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The Future Is Now: Columbia University Medical Center Surgeons Perform Nation's First Robotically-Assisted Atrial Septal Defect Heart Surgery
On July 24, 2001, cardiac surgeons at NewYork-Presbyterian Hospital's Columbia University Medical Center performed the first robotically-assisted atrial septal defect repair, without a chest incision of any kind.
Michael Argenziano MD, Director of Robotic Cardiac Surgery, and Mehmet C. Oz MD, Director of the Cardiovascular Institute, performed the surgery on a 33-year-old mother of two young children.
The young woman chose to become a pioneer by participating in the FDA-sanctioned clinical trial because it promised a fast recovery time that would allow her to return to her husband and children quickly, and it also left minimal scar tissue. It was expected that her hospital stay would be several days less than if she had had open-heart surgery, and that her recovery period would be significantly reduced as well.
News of the surgery was presented at a news conference at NewYork-Presbyterian Hospital with the surgeons and the patient and her family. The surgery was featured by ABC-Good Morning America, Bloomberg Radio and Bloomberg News, Crain's Health Pulse, all of New York's major television news programs, the Daily News, New York Newsday, Hurriyet (Turkish news), Ch. 41 (Univision), The Fox News Channel (national), and the Charlie Rose Show.
Robotically-assisted surgery requires three pencil-sized holes made between the ribs, compared with an eight- to ten-inch incision for open-chest procedures. Through these holes, two robotic "arms" and an endoscope (tiny camera) gain access to the heart, making surgery possible without opening the chest. The surgeon manipulates the robot's movements from a viewing console several feet away from the patient. The robot, bent over the operating table, performs all of the delicate procedures required in heart surgery. The Columbia University Medical Center team used Intuitive Surgical's da Vinci™ Surgical System, which has been approved by the Food and Drug Administration for a number of clinical trials in heart surgery.
Part of the robot's uniqueness lies in the fact that, unlike most surgical instruments, it can enhance human capability. The robotic appendages-pencil-sized arms with pincer-like digits attached by "wrists"-are designed to mimic the dexterity of a surgeon's forearm and wrist. In fact, the robotic wrist surpasses the human range of motion and is less susceptible to tremors, allowing surgeons a finer degree of precision than ever before. In addition, the endoscope provides an improved view of the surgical site, with 360-degree range of vision, the ability to zoom in and out, plus high-definition, full-color, 3-D images. "It's as close as you can come to true binocular vision," said Craig R. Smith MD, Chief of the Division of Cardiothoracic Surgery. "It's almost better than what you see yourself because you have such magnification and continuous range."
An ASD is a hole, or defect, in the wall of the atrium, the upper chamber of the heart. It was discovered during a routine physical, and confirmed with an echocardiogram. Left untreated, an ASD can result in heart failure or stroke. Until now, the only way to repair an ASD was by opening the chest to gain access to the heart.
Because of the advantages afforded by this new technology, robotics will not only be able to help improve existing minimally invasive techniques, but may be able to aid in the development of new minimally invasive procedures as well. "Robotics may be the next real step forward in the application of exotic technology o what we do every day," Dr. Argenziano said. "In addition, we believe that da Vinci™ will allow us to develop new minimally invasive operations, such as beating heart procedures for the treatment of atrial fibrillation."
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