Robotic technology provides less invasive procedure for mitral valve repair

Los Angeles 18 June 2007Certified public accountant (CPA) Steve Garelick of West Hills, California, knew the complex heart surgery he needed in late February to repair his leaking heart valve couldn't be postponed until after tax season. Yet thanks to robotic surgical technology available at Cedars-Sinai Medical Center, Steve Garelick, aged 54, was back in the office on a part-time basis just two-and-a-half weeks after his surgery.


Steve Garelick's surgeon, Alfredo Trento, M.D., director of the Division of Cardiothoracic Surgery at Cedars-Sinai, has performed 70 robotic mitral valve repair surgeries over the past two years, a surgical volume that ranks fourth in the United States among cardiovascular surgeons who perform this highly skilled surgery.

"With robotic technology, surgeons can visualize the mitral valve in such a way that they gain a much better understanding of the valve's pathology when compared to traditional sternography. We can actually see inside the valve ... it's amazing technology", stated Dr. Trento.

Cedars-Sinai is the largest mitral valve repair centre in the Los Angeles area, completing approximately 100 repairs of different types annually. By repairing the valve rather than replacing it, a patient can avoid long-term use of blood thinners and problems such as infection.

The mitral valve opens and closes, controlling the blood flowing into the left side of the heart. When it becomes damaged, it can't completely seal the heart's left ventricle which causes the heart work to harder and leads to potential complications like congestive heart failure.

Mitral valve repair involves delicate reconstruction of valve tissues. Traditional repair - sternotomy - is performed by sawing open the breastbone and spreading the ribs apart to expose the heart. The less invasive procedure, which requires only a few very small incisions under the right side of the breast, uses Intuitive Surgical's daVinci Surgical System.

From a console a few feet away from the patient, the surgeon views a high resolution 3D image of the surgical site through a camera. Miniaturized instruments - inserted into the body through a series of dime-sized incisions - are controlled by the surgeon's hand movements which are scaled, filtered and translated into precise movements completed by four robotic arms located next to the operating table. The system relays force feedback sensations back to the surgeon that provide a substitute for tactile sensation.

In addition to improved visualization, Dr. Trento said the robotic procedure has less risk of infection, less blood loss and faster post-hospital recovery than traditional surgery. Sternotomy typically takes between one and three months post-surgical recovery time. "If I decide that I can repair a patient's mitral valve rather than replace it, I'll do the procedure robotically", Dr. Trento explained.

Steve Garelick was referred for the procedure after he began experiencing fatigue following activities such as swimming and gardening. According to his doctor, Ilan Kedan, M.D., a cardiologist with the Cedars-Sinai Medical Group, Steve Garelick was an excellent candidate for the da Vinci procedure because he was not overweight and didn't have any coronary artery disease nor other complicating illness.

"I had always considered myself to be very active", stated Steve Garelick. "About six months before the surgery I'd find I was winded and have to rest after swimming only 100 yards. I started to cut back on exercise, thinking it was just normal aging. It turned out it wasn't. I thought I was healthy ... finding that I had mitral valve prolapse was a real surprise to me."

Steve Garelick said he wasn't concerned about having a robot as part of his surgical team. "I'm very grateful to Drs. Kedan and Trento for their knowledge and foresight in this field."

The first in Southern California and one of only 10 hospitals in the state whose nurses have been honoured with the prestigious Magnet designation, Cedars-Sinai Medical Center is one of the largest non-profit academic medical centres in the Western United States. For 19 consecutive years, it has been named Los Angeles' most preferred hospital for all health needs in an independent survey of area residents.

Cedars-Sinai is internationally renowned for its diagnostic and treatment capabilities and its broad spectrum of programmes and services, as well as breakthroughs in biomedical research and superlative medical education. It ranks among the top 10 non-university hospitals in the United States for its research activities and is fully accredited by the Association for the Accreditation of Human Research Protection Programs Inc. (AAHRPP).

Leslie Versweyveld

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