Thursday, November 04, 2010
Robot helps make smaller incision possible in high risk patients
Cardiac surgeons at the University of Maryland Medical Center in Baltimore are the first in the world to use a surgical robot to help perform minimally invasive aortic valve bypass surgery. The robot gives surgeons a very precise tool to complete the complex bypass procedure.
James S. Gammie, M.D., a cardiac surgeon, associate professor of surgery at the University of Maryland School of Medicine and director of the University of Maryland Center for Heart Valve Disease, led the team that performed the aortic valve bypass.
The robot extends the surgeon’s reach deep into the chest to access the aorta through a three-inch opening, smaller than would have been possible without the robot. During the procedure, surgeons place a tube that contains a replacement aortic valve between the tip of the heart and the body’s main blood vessel (the aorta) in the back of the chest. When it is put in place, the tube relieves the blockage by bypassing the narrowed aortic valve. Surgeons do not need to stop the heart during the procedure, so a heart-lung machine is not necessary.
“Using the robot enables us to attach the bypass tube to the aorta with greater precision than we can by hand. This procedure is an excellent alternative for higher-risk patients with aortic stenosis,” says Dr. Gammie.
An 83-year-old man from Bel Air, Md., John Warner, had this new surgical approach on October 4, 2010. Mr. Warner had aortic stenosis, a severe narrowing of the aortic valve that caused difficulty breathing. He had undergone previous heart surgery and faced several other medical problems that would have made conventional, open-heart aortic valve replacement very risky.
Within hours of having the minimally invasive, robotically assisted procedure, Mr. Warner was awake and talking to his family. He left the hospital a week later, with his breathing much improved.
Aortic stenosis is a common, life-threatening condition. More than 70,000 people in the United States undergo aortic valve procedures each year. One approach is to replace the defective valve. Another is to bypass it entirely. Some patients who have had aortic valve bypass continue to do well more than 25 years after their surgery. Dr. Gammie has performed over 60 valve bypasses since 2003. Using the surgical robot for part of the operation is a further innovation.
Dr. Gammie says one key advantage of a bypass over a valve replacement is the reduced risk of stroke. The defective valve is not touched or manipulated as it is in valve replacement, reducing the chance that dislodged particles will reach the brain and cause a stroke.
“As we are able to adapt the use of the surgical robot to more cardiac operations, we will be able to provide more patients with a minimally invasive procedure that requires a shorter recovery time,” says Johannes Bonatti, M.D., director of coronary surgery and advanced coronary interventions at the University of Maryland Medical Center and a professor of surgery at the University of Maryland School of Medicine. Dr. Bonatti is one of the world leaders in using the surgical robot to perform heart surgery. He was a pioneer in performing double and triple vessel coronary bypass operations with the robot, which means that the operations are performed in a minimally invasive way without a large incision.
“The addition of robotic assistance to aortic valve bypass builds on our philosophy of providing a more patient-friendly approach to heart surgery at the University of Maryland that results in better patient outcomes and comfort,” says Bartley P. Griffith, M.D., chief of cardiac surgery at the University of Maryland Medical Center and professor of surgery at the University of Maryland School of Medicine.
“Our cardiac surgeons continue to bring innovation to improving patient care” says E. Albert Reece, M.D., Ph.D., M.B.A., vice president for medical affairs at the University of Maryland and dean of the University of Maryland School of Medicine. “Adding robotic assistance to aortic valve bypass makes an already great alternative to valve replacement in high risk patients even better.”
In addition to Dr. Bonatti, Eric J. Lehr, M.D., Ph.D., Murtaza Dawood, M.D., and anesthesiologist Ileana Gheorghiu, M.D., were part of the team with Dr. Gammie during this first robot-assisted aortic valve procedure. Dr. Lehr and Dr. Dawood are instructors at the University of Maryland School of Medicine. Dr. Gheorghiu is an assistant professor of anesthesiology at the School of Medicine.
Dr. Gammie is a co-founder of Correx, Inc., headquartered in Waltham, Ma., which has developed devices currently in the regulatory approval process that may expedite and simplify the most difficult aspects of aortic valve bypass procedures. These devices are unrelated to the use of the surgical robot.