CNN's Dr. Sunjay Gupta on da Vinci Surgery

Researchers laud robot-guided heart surgeryBy Debra GoldschmidtCNN Medical UnitTuesday, November 19, 2002
CHICAGO (CNN) -- Robotic heart surgery using the da Vinci Surgical System has many advantages for patients and doctors, according to research presented to cardiologists at the annual Scientific Sessions of the American Heart Association on Tuesday.
Surgeons from New York Presbyterian Hospital presented the outcomes of 17 patients after having a heart defect -- called atrial septal defect -- repaired using the robot for assistance.
Of the 17 patients, 16 of them had their hearts repaired in a totally robotic operation. One patient required additional repair five days after the first surgery. The average length of stay in the hospital after the surgery was three days compared with seven to 10 days for traditional surgery. None of the patients experienced major complications.
The robotic technique requires four puncture wounds, each an inch in diameter. Surgeons use pencil-sized instruments to operate on the heart. They sit several feet away from the patient at a console where they see inside the patient on a monitor.
Lead researcher, Dr. Michael Argenziano said the success rate "proved we can do this surgery in a closed chest approach." The alternative is the traditional technique of cracking the chest -- done by a long incision, cutting the bone, and then splitting the ribs.
"The main advantage is that these patients were able to recover quickly." he said.
Patients recovering from the traditional approach usually have several inactive weeks before they're able to resume regular activity, but patients who undergo robotic surgery only spend a couple of days recovering from local wounds. Argenziano was amazed when one of his patients was able to pick up her toddler the day after her surgery.
Compared with other minimally invasive heart surgery approaches, robotic assistance allows surgeons to have better control over the surgical instruments and a better view of what they are doing.
However, there are disadvantages -- time being one of them. Robotic-assisted surgery takes nearly double the amount of time that a typical open-heart surgery takes. That means a patient is under anesthesia longer and nurses and other staff must also work longer hours.
The cost seems to be a disadvantage as well. In the short term, hospitals pay millions of dollars for the robot and the disposable instruments needed.
But Argenziano argues that although the robotic-assisted surgeries cost about $2,000 more per operation, in the end the cost comes out about even because patients are out of the hospital sooner.
Money is saved after surgery on nursing care and pain medications, he said, in addition to the societal benefits from faster recovery.
The procedure is still experimental under a U.S. Food and Drug Administration clinical trial; therefore, the robot's manufacturer picks up any costs that exceed the normal cost of heart surgery.
Seven other patients have undergone the procedure at other centers as part of the trial.
Argenziano said they've had no trouble finding patients willing to try the experimental surgery because of the faster recovery time. He added that the surgeons can have the patient's chest open in one minute's time should they suddenly need to convert to traditional surgery -- something they haven't had to do.
In another trial, Argenziano and other surgeons are using the robot to perform closed-chest coronary bypass surgery.
Last week the FDA gave approval for the robot to be used for mitral valve repair surgery. This is the first robotic heart surgery to be granted clearance by the FDA.
The da Vinci Surgical System is made by California-based Intuitive Surgical Systems. There are 132 systems in hospitals worldwide and nearly 100 are in U.S. hospitals.
Source>http://archives.cnn.com/2002/HEALTH/11/19/heart.robots/index.html

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Da Vinci Surgical System

From Wikipedia, the free encyclopedia

Da Vinci Surgical System Manufacturer Intuitive Surgical Type Robotic surgery Units sold 1,032 units worldwide

The da Vinci Surgical System is a robotic surgical system made by Intuitive Surgical and designed to facilitate complex surgery using a minimally invasive approach. The system is controlled by a surgeon from a console. It is commonly used for prostatectomies and increasingly for cardiac valve repair and gynecologic surgical procedures.

Overview

The da Vinci System consists of a surgeon’s console that is typically in the same room as the patient and a patient-side cart with four interactive robotic arms controlled from the console. Three of the arms are for tools that hold objects, act as a scalpel, scissors, bovie, or unipolar or dipolar electrocautery instruments. The fourth arm is for an endoscopic camera with two lenses that gives the surgeon full stereoscopic vision from the console. The surgeon sits at the console and looks through two eye holes at a 3-D image of the procedure, meanwhile maneuvering the arms with two foot pedals and two hand controllers. The da Vinci System scales, filters and translates the surgeon's hand movements into more precise micro-movements of the instruments, which operate through small incisions in the body.
According to the manufacturer, the da Vinci System is called "da Vinci" in part because Leonardo da Vinci invented the first robot. The artist Leonardo also used anatomical accuracy and three-dimensional details to bring his works to life.
To perform a procedure, the surgeon uses the console’s master controls to maneuver the patient-side cart’s three or four robotic arms (depending on the model), which secures the instruments and a high-resolution endoscopic camera. The instruments’ jointed-wrist design exceeds the natural range of motion of the human hand; motion scaling and tremor reduction further interpret and refine the surgeon’s hand movements. The da Vinci System incorporates multiple, redundant safety features designed to minimize opportunities for human error when compared with traditional approaches. At no time is the surgical robot in control or autonomous; it operates on a "Master:Slave" relationship, the surgeon being the "Master" and the robot being the "Slave."
The da Vinci System has been designed to improve upon conventional laparoscopy, in which the surgeon operates while standing, using hand-held, long-shafted instruments, which have no wrists. With conventional laparoscopy, the surgeon must look up and away from the instruments, to a nearby 2D video monitor to see an image of the target anatomy. The surgeon must also rely on his/her patient-side assistant to position the camera correctly. In contrast, the da Vinci System’s ergonomic design allows the surgeon to operate from a seated position at the console, with eyes and hands positioned in line with the instruments. To move the instruments or to reposition the camera, the surgeon simply moves his/her hands.
By providing surgeons with superior visualization, enhanced dexterity, greater precision and ergonomic comfort, the da Vinci Surgical System makes it possible for more surgeons to perform minimally invasive procedures involving complex dissection or reconstruction. For the patient, a da Vinci procedure can offer all the potential benefits of a minimally invasive procedure, including less pain, less blood loss and less need for blood transfusions. Moreover, the da Vinci System can enable a shorter hospital stay, a quicker recovery and faster return to normal daily activities.
The robot costs on average $1.3 million in addition to several hundred thousand dollars of annual maintenance fees. Surgical procedures performed with the robot take longer than traditional ones. Critics have pointed out that hospitals have a hard time recovering the cost and that most clinical data does not support the claim of improved patient outcomes