California Pacific Medical Center performs "touch-free" heart surgeries on children and adults
San Francisco 20 October 2003"Touch-Free" heart operations using tiny incisions in the chest in combination with miniaturized instruments, digital cameras and robots, are now routine at California Pacific Medical Center. Patients, whether a neonate or an adult, do not need to undergo heart surgery by techniques of the past. California Pacific Medical Center recently acquired the da Vinci Telemanipulator to complement Dr. Michael Black's surgical philosophy.
Dr. Michael Black, chief of California Pacific's Division of Paediatric Cardiac Surgery and the surgical director of its Paediatric and Adult Congenital Heart Programme, is an internationally-known pioneer in the robotic, minimally- invasive repair of heart defects. Dr. Black has developed equipment that makes such surgery possible and has traveled abroad to teach and perform his "touch-free" techniques in Asia.
"Seeing children with band-aid sized incisions and no breathing tubes as they roll out of the operating room is very gratifying", Dr. Black stated. Most children are discharged home within two days after the repair. Robotics and video-assisted cardiac procedures allow surgeons to get closer to the surgical site than human vision will allow, and to work at a much smaller scale than conventional surgery permits.
Traditional heart surgery requires that the patient's chest be "cracked" open by way of a large midline incision, accompanied by the division of the entire sternum or breast bone. Traditional large thoracotomies or incisions between the ribs may be painful and disfigure girls as they pass through adolescence. With video-assisted surgery and robotics, Dr. Black is able to perform delicate procedures on the heart utilizing 3 to 4 small ports.
"Robotics is revolutionizing the practice of cardiothoracic surgery", according to Dr. Black. "Being able to operate in the deep recesses of the chest can be difficult with long instruments and a camera. Imagine trying to tie your shoe laces with a long plier and a flashlight. Robotics allows the surgeon to approach the problem with the same dexterity that one is accustomed to", he added.
Patients benefit from robotic surgery by:
- Less blood loss which decreases the potential need for transfusions;
- Less post-operative pain or discomfort;
- Decreased risk of infection since the surgeon's gloved finger never makes contact with tissue;
- Significantly shortened hospital stay;
- Faster recovery;
- Less scarring and much improved cosmesis.
Sitting approximately eight feet away from the patient, Dr. Black moves highly-sensitive instruments on a computer console that direct the camera-equipped, three-armed robot. The patient's heart is magnified on a screen. The robot precisely matches Dr. Black's hand and wrist movements, translating them to tiny instruments placed inside the patient through the minimal incisions. "The robot can be so delicate and precise, you can place sutures the size of a human hair in a very tiny area", Dr. Black noted.
This "touch-free" technique allows Dr. Black to operate on the smallest patients - the youngest to date being 28 weeks gestation or equivalent to a second trimester foetus, with heart-lung machines modified for the patient's decreased size. In Dr. Black's foetal lab, he has mastered his ability to manoeuvre in very small spaces and cannulate devices and tubes in very tiny vessels.
"We are encouraged that our initial experience performing such complex robotic heart surgery in the foetal lab can translate to premature neonates. We can offer parents hope that even the most premature infants can routinely undergo corrective open heart surgery in the near future", stated Dr. Black.
Michael D. Black, M.D., F.A.C.S., received his medical degree from the University of Toronto, Ontario, Canada. He completed a fellowship in cardiovascular surgery at the Hospital for Sick Children in Toronto, where he was an R.S. McLaughlin Scholar. He has served as a clinical instructor at the Division of Paediatric Cardiothoracic Surgery at the University of California, San Francisco. Before joining California Pacific Medical Center, Dr. Black was chief of cardiac surgery at Lucile Packard Children's Hospital at Stanford University and an associate professor of Surgery at the University of California, San Francisco.
California Pacific Medical Center (CPMC), a Sutter Health affiliate, is one of the largest private, not-for-profit teaching medical centres in Northern California. It is a tertiary referral centre providing access to leading-edge medicine while delivering superior personalized care. CPMC provides a wide variety of services, including acute, post-acute and outpatient hospital care; home care and hospice services; preventive and complementary care; and health education. Through its medical education programme and its research institute, physicians at California Pacific Medical Center are able to bring health care innovation to the bedside.
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