Atrial fibrillation is a major burden to the aging population. This common cardiac condition is a disturbance of the heart's normal rhythm and is estimated to affect over 100.000 people in Canada. With this medical condition, the upper chambers of the heart contract in a rapid, unco-ordinated way causing an irregular heartbeat. This rapid, irregular heartbeat causes symptoms such as dizziness and shortness of breath. It can lead to an increase in clot formations and stroke and in many cases is a sign of advanced heart disease.
Treatment options usually include blood-thinning medication or surgery. Although left atrial appendage ligations are performed routinely using a minimally invasive approach at LHSC and at other centres, often the chest is opened to access the heart resulting in prolonged hospitalization. This was the first time that the procedure was performed with the use of the da Vinci surgical robot as a solitary procedure in order to keep the surgery as least invasive as possible.
Ruthven Ontario resident Joe Policella had never heard of AF before he suffered a mild stroke while vacationing in Florida. The 72-year-old recent retiree was not a candidate for blood thinning medication and the prospect of undergoing invasive surgery carried significant risks given his age. Dr. Bob Kiaii, cardiac surgeon at LHSC and CSTAR scientist, suggested a robotic option to Joe Policella. "The decision to do this surgery robotically was a family decision and we were confident in Dr. Kiaii's abilities", explained Joe Policella's daughter Nina.
"Being able to perform this procedure fully robotic-assisted allows us greater precision and less chance of complications that could potentially make a less invasive procedure an invasive one", stated Dr. Kiaii. "The four-armed da Vinci robot makes a huge difference and provides a significant advantage by providing greater dexterity and accuracy that I would not have - even with the minimally invasive thorascopic approaches."
After the robotic surgery, Maria Policella was surprised at how good her husband looked. "His recovery was very good. When I saw him after the surgery I couldn't believe he just had surgery." Joe Policella returned home within 3 days of the surgery and within a couple of weeks returned to his active life and regular routine. "I wanted to get back to the gym", joked "Papa Joe" during a follow-up examination with Dr. Kiaii.
"CSTAR continues to expand the frontiers of robotic surgery", stated Tony Dagnone, President and CEO of London Health Sciences Centre. "The accelerated pace of medical advancement by the CSTAR team provides enormous contributions to the future of medicine and ultimately to high quality of patient care."
"Robotics is revolutionizing the way surgery is done", explained Dr. John Denstedt, Citywide Chief of Surgery at LHSC and St. Joseph's Healthcare London. "This procedure is another major step forward in the process of ensuring successful patient outcomes." Dr. Kiaii stresses that while this procedure is not a cure for atrial fibrillation, it does offer another treatment option for high-risk patients suffering from AF.
This procedure is one of many "firsts" at CSTAR. Most recently in October 2004, an interdisciplinary medical team led by Dr. Bob Kiaii, leader of CSTAR's Robotic Coronary Artery Bypass research project and cardiac surgeon at LHSC, and Dr. Bill Kostuk, cardiologist at LHSC, were the first in North America to complete two different procedures to clear blocked arteries during the same episode of care. Both a minimally invasive robotic-assisted heart bypass surgery and angioplasty with stenting were performed sequentially in time in the same operating room. Advanced technology such as 3D imaging in CSTAR's specialized Hybrid Operating Room/Angiosuite at London Health Sciences Centre, one of a few such facilities in the world, has made this new intervention possible.
Research at CSTAR is supported by grants from the Canada Foundation for Innovation and the Ontario Government. Canadian Surgical Technologies and Advanced Robotics is Canada's national centre for developing and testing the next generation of minimally invasive surgical and interventional technologies and techniques, including robotics. CSTAR trains the surgeons of the future and shares expertise around the world. Building on world and national firsts pioneered by surgeons in London, CSTAR was launched in December 2001. CSTAR is a collaborative research programme of London Health Sciences Centre (LHSC) and Lawson Health Research Institute, and is affiliated with the University of Western Ontario.
CSTAR is one of the first interdisciplinary research and training facility in the world to bring together practitioners, students, and researchers in surgery, engineering, imaging, robotics, information technology and business. Project teams have attracted $18,8 million from the Canada Foundation for Innovation, the Ontario Government and industry to fund discoveries in many areas of medicine, from robotic foetal procedures to cancer therapy.
More news on the da Vinci surgical robot is available in this VMW issue's article Robotic surgery dramatically reduces physical trauma for head and neck cancer patients.