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International Physician Update
Using Robotics, Surgeons Avoid Open Heart Surgery
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| Cardiac surgeon David Yuh, at the helm of the robotic operating system. |
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The 55-year-old woman was almost always tired and out of breath because of dilated cardiomyopathy, a deadly heart disease that decreases the ability of the left ventricle to pump blood throughout the body. The good news was that pacemaker resynchronization therapy could electrically stimulate her left ventricle to perform in syncrony with her right ventricle and prevent heart failure. Because three pacemaker leads could be threaded through a catheter in her leg to her heart, she wouldn’t need open heart surgery and the potential complications that go with it.
The patient was relieved. But during the procedure doctors couldn’t place an essential third lead on the left side of her heart because her coronary sinus, where the lead would be inserted, was too small. She would need open surgery after all. Then, cardiac surgeon David Yuh came up with another option: a minimally invasive approach using a robotic surgical system. Rather than operating through a large incision in the patient’s chest, Yuh would make four small incisions on her side and insert tubelike ports through which a miniature video camera and robotic instruments, controlled by Yuh, would be used to operate on the heart.
“Normally we would do a thoracotomy, a painful and somewhat disfiguring incision,” Yuh says. “But the robot allows us to do the same surgery through tiny incisions.”
That’s possible, Yuh explains, because of advances in robotic arms that give them all the dexterity and motion of a human wrist, and the ability to operate on a beating heart in an area the size of a fist. In addition, new high-resolution, stereoscopic cameras provide three-dimensional views of tissues and the ability to see behind structures, something surgeons can’t do well even in open operations.
Yuh, sitting at a robotic control module 20 feet from the patient, deftly cuts through the pericardium, the membrous sac that encloses the heart, cauterizing tissue along the way to eliminate bleeding. Using micro forceps and a clamp, he puts a suture through the pacemaker lead, then through the outer tissue of the heart itself. Four suture knots later, the lead is secured to the heart.
“With this third lead in, the pacemaker can take full advantage of its function to synchronize the left and right ventricles,” Yuh explains. “Her heart is beating more efficiently, her symptoms are improving.”
Yuh adds that he and other cardiac surgeons at Hopkins will be using the robotic system for other procedures, including atrial septal defect closure, mitral valve repair and possibly coronary artery bypass.
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