Tuesday, July 7, 2009

Meet the da Vinci

Robotic-assisted surgical system broadens options for minimally invasive heart surgery

The da Vinci surgical system, hand on control

Massachusetts General Hospital’s cardiac surgical team welcomed a new high-tech member in June. The da Vinci Surgical System made its debut in the cardiac operating room, allowing surgeons to perform complex minimally invasive procedures with more control and less down-time for patients.

Robotically assisted heart surgery is the latest advancement at the Mass General Heart Center aimed at making minimally invasive procedures available over traditional open heart surgeries.

“For the right patients, robotic-assisted cardiac surgery can be a great option, allowing them to recover more quickly and with less pain,” says Arvind Agnihotri, MD, cardiac surgeon. Agnihotri began performing robotic-assisted coronary artery bypass grafting and mitral valve repair procedures last month.

The da Vinci Surgical System

Traditional open surgery has a number of drawbacks because of the large incision and need to split the breastbone. However, the miniaturized instruments of the da Vinci Surgical System allow surgeons to access the heart and its vessels through tiny incisions between the ribs, resulting in less blood loss and pain, faster recovery times and less risk of infection.

The da Vinci console

“Traditional open heart surgery usually means the patient will spend a week in the hospital, six weeks before getting back to work, and perhaps another six weeks before they are really feeling good. It takes a considerable amount of time to get back to normal,” says Agnihotri. “This system has the potential to reduce post-surgery hospitalizations to just three days and perhaps no more than a week before patients can get back to their daily routines.”

The robot’s instruments are guided by the movements of the surgeon, who is seated at a console with a magnified, high-resolution 3D image of the surgical site. The device then translates the surgeon's wrist and finger movements into precise micro-movements.

“The wristed instruments have a broader range of motion and better dexterity than a surgeons’ hands would be capable of in tiny chest incisions,” says Agnihotri.

CABG and mitral valve repairIn June, the Mass General Heart Center began offering coronary artery bypass using the da Vinci Surgical System and is the only hospital in New England using it for mitral valve repairs.

Tom Holland of Alfred, Maine, was the first patient to have a mitral valve repair performed by Dr. Agnihotri using the da Vinci system.

“I wasn’t nervous about having the robotic surgery,” he said. “I figured that being chosen as the first one meant that I must have been a prime candidate for the procedure.”

Holland had been diagnosed with a mitral regurgitation, or a leaky valve, five years ago. The condition had deteriorated to a point that the leak was damaging his heart function. But just a few days after the procedure, Holland was ready to head home to enjoy the Maine summer.

“I’m glad I was chosen for this robotic surgery,” he said shortly before being discharged from the Cardiac Step Down Unit. “I feel great. They are just trying to figure out what I can and cannot do before I head out.”

Mass General also offers robotic-assisted coronary artery bypass grafting (CABG). Traditional CABG surgery requires the patient to be connected to a heart and lung machine that stops the beating of the heart while the bypass is performed. Using the da Vinci system, and other minimally invasive options, the work is done while the heart continues to pump blood normally, making the process much safer for patients.

Minimally invasive heart procedures and hybrid approaches, mixing traditional heart surgery and robotic-assisted options, have a promising future, says Agnihotri.

“While robotic-assisted surgery may not be the best option for all patients, it’s important for a comprehensive surgical program to offer a full range of options for patients,” says Agnihotri. “We are excited about the opportunities presented by the da Vinci Surgical System and other minimally invasive techniques that are in the research pipeline.”

Learn more about the Heart Center

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