Young Mother of Two Receives Historic Surgery
New York, NY (July 26, 2001) – Once the stuff of science fiction, robots may now become standard fixtures in hospital operating rooms. Cardiac surgeons at NewYork-Presbyterian’s Columbia Presbyterian Medical Center have performed the first robotically-assisted atrial septal defect repair, without a chest incision of any kind, on July 24, 2001. The operation was performed as part of a clinical trial sanctioned by the FDA. The first patient in the U.S. to receive this surgery is a 33-year-old mother of two from Yonkers, New York. Atrial septal defect repair, until this point, had required open-chest surgery, which involves an eight to ten-inch incision made in the chest. Robotically-assisted surgery requires only three pencil-sized holes made between the ribs. Through these holes, two robotic “arms” and an endoscope (a tiny camera) gain access to the heart, making surgery possible without opening the chest.
Like a puppet-master, the surgeon manipulates the robot’s movements from a viewing console located several feet away from the patient. The robot, bent over the operating table, performs all of the delicate procedures required in heart surgery. The surgical robot in use, Intuitive Surgical’s da VinciTM Surgical System, has been approved by the Food and Drug Administration for a number of clinical trials in heart surgery.
Part of the robot’s uniqueness lies in the fact that, unlike most surgical instruments, it can enhance human capability. The robotic appendages—pencil-sized arms with pincer-like digits attached by “wrists”—are designed to mimic the dexterity of a surgeon’s forearm and wrist. In fact, the robotic wrist surpasses the human range of motion and is less susceptible to tremors, allowing surgeons a finer degree of precision than was before possible. By the same token, the endoscope, acting essentially as the “eyes” during surgery, provides an improved view of the surgical site, with 360-degree range of vision, the ability to zoom in and out, plus high-definition, full-color, magnified, 3-D images. Dr. Craig Smith, chief of cardiothoracic surgery at Columbia Presbyterian, professor of surgery at Columbia University College of Physicians & Surgeons, and chief investigator of the robotic mitral valve trial, says, “It’s not like looking at a video game. It’s as close as you can come to true binocular vision—it’s almost better than what you see yourself because you have such magnification and continuous range.”
Because of the advantages afforded by this new technology, robotics will not only be able to help improve existing minimally invasive techniques, but may be able to aid in the development of new minimally invasive procedures as well. Dr. Michael Argenziano, director of robotic cardiac surgery, assistant professor of surgery at Columbia University College of Physicians & Surgeons, and principal investigator of the first United States trial of robotic atrial septal defect closure, says, “Robotics may be the next real step forward in the application of exotic technology to what we do every day. In addition, we believe that da VinciTM will allow us to develop new minimally invasive operations, such as beating heart procedures for the treatment of atrial fibrillation.”
Studies show that patients who have minimally invasive operations get out of the hospital one to two days earlier than patients recovering from conventional cardiac surgery. Dr. Mehmet C. Oz, director of the Cardiovascular Institute at Columbia Presbyterian, and associate professor of surgery at Columbia University College of Physicians & Surgeons says, “Known advantages of minimally invasive surgery include quicker patient recovery time, less pain, and dramatically less scarring than traditional open-heart surgery, as well as a shorter hospital stay.” Conversely, there are some trade-offs associated with minimally invasive approaches. For one, operations through small incisions usually take longer and are more technically challenging for even the most highly skilled surgeons. Still, while minimally invasive approaches are not for every patient and every case, they are well-tolerated by the majority of patients.
As of July of 2001, the cardiac surgery team at Columbia Presbyterian has performed nearly 20 robotic cardiac operations, including internal mammary artery (IMA) harvests, mitral valve repair, and atrial septal defect repair. Robotic IMA harvesting has facilitated the completion of minimally invasive direct coronary artery bypass surgery (MIDCAB), in which coronary bypass surgery is performed through a very small incision and without the use of the heart-lung machine.
The Columbia Presbyterian team is involved in a number of FDA clinical trials that are studying the feasibility of robotic assistance in a number of cardiac procedures. Columbia Presbyterian is the only center in the U.S. conducting the atrial septal defect repair clinical trial and one of only nine centers participating in the Mitral Valve Repair Trial. In addition, Columbia Presbyterian will be one of the first U.S. centers to perform totally endoscopic coronary bypass surgery this fall.
Patient referrals for the Columbia Presbyterian robotics trials, as well as information about the Cardiac Surgical Robotics Program, can be obtained by calling a toll-free hotline, 866-ROBOT-OP.
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