May 27, 2008
Robotic Surgery Systems Begin to Earn Their Keep
A controversial robotic surgery is gaining popularity among cardiac surgeons for repairing defective heart valves and bypassing clogged coronary arteries.
Dr. Kenneth Liao used the da Vinci surgical robot Thursday to restore lost blood flow to the heart of 58-year-old John Carter Holmes. It's roughly the 50th coronary artery bypass Liao has performed using the robotic system at the University of Minnesota Medical Center, Fairview, and the surgeon said he's seen enough cases to believe it's making a difference.
The da Vinci is criticized by health policy experts as the poster child for the medical arms race -- the competitive fever among hospitals to buy new technology whether or not it improves care. The robotic systems come with million-dollar price tags and are used for a limited number of surgeries -- mostly the removal of cancerous prostates in men or uteruses in women.
Studies have disagreed on whether the outcomes of these surgeries are better when using the robotic system versus other minimally invasive techniques.
Those limitations haven't deterred hospital executives, though, who see the robotic systems as crucial for attracting and retaining surgeons and patients. The number of da Vinci robots has doubled in Minnesota in less than two years, with two at the university and four at the Mayo Clinic in Rochester.
Surgeons believe the growth in robotic heart
procedures will help justify those investments and may ultimately reduce costs if they shorten patient stays. There's a competitive interest for heart surgeons as well. With more patients using stents to prop open clogged arteries, surgeons are seeing their own number of procedures decline.
When California-based Intuitive Surgical first unveiled the da Vinci eight years ago, it was marketed as a heart surgery device. The learning curve for cardiac surgeons was too steep, though, and the system's tools weren't as useful for heart surgeries as they were for other procedures, said Dr. Goya Raikar, a cardiothoracic surgeon at Regions Hospital in St. Paul.
"The system and instruments have kind of caught up to the point where heart surgeons are taking a close look at this now," he said.
Regions and Mercy Hospital in Coon Rapids started using da Vincis for heart procedures in the past year, and Methodist Hospital in St. Louis Park is preparing to do so. Raikar mostly uses the surgical robot to repair or replace damaged mitral valves, which separate the two chambers on the left side of the heart.
The robotic system puts a surgeon at the controls of a large viewing console. The doctor peers inside at magnified three-dimensional images coming from cameras inside the patient. Hand-held controls allow the surgeon to maneuver tools that are threaded into the patient through small incisions.
Raikar said the magnified vision allows him to do more valve repairs, which present lower risks of complications than replacements. Unlike other surgeries, there are no minimally invasive alternatives for valve repairs, he said. The only other option is open-heart surgery, which carries a higher risk of infections and longer recoveries.
Liao said the robotic surgery was the right choice for Holmes, the bypass patient.
Holmes was a competitive decathlete with no hint of heart problems until he collapsed earlier this year at the University of Minnesota Field House and his heart stopped beating. Workers there used an external defibrillator to restart his heart, and doctors cooled him into hypothermia to reduce damage to the brain caused by the disruption of blood flow.
Later, Holmes learned a key artery to his heart was completely clogged. Liao feared that cutting open Holmes' chest and sternum for an open bypass surgery would disrupt his rehabilitation from the cardiac arrest and delay his plans to return to athletics.
Using the da Vinci, Liao disconnected the mammary artery -- which usually directs blood to the left breast -- and connected it to the heart so normal blood flow could resume. A stabilizer held a section of the beating heart in place so he could secure the new coronary artery.
If all goes as expected, Holmes could go home today.