discomfort to the patient", explained Dr. Katz. The procedure all-in-all took approximately 45 minutes to complete.

"Because of its location near the most vital coronary artery branch, the left anterior descending (LAD), we are able to transfer the lower end of the IMA down to the heart surface to use as a bypass graft to the coronary artery vessels", Dr. Katz added. As compared to veins from the legs, the IMA is smaller and more delicate. Recent studies have revealed that the use of the left internal mammary artery (LIMA) is shown to have improved long term results from bypass surgery. There are two IMAs, one on each side of the breastbone or sternum. They run along the inside edge of the sternum, branching out to the bones, cartilage, and soft tissue of the chest wall.

Dr. Katz believes the applications for da Vinci heart surgery are phenomenal and commented: "We are truly at the threshold of a new era in cardiac surgery. This system will revolutionise cardiac surgery and the quality of patient care. With this new technology, smaller incisions, less trauma to the body, and a quicker recovery will become the norm in cardiac surgery." In Europe, the da Vinci is being used to perform minimally invasive still and beating-heart bypass surgery. Hospital stays are reduced to three days, as opposed to a week-length stay in an open-heart procedure.

Henrico Doctors' Hospital has been chosen by Intuitive Surgical, the da Vinci manufacturer, to participate in beating as well as still-heart coronary artery bypass surgery trials. Once approved by the FDA, only nine hospitals across the United States will be involved in these trials. Roanoke Memorial Hospital and Inova Fairfax Hospital are the only other health care facilities in Virginia currently using the da Vinci Surgical System. Henrico Doctors' Hospital is a 340-bed tertiary care facility. For over twenty-five years, Henrico Doctors' Hospital has provided innovative and world-class health care, typically found at a university medical centre, delivered in a community hospital.

More news on surgical robotic systems and their performance can be found in the following VMW articles:


Leslie Versweyveld

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