Sunday, August 17, 2003

Robotics elevates UC medicine


Gift lures top surgeon back to town

By Peggy O'Farrell
The Cincinnati Enquirer

[IMAGE] Dr. Randall Wolf exhibits the da Vinci robot arm Friday at University Hospital.
(Glenn Hartong photo)
| ZOOM |
A world-class surgical innovator who left Cincinnati to work with state-of-the-art equipment in Columbus is returning to spearhead a new research and development collaborative among physicians, engineers and industry.

Dr. Randall K. Wolf, who grew up in Clermont County, headed to Ohio State University in 1999 to work with robotic surgical systems.

He was the first U.S. surgeon to perform cardiac surgery in Europe using robotic technology - called the da Vinci Surgical System - that transports the doctor's hands and eyes inside the chest of a patient. Instead of an 8- to 10-inch incision through the chest wall, Wolf uses two robotic arms and a camera system to gain access to the heart and perform surgery without opening the chest.

He agreed in July to return and lead the University of Cincinnati's new Center for Surgical Innovation, a treatment and research effort aimed at testing and developing new surgical techniques and devices.

Wolf's return is made possible by a donation from Carl Lindner, chairman and CEO of American Financial Group Inc. and chief executive officer of the Cincinnati Reds.

The gift of more than $1.5 million will purchase a da Vinci robot to be used strictly for research. The UC College of Medicine and University Hospital will purchase a second robot for treating patients at University Hospital.

Wolf's return, coupled with Lindner's gift and the new surgical complex, lays the groundwork to make Cincinnati a center for the development of new procedures and equipment to make surgery simpler for patients, UC medical officials predict.

The combination of engineering, medicine and industry makes the possibilities endless, Wolf said.

Acquiring two surgery robots is the key to the initiative: one for patient care, the other for technology research.

UC is the second area provider to enter the robotic medicine age. Good Samaritan Hospital acquired a da Vinci system earlier this year.

More jobs and research

Improving patient care is the primary focus of the new technology: Smaller incisions mean patients suffer less trauma and fewer infections, and leave the hospital sooner.

But the synergy of technology and researchers has the potential for creating industry and bringing new medical research positions to the region. It also changes the way surgeons do their job.

"This is about caring for patients today, but also developing the basis for the surgical practices of tomorrow," said Dr. Jeffrey Matthews, Department of Surgery chairman at UC's College of Medicine and University Hospital surgeon-in-chief.

"It is important that we have 24/7 access to a robotic system that can be used for research."

The two robots are on order from manufacturer Intuitive Surgical of Sunnyvale, Calif. The systems should be in place by the end of September, Matthews said.

Wolf left Cincinnati for Ohio State four years ago because he wanted access to robotic surgical technology. That school, the state's largest university and a prominent U.S. research center, was the country's first institution to purchase the da Vinci system, which Wolf helped test in Europe.

RANDALL K. WOLF
Wolf, 50, who grew up in Clermont County and Bright, Ind., is returning to Cincinnati to head up the University of Cincinnati's new Center for Surgical Innovation. The center is a collaborative effort of UC's College of Medicine and School of Engineering and will combine patient treatment and research with development of new surgical techniques and devices.

Personal:
Wife Amy Sternstein is a pediatrician. They have three children: Andrea, 13, Kevin, 10, and Travis, 8.

Professional:
A pioneer in robotic cardiac surgery, Wolf was the first U.S. surgeon to perform cardiac bypass surgery using the da Vinci robotic surgery system in 1999. That year, he left Christ Hospital's Department of Cardiac Surgery to head the "Minimally Invasive Cardiac Surgery and Robotics" program at Ohio State University.

B.A. in biology, Indiana University, 1975

M.D., Indiana University School of Medicine, 1979

Prior postings in vascular and cardiothoracic surgery at Jewish Hospital and University of Cincinnati, and collaborative with Cincinnati Children's Hospital Medical Center on video-assisted minimally invasive surgery to correct scoliosis.

Research interests:
Robotic assistance in minimally invasive heart surgery, minimally invasive coronary artery bypass and valve repair, instrumentation for minimally invasive heart surgery, video thoracoscopy and video-assisted thoracic surgery, lung volume reduction surgery for emphysema, thoracoscopic spine surgery, surgical treatment of atrial fibrillation, automated devices for coronary anastomosis.

Surprise:
Wolf and his children perform several magic shows a year. His favorite trick: Sawing daughter Andrea in two. "If something goes wrong, I can always put her back together."

The technology and the chance to lead the new Center for Surgical Innovation inspired Wolf to return to Cincinnati.

"I'm coming back because it's clear to me that Carl Lindner shares this vision with Dr. Matthews and (College of Medicine Dean William Martin) and they support the vision, and we're all dedicated to making it a reality," Wolf said.

"This is a tremendous addition not only to the University of Cincinnati, but for the city and the Tristate. Mr. Lindner's vision is to have the best state-of-the-art health care ... right here in Cincinnati."

Lindner said he made the donation for the good of Cincinnati.

"The city's been very good to me," he said. "I wanted to put the town on the map."

Lindner has donated more than $20 million to UC and more than $100 million for educational causes, according to Mary Sue Cheeseman, assistant dean of the college of medicine and vice president for development.

Wolf's return and the start of the new center come at a critical time for Greater Cincinnati. The state of the region's health care system has come under criticism in recent years as providers and patients have criticized the loss of physicians, lack of access to some types of specialized care and aging facilities and technology.

Lindner's gift allowed UC to recruit Wolf, whose presence should attract other top-flight surgeons and researchers, Martin said.

Martin and others hope the new center will help make Cincinnati a hub for biomedical research and development, attracting high-tech, high-paying jobs and industries.

Building partnerships

The Center for Surgical Innovation is a unique partnership between surgeons and biomedical engineers, said Stephen T. Kowel, UC's dean of engineering.

As they learn to use the da Vinci system, surgeons will develop new applications for the technology. Those applications will require new instruments and other devices.

The engineers will translate the surgeons' ideas into reality.

The next key component in the process is building partnerships with industry. Wolf is already affiliated with AtriCure Inc. and Ethicon-Endo Surgery, both based in Greater Cincinnati. Those firms will work with the Center for Surgical Innovation to develop and test new technology.

More academic centers are aligning with industry, Kowel said. The cost of technology and research and development are so high that few entities can afford to go it alone.

The da Vinci robots will be, at least initially, the centerpiece of the new initiative. They will allow University Hospital surgeons to do coronary artery bypasses, prostatectomies and other procedures without making large incisions.

Robots saving humans

Matthews compares using a da Vinci to a virtual-reality game. But the playing field is an operating room and the alternate universe is the patient's body.

"It's not a robot like we saw on Lost in Space that flashed and buzzed, 'Danger, Will Robinson,' " Matthews said. "The robot doesn't come into the operating room and do the surgery. The surgeon is at the controls."

With the robot surgical system, the surgeon peers into a video monitor as he controls the robot's "arms" with his hands. The technology corrects for the natural tremor in the human hand. It allows the use of tiny surgical instruments small enough to fit through incisions that won't accommodate a surgeon's hand.

"Nobody needs a big incision because they need a big incision. You need the incision for the surgeon's hand," Matthews said.

The da Vinci system allows the surgeon more control of instruments, Wolf said. Earlier versions required the surgeon to grip instruments at an awkward angle, "like trying to sign your name while you're holding a pencil by the eraser," he said.

Increased precision means less damage to nerves, arteries and tissue. Smaller incisions mean quicker recovery, less trauma and less risk of infection.

Robotic surgery is most commonly used for heart procedures, including coronary artery bypasses, surgery to correct atrial fibrillation and valve replacements, liver procedures and obesity surgery.

"These are all areas that we're ready to go with," Matthews said. "But it really can be applied in all kinds of circumstances."

'Ultimate innovator'

Colleagues describe Wolf as a world-class heart surgeon. But his true gift, they say, is finding new ways to do all kinds of surgeries.

He and Dr. Alvin Crawford, chief of pediatric orthopaedics at Cincinnati Children's Hospital Medical Center, collaborated in the early 1990s on endoscopic spinal surgery to correct scoliosis, or curvature of the spine.

Previously, surgeons had to make incisions through muscle along the length of the spine to accommodate steel rods that supported and straightened the spine.

Crawford and Wolf found a way to insert the rods through small incisions that cut recovery time dramatically, Crawford said.

"Randy, I thought, was the ultimate innovator in surgical techniques. He's a cardiothoracic surgeon, but he has ideas that are pervasive for people who work around him and with him," Crawford said.

E-mail pofarrell@enquirer.com




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