Cardiothoracic Robot

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Marty

Marty

Well-known member
Joined
Jun 10, 2001
Messages
1,597
Location
McLean, VA
In my latest newsletter from my Fairfax County hospital they have a front page article with a picture of my surgeon, Ed Lefrak, seated at a robot console far away from the patient. They said he was doing an off pump minimally invasive mitral valve repair through three tiny incisions! Fairfax County is one of twelve sites in the USA approved to try the robot. I'm interested in knowing if anyone on our forum has a robot in their backyard, how its doing, and if they know of any body operated on with the help of the robot? Gosh,if they can repair a mitral way down in a hole they should be able to do most anything. Ed thought my mitral was too far gone to repair '98 so I have a mechanical St. Jude and manage my Coumadin with Coaguchek.
 
da Vinci Robot at Fairfax

da Vinci Robot at Fairfax

Gina, Fairfax has a da Vinci robot, I don't know the company.I will find out. I also will contact Lefrak to see if the thing can do replacements and what else. I don't think it can bypass an artery on the back of the heart and there are probably other areas where it can't be used.
 
da Vinci robot cont.

da Vinci robot cont.

The da Vinci robot was created by Intuitive Surgical , Inc. The first operation ,a mitral repair with annuloplasty ring was done at Fairfax by Ed Lefrak September 10 through three small incisions. The patient had severe regurgitation due to posterior leaflet prolapse and no other problems. The patient had to be on the bypass pump. Robot surgery has been pioneered in France and Germany.
The advantages of robot include small incisions, elimination of surgeon tremor, magnification 10X with depth perception,decreased surgeon fatigue, etc.
 
Watched robotic valve surgery last night on Discovery. It was very well controlled surgery. If I remember correctly, it was a mitral valve repair with a ring.

Robotic kidney surgery was also featured.

Both results were fine.

Joe's last surgery (mitral repair) was port accesss, but I don't think it was robotic.
 
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More Robot

More Robot

I E-mailed my friend, savior, and surgeon Ed Lefrak asking him how the robot patients operated since September 10 at Fairfax were doing and I also asked just what could they can do and not do with the robot. Ed is Chief of Cardiovascular Surgery at Fairfax
which is a county hospital 20 miles outside Washington. Ed has ten heart surgeons on his staff and they do about 2200 open hearts a year. Here is his reply:

"Marty, the four patients we have done with the robot are all well,
including one 2 days ago. The device is under study protocol by the FDA to 120 mitral repairs in the US. We are one of 12 centers actively involved. MVR(mitral valve replacement) will be possible and reasonable but not yet. Lots of people...esply in Germany....
Dresden and Leipzig are working on coronary bypass with the robot....much more of a deal. AVR(aortic valve replacement) has not been approached yet, whereas ASD(atrial septal defect) is being done under protocol at three US centers and in Milan Italy.
Regards, Ed"
 
Excellent Marty. Have they tried a mechanical replacement or re-do? If not, have any idea if they plan to?

My cardioligist highly recommeded that facility.
Unfortunatley, it's not as close as I would like it to be.

Hopkins in 'Charm City' will hopefully serve me just fine. Don't want to travel if surgery is ever indicated.
 
What can the robot do?

What can the robot do?

Gina, I gather the robot will do a mechanical valve replacement in the mitral location soon but it hasn't been done yet. I'm really not clear why the aortic valve is harder to do. I can understand why the CABG is difficult because of the arteries on the back of the heart. Redos's are even farther in the future.Don't worry about Hopkins, it is great and will be right in your backyard. If you get a chance ,ask to see their heart surgery video to which our friend Kathy Custer contributed.
 
Must have just caught the same Mitral valve repair on Discovery Health. Da Vinci robot. Facility in NC. They stated they were the first to try it.

It has me convinced. Like Marty, my valve was too far gone....but just the thought of what is to come in the future is very promising!
 
Stephen Colvin at New York University and Vaughn Starnes at University of Southern California are also part of the FDA trials on robotics. Cleveland Clinic also said they have received the "huge machine" and will be starting to do surgeries with it in the near future. The degree to which the surgeries are actually being done by the robotic method varies. Back in October, NYU told me they were just using it to take a few stitches, not to do the whole surgery yet.

I did see the Discovery Health program "Super Surgeries" a couple months ago. Dr. Chitwood in North Carolina certainly makes it look easy and it was amazing that the guy whose mitral valve he repaired was back operating a small forklift at his manufacturing plant within 7 days of his surgery.
 
More Robot

More Robot

Jennifer, thanks for the additional robot info. Its so nice to hear you are doing well. Your literate insightful comments show no sign of "pumphead" effect. Wonderful!
 
Thanks Marty although my powers of concentration are definitely affected. The worst are migraine "aura" effects on my vision that make it difficult to see and can scramble your brain as well.

I'm not doing any reading and even all those books on tape I took with me to listen to were hard to concentrate on. I only finished one of them.

We just flew home yesterday - it took 5 1/2 hours in the plane.

I did sleep much better at home last night - the pillows are definitely softer than the hospital or the hotel.
 
Here are some good links for further information:

http://www.msnbc.com/news/588560.asp?cp1=1


www.technologyreview.com/articles/ditlea1100.asp

www.computermotion.com

www.intuitivesurgical.com


I considered the robotic method for my own surgery but since I was gettting such pessimistic forcasts about my chances for repair from some surgeons, I was afaid to compound the complexity with something so new as the robotics. I also had to do a sell job to my insurance company to get them to cover the surgery "out of network" and I figured I needed a real sure track record like Cosgrove's to get them to approve my appeal. They would have probably considered the robotics "experimental."
 
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? Pumphead

? Pumphead

Jennifer, I had a lot of double vision and shimmering vision post op. I even talked to a neuro ophthamologist post op. He said I was probably throwing little emboli and offered an MRI. I never went through with it. I kept on trying to read as much as possible but when the visual symptoms stopped me I would simply rest in the dark and they usually took about 20 minutes to go away. However I now think the symptoms were due to medication rather than emboli. In my case when I got off Percoset the symptoms disappeared and have not recurred. I was on the pump 87 minutes for replacement but Dr. Cosgrove did a repair for a friend of mine with 58 minute pump time. How long were you on? My advice and there is some support for this in the literature- keep reading, keep your mind active, and you'll be back to normal or better than normal in no time.
 
Choose the robot?

Choose the robot?

Should a patient choose to have robot surgery? I don't think so.
Choose a good surgeon like Dr. Lefrak or Dr. Cosgrove and let them decide what is best for you the patient and for them the surgeon. At Fairfax they are very selective and it is the reason the first four robot patients are doing so well. The surgeons have a learning curve to climb and they will very gradually do more and more complicated surgery. If Dr. Lefrak had found me reparable in the preop and said he would like to use the robot I would have said fine. Its the surgeons decision that counts.
 
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