Valve Repair Using Robot Surgeon

[alan_delac]

Today I read in Australian newspaper about ?first in Australia? use of NASA-derived robot for a valve repair surgery. Apparently it has been widely used in US (news to me). Instead of the usual full breastbone cut, a 5cm (2?) long cut was used under the patient?s right arm to insert the robot that is controlled from a console next to the operating table. The robot probe has one arm with a camera and three more arms that operate instruments. High-resolution pictures and excellent control give a surgeon virtual feeling in her/his hands. Operation on 68year old patient was success with greatly reduced recovery time.
There were no more details about which valve was repaired or if this procedure could be used for valve replacement.
Does anyone know more about this robot/procedure? The robot costs about US$2.5 million.

Regards

Alan

 

[Marge]

That this procedure is "widely" used in the US is news to me, too. But robotic surgery is an area in which Dr. Alain Carpentier, the French valve surgery pioneer, has been active.

Dr. Carpentier pretty much invented mitral valve repair -- see the paper he wrote in the 1980's, "The French Correction." He's the "Carpentier" in the "Carpentier-Edwards Bovine Pericardial Valve."

http://sidebar.cnn.com/HEALTH/9902/23/robotic.surgery/

<< Surgery by remote control: Using a computerized robotic system, a surgeon controls the operation procedure from the other side of the room.
*
February 22, 1999
Web posted at: 4:15 p.m. EST (2115 GMT)

From Medical Correspondent Al Hinman


PARIS (CNN) -- The operation is delicate enough under normal conditions. But for Dr. Alain Carpentier, repairing a disease-damaged heart valve is made more complicated by the patient's location -- another part of the room.

Carpentier is controlling the delicate procedure by remote control, using an experimental, computerized robotic system designed to advance the potential of minimally-invasive surgery.

Some doctors believe the endoscopic procedure allows them to perform the most delicate of operations with little risk and post-operative discomfort.

If robotic surgery continues to show it's safe and successful, it could mean doctors may need to cut across the chest and crack the rib cage to perform open-heart surgery only in rare cases.

"For the patient, the benefit is obvious," said Carpentier, a medical professor and world-renowned French cardiac surgeon. "Small incisions mean less pain, less bleeding, less operative trauma, faster recovery."

Lazare Winn was the first patient ever to undergo a robotic, endoscopic heart bypass, in May 1998.

He was up and celebrating his 70th birthday just days after surgery, avoiding the usual months of painful recovery associated with a conventional bypass.

During the procedure, robot arms are positioned over the patient. Inside, new, highly-flexible surgical instruments the size of a pencil perform the work.

"You have to imagine how the surgeon feels being inside the heart himself," Carpentier said.

Robotic surgical devices also offer the potential of possible long-distance surgery, with patients on one continent and the specialist on another. But first, they have to win the confidence of more doctors -- as well as regulatory approval in the United States and abroad.>>

 

[sylviayasgur]

hi alan and marge!
i think i had read somewhere that they were using robots to perform OHS at columbia presbyterian in NY. i cannot remember if it was being done by dr. mahmet oz or one of the others there. i'm also unsure if they have gotten past the initial stages.
cool stuff though, don't you think? how would you feel knowing your surgeon was a robot though? more confident or more frightened? i'm not sure... i think i'd like to know there was a human surgeon supervising..
stay well, sylvia

 

[Marge]

<< how would you feel knowing your surgeon was a robot though? more confident or more frightened? i'm not sure... i think i'd like to know there was a human surgeon supervising..>>

Well, from my understanding, in this sort of procedure the robot is not just supervised but is actually controlled by the surgeon. I'd feel VERY confident if I thought the surgeon controlling the robot was Dr. Carpentier. Carpentier talks about the feeling the surgeon has of actually "being inside the heart himself." Pretty awesome!

 

[RCB]

Misconception

Misconception

The term robot is a bit misleading here.
It is not a robot in the sense of the "lost in space" robot
shouting"DANGER, DANGER Will Robinson" but rather a machine interface with biofeedback to control laparoscopic
surgerical instruments. Marge is 100% right about a human
being at the controls guiding the instrument in the surgery.
It is an advancement of traditional laparoscopy in which the surgeon hold the instruments. The new method is completely all machine, which allows the movement to be more precise and work in tighter areas. Actually, this is just a further refine of endoscopy which is over 150 year old.
Surgeon just love to have more tools to play with and it is
good for pts. too.

 

[Abbanabba]

I caught the tail end of this report on the news the other night, but from my understanding, the surgeon actually gets a BETTER view of what is going on because of the camera inside the heart. I just wonder at how they sterilise such a piece of equipment between surgeries?

Cheers
Anna : )

 

[bvdr]

Dr. Chitwood at ECU (Eastern Carolina University) here in North Carolina is well known for doing alot of "robotic" heart surgery. I don't personally know of anyone who had valve replacement that way but I would think it would be a plus for a person provided the patient was a suitable candidate for it. I don't know what the criteria would be but I would think it would be restricted to certain types of patients and surgeries.

 

[RCB]

Autoclave

Autoclave

Anna,
The various cutting, holding, optics and sewing devices
that are at the end of the arms, come off and are autoclaved
between surgeries. Much like you do eating utensil but hotter and for alonger period of time.

 

[Raverlaw]

The advances in treatment are truly amazing. My relatviely standard AVR procedure wasn't available when I was a child and diagnosed with a BAV.

I wonder, though, if endoscopy will ever be able to be used for valve replacement, since the heart still has to be stopped and the patient placed on the heart-lung machine?

 

[alan_delac]

Few links regarding robot assisted surgery. It seems to be used for mitral valve repair and replacement. No data on aortic valves.

Regards

Alan



http://www.ncbi.nlm.nih.gov/entrez/...ve&db=PubMed&dopt=Abstract&list_uids=10800815

http://www.heartcenteronline.com/myheartdr/home/research-detail.cfm?reutersid=3360&name=moreover


http://www.clevelandclinic.org/hear...ics.asp?firstCat=56&secondCat=57&thirdCat=488


http://www.pennhealth.com/cardiac/presby/valve.html

http://www.columbiasurgery.org/divisions/cardiac/robot_faqs.html

 

[catwoman]

My cardiologist's practice is on the top floor of the Hamilton Heart Hospital, part of Baylor Medical Center near downtown Dallas. While I was there 4/1/04 for a checkup, I checked out the huge display about procedures available at Baylor and Hamilton. There was a section on robotics used in surgery and included a photo. I was in a hurry so I didn't read it. I assume, though, that robotics is used in surgery there.

 

[Hansolo]

da Vinci Surgical System

da Vinci Surgical System

Just have a look for yourself. This system is not just being used as an alternative for mitral valve surgery but also as a staging platform for surgeries in remote locations where the surgeon simply has to plug-in.

A mitral valve surgery was on a live web cast several days ago from East Carolina University/Pitt County Memorial Hospital using the da Vinci Surgical System.

http://www.or-live.com/PittCounty/1278/

Neat stuff. The mitral valve is in a relatively easily accessible position for this type of surgery. Too bad the others are not.

Cheers

 

[labguides]

Prior to our daughter's mitral valve repair (Jan 04), we asked her surgeon at UCLA about robotic surgery. At that time, he felt it was not perfected enough. He said it was being done at USC.

 

[Innercalm]

help me understand

help me understand

To Hansolo from innercalm. My brother in law (former hospital administrator in Fla) discouraged me from considering Dr Chitwood because of the location of the hospital where the surgery is done. He felt that too remote is equal to too not acceptable. Is this true?

Just have a look for yourself. This system is not just being used as an alternative for mitral valve surgery but also as a staging platform for surgeries in remote locations where the surgeon simply has to plug-in.

A mitral valve surgery was on a live web cast several days ago from East Carolina University/Pitt County Memorial Hospital using the da Vinci Surgical System.

http://www.or-live.com/PittCounty/1278/

Neat stuff. The mitral valve is in a relatively easily accessible position for this type of surgery. Too bad the others are not.

Cheers

 

[Tony]

My surgeon, Dr. Jeffery Altshuler, was interviewed on the radio recently, (maybe last March) regarding new developments at Beaumont Hospital in suburban Detroit.
He stated that they are practicing using robots for heart surgery.
As I recall his comments, the time required for surgery would be longer using robotics and this had to be factored into the selection of the best method for the patient.
A nurse who works in the ICU for open heart surgery at Beaumont told me that the surgeons there experiment with new techniques on an ongoing basis.

 

[GregB]

Da Vinci Robots

Da Vinci Robots

For any southern hemisphere residents Epworth Hospital in Melbourne has acquired two Da Vinci robots, one at their Ricmond site and one soon in action at the newly opened Box Hill site. Initially I believe they were used for prostate surgery but heart surgeons and nurses have been trained so it seems that they have or soon will be used for heart surgery as well. It is true that the surgeons operate the robotic arms from across the room and it seems they do have a better view of the heart.

GB