Wednesday, September 10, 2003

Robot makes the cut in OR

Surgeon's hands work controls like video game

By Peggy O'Farrell
The Cincinnati Enquirer

[IMAGE] Dr. J. Michael Smith (foreground) operates the da Vinci Surgical System at Good Samaritan Hospital Tuesday.
(Tony Jones photo)
| ZOOM |
It's hard to know where to look while Dr. J. Michael Smith repairs Glenn Storrs' heart.

On one side of the operating room at Good Samaritan Hospital, Smith - a cardiac surgeon and director of robotic technology for TriHealth - is bent over a control console, hands working like he's playing a next-generation video game.

Eight or 10 feet away, something that looks like a giant metal spider - actually the da Vinci Surgical System, or surgical robot - hovers beside the patient, a 46-year-old Covington man. A video monitor on the wall shows what's happening inside the patient's heart as Smith directs the robot to fix Storrs' mitral valve with instruments no bigger than a fingertip.

At the control console, Smith peers at a three-dimensional view of the inside of Storrs' chest as his fingers direct the robot's actions. His hands move at the controls and the robot trims stretched-out tissue from Storrs's mitral valve with tiny scissors. Smith's hands move again and the robot clips and sutures a fabric ring into place to reinforce the valve.

Smith admires the view as he works. "I can see every little wrinkle on his heart valve," he said.

The $1.2 million robot has been at Good Samaritan Hospital since March. The hospital recently purchased a fourth "arm" for the robot at a cost of approximately $200,000.

Already used for urological and gynecological procedures, Tuesday was one of the first times it was used in heart surgery.

Good Samaritan has the city's first robot. University Hospital will soon have two da Vinci Surgical Systems and a new center to research and develop related techniques and equipment. And the Bethesda Foundation is raising funds to buy a robot for Bethesda North Hospital.

Adding the robot to the operating room reduces trauma, blood loss and infection risk for patients and speeds up healing time, doctors say.

In conventional mitral valve repair surgery, an 8- to 10-inch incision would be cut down the center of the patient's chest to allow room for the surgeon's hands.

For Tuesday's procedure, Smith makes a 2 1/2-inch incision on Storrs's groin to allow access for the camera and for sutures and other equipment, plus three "poke holes" measuring less than a tenth of an inch each to accommodate the robot's "arms."

The surgery corrects a mitral valve prolapse, or enlargement of the "flaps" on the valve that separate the two left chambers of the heart. When the valve doesn't open and close properly, blood leaks backward between the chambers, forcing the heart to pump harder and often leaving the patient short of breath or easily tired.

The procedure is straightforward: Remove the extra tissue and install a fabric ring around the mitral valve to reinforce it. Tuesday's surgery took about five hours, slightly longer than a conventional procedure. But the greater precision, improved view and reduced trauma to the patient were worth the extra time, Smith said.

"The valve repair looked very good at the end of the surgery," he said.

The high price tag of the da Vinci Surgical Systems could raise questions about how much more patients could end up paying for all that technology.

But Dr. Randall K. Wolf, the surgeon who will oversee University's robot system and the Center for Surgical Innovation, called the systems capital equipment expenses.

"The cost of the surgery is the same to the patient whether we use the da Vinci or not, and the cost to the hospital is the same. The reimbursement is the same," he said.

More robot surgery systems won't mean more surgeries, Wolf added. "Patients are going to have these surgeries anyway." The systems are used in only about 1 percent of the surgeries performed nationally, he said.

Technology race is on

Robots could soon overrun Cincinnati's operating rooms. Two hospitals have purchased or ordered da Vinci Surgical Systems, and a third is raising money to buy the system.

TriHealth started the race when Good Samaritan Hospital introduced its robot system in March.

In August, University Hospital and the University of Cincinnati announced they would acquire two robots, one for patient care and one for research, as the centerpiece of a new Center for Surgical Innovation.

Dr. Randall K. Wolf, the first American surgeon to use the da Vinci for heart surgery, returned to Cincinnati from Ohio State University to head the new center.

The center will research and develop new surgical techniques and equipment based on the da Vinci Surgical System.

And at TriHealth's Bethesda North Hospital, the Bethesda Foundation is raising $1.2 million to purchase a robot surgical system.

Doctors and nurses at Cincinnati Children's Hospital Medical Center are training to use the Zeus Surgical System. Doctors hope to start using the system on patients this winter or spring.

St. Elizabeth Medical Center spokeswoman Leslie Skiles said officials are looking into robot-assisted surgery technology, but haven't purchased anything yet. The Mercy Health System has no plans to add robot technology at this point, spokeswoman Karen Kuhn said.


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