East Carolina University surgeons report surprising results using da Vinci robot in mitral valve repair

Greenville 06 February 2002Cardiac surgeons at East Carolina University are reporting encouraging research data on the largest number of patients who have had mitral valve repair using the robotic da Vinci Surgical System, developed by Intuitive Surgical. The findings, showing decreased length of hospitalisation compared to the traditional approach and decreased surgical repair time, as experience using the robotic device grew, were presented during the 38th Annual Meeting of the Society of Thoracic Surgeons in Fort Lauderdale by Dr. Wiley Nifong, director of surgical robotics at the Brody School of Medicine at East Carolina University.

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Dr. W. Randolph Chitwood, an internationally recognised expert in robotic cardiac surgery, performed all 38 patient cases in operating rooms at Pitt County Memorial Hospital, the medical school's affiliated teaching hospital. Dr. Chitwood is chairman of the Department of Surgery at the Brody School of Medicine and chief of surgery for the hospital.

"Our data chronicles the world's largest experience with robotic mitral valve repairs. Our findings offer a feasible and beneficial procedure for patients with mitral valve disease", reported Dr. Nifong, lead author for the scientific paper, Complete Robotic Mitral Valve Repair: Experience with the da Vinci System.

On February 4, 2002, Dr. Chitwood completed the 40th mitral valve repair using the robotic device, the most performed in the world by any cardiac surgeon. All of the surgeries were performed as part of a Food and Drug Administration (FDA) clinical trial to study the safety and efficacy of the minimally invasive, robotic-assisted technique versus traditional sternotomy, or open-chest procedure, in repairing defective mitral valves.

The mitral valve has two leaflets, or flaps, which control the flow of blood between the left atrium and the left ventricle, making a surgical repair of the valve a true intra-cardiac procedure. Dr. Nifong noted that average length of stay for patients with robotic-assisted mitral valve repairs was 3,8 days. With traditional sternotomy incisions, hospitalisation is usually seven to ten days. Traditional open-chest surgery requires surgeons to make an 8- to 10-inch incision, saw through the sternum, and open the rib cage to gain access to the heart.

With the da Vinci Surgical System, Dr. Chitwood and his colleagues make three dime-sized incisions in the chest, through which they insert three robotic arms. One arm holds a tiny camera which projects three-dimensional images onto a monitor in front of the surgeon; the other two arms hold the pencil-sized instruments, which have tiny computerised mechanical "wrists" designed to transmit the dexterity of the surgeon's forearm and wrist into the chest at the operative site.

Seated at a computer console located approximately ten feet away from the operating table, the surgeon views a magnified, three-dimensional image and manipulates the surgical instruments using two fingertip controls. Dr. Nifong reported that the time using the robotic device and the actual repair of the defective mitral valve leaflet decreased as the surgical team's experience increased. The 38 patients were divided into two groups of 19 each. Both total robotic use and valve leaflet repair times decreased by approximately 24 minutes from the first group to the second. Total operating times also decreased by approximately 42 minutes between groups.

Even though the total operating room times are approximately 30 minutes more for the robotically-assisted approach, Dr. Nifong stated that the patients have no adverse side effects or complications. "In fact, patients recover more quickly despite being in the operating room an additional 30 minutes because of the minimally invasive approach. We are working on adjunctive technology which will allow us to decrease the operative times toward conventional procedures", he added.

"Robotic procedures will become more applicable to a larger number of patients as technology advances", Dr. Nifong concluded. For example, within two months East Carolina University (ECU) surgeons plan to perform coronary artery bypass grafting using the da Vinci surgical system. In addition to the FDA clinical trials tracking da Vinci's efficacy, ECU is equally the lead international training site for the da Vinci Surgical System for all surgical disciplines. More than 90 medical centres from across the United States and abroad have completed certified training at ECU.

Dr. Chitwood performed the first total mitral valve repair using the da Vinci robot in North America in May 2000. You can read an account on the first ECU clinical trials with the da Vinci surgical robot in the VMW December 2000 article East Carolina University to test da Vinci robot in cardiac surgery trials.


Leslie Versweyveld

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