Closed Chest Heart Surgery Possible with Robotics System

CHICAGO – Surgeons at Columbia-Presbyterian Medical Center in New York reported here this week that they have successfully performed “closed chest surgery for atrial septal defects through four small punctures in the chest wall.

Principal investigator Dr. Michael Argenziano presented his team’s findings, at the American Heart Association’s Scientific Sessions 2002, of 15 patients who underwent what he describes as “closed chest open heart surgery” to repair atrial septal defects.

In the procedure, surgeons make four “pencil-sized” punctures in the chest wall. Dr. Argenziano told Reuters Health that a camera is inserted in one, robotic “arms” in two more and suction equipment in the fourth. He pointed out that the system used, called the Da Vinci(tm) system uses true binocular, 3-dimensional viewing, unlike standard robotic devices, in which the surgeon performs the procedure while looking at a mirror image.

Surgery was successful in all cases. Length of stay in the hospital was 3 days for the robotics group, compared with 10 days for patients undergoing standard open chest open heart surgery. Patients undergoing the closed chest procedure were back at their normal routines, including work, within 2 weeks, Dr. Argenziano reported.

There were no deaths and 2 cases of complications, one of which required reoperation. Patients still required heart-lung bypass. “We are not really changing the heart procedure. We’re changing the chest operation,” Dr. Argenziano commented.

The New York team envisions that the approach is adaptable to valve repair and replacement and even for coronary artery bypass surgery. The DaVinci system has already been used successfully in Europe for coronary artery bypass graft surgery, and has already received approved for use in abdominal surgery, Dr. Argenziano noted. His group is hoping for expanded use of the device. The FDA has requested that the Da Vinci system be tested in 125 cardiac patients