Article published June 30, 2008
DA VINCI SURGICAL SYSTEM
Perrysburg resident one of more than 1,000 to have minimally invasive robotic heart surgery
Dr. Thomas Schwann shows off new new robotic heart surgery equipment at St. Vincent Mercy Medical Center.
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BLADE PHOTOS/HERRAL LONG
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By GABE NELSON
BLADE STAFF WRITER
Five weeks after surgeons stopped her heart, Connie Karcher could joke about the robotic surgery that sidelined her from work for almost two months.
"I'm back, without missing a beat," the Perrysburg resident wrote in e-mails to clients announcing her return.
Of course, that wasn't exactly true. The surgeons had placed her on a heart-lung machine for more than an hour while they repaired her potentially fatal condition, called mitral valve prolapse.
But it sure felt like it for Ms. Karcher, who had recovered in weeks from a surgery that usually means months of rest and rehab, and who had only a few small scars to remind her of the ordeal.
"You know, I went through this major surgery. They stopped my heart. I could have died. And now, it's all over," said Ms. Karcher, an advertising representative at The Blade. "It was just like a dream, and it's over now."
The part that functions like a hand to hold tools for an operation.
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Last year, more than 1,000 people in the United States underwent minimally invasive robotic heart surgery, a rapidly growing field that promises faster recovery, smaller scars, and fewer surgical side effects.Using a high-tech device called the da Vinci Surgical System, doctors operate on a patient by controlling robotic surgical tools and cameras inserted through several incisions roughly an inch long.
The device is more commonly used in urology and gynecology, but increasingly more hospitals, including Toledo's St. Vincent Mercy Medical Center, are beginning to use it for heart procedures. The da Vinci machine offers a glimpse of a future in which robotic technology will play a role in most of the hundreds of thousands of heart procedures performed in the United States each year, surgeons said.
"We are at the threshold of changing how we take care of the human body," said Dr. Thomas Schwann, a cardiothoracic surgeon who performs procedures with the machine. "The future is limitless. It's just going to depend on our imagination and our ability to innovate."
Over the past two years, Dr. Schwann has used the device to perform about 15 coronary artery bypass grafts - a simpler procedure than a mitral valve repair, he said, noting that no heart surgery is simple.
St. Vincent's bought its first da Vinci device in 2003. Earlier this month, the hospital received a second machine, this one exclusively dedicated to heart and vascular surgery.
Connie Karcher shows Republican presidential candidate Sen. John McCain a robotic surgical system by Intuitive that was used during her surgery at the Cleveland Clinic.
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Dr. Schwann is training to perform mitral valve repairs using the machine and plans to start offering the surgery using the da Vinci machine next month. His private practice, Advanced Cardiothoracic Surgeons of Northwest Ohio, also performs procedures at the University of Toledo's medical school, the former Medical College of Ohio, and St. Luke's Hospital in Maumee.
No Toledo-area surgeon offered the procedure when Ms. Karcher needed surgery, which is why she traveled across the state to the Cleveland Clinic.
Ms. Karcher, whose brother and sister died at young ages from heart conditions, had been diagnosed eight years earlier with mitral valve prolapse, in which the flaps dividing the left ventricle and atrium fail to properly close. In severe cases like hers, blood backs up into the atrium, eventually causing arrhythmia and death.
People with leaky mitral valves have options: they can get the valve replaced with an animal or mechanical valve, or they can undergo surgery to repair it.
In a conventional mitral valve repair, surgeons saw open the sternum and spread the ribs to expose the heart. But in a robotic-assisted repair, surgeons make several small incisions on the side of the patient's chest rather than crack the chest wide open.
"I thought, I'd have to be crazy to have the conventional surgery," Ms. Karcher said.
Robotic surgery, a symbol of modern medical innovation, drew the attention of presumptive Republican presidential nominee John McCain at a recent campaign stop.
Ms. Karcher was invited back to the Cleveland Clinic in early May to meet with Mr. McCain, who was visiting to talk about his health care proposals. She and her surgeon, Dr. Tomislav Mihaljevic, showed him the da Vinci machine.
"This is a wonderful thing," the Plain Dealer reported Mr. McCain saying. "You look wonderful," he said to Ms. Karcher, who had gone under the knife just two weeks before.
The machine was born from Department of Defense-funded research aimed at allowing surgeons to perform battlefield surgeries remotely with robotic instruments. The researchers at Stanford Research Institute soon realized that similar technology could give surgeons greater precision in delicate procedures.
They formed Intuitive Surgical, which started selling the machine in 1999. It has sold more than 850 to hospitals around the world.
Though robotic heart surgery was the clear choice to Ms. Karcher, others are uncertain about the new technology.
Doug Deacon, a friend of Ms. Karcher's, was told several months ago that he needed surgery for his mitral valve prolapse.
Mr. Deacon, the vice president of professional services at St. Luke's Hospital in Maumee, wants his surgery done there. He said the benefits of robotic surgery sound enticing, but he would like Dr. Schwann to perform some mitral valve repairs using the da Vinci system first. Mr. Deacon said he will undergo the surgery his doctors suggest, robotic or otherwise.
"If they had done more procedures, I wouldn't have a problem," Mr. Deacon said. "I'm relying on what my cardiothoracic surgeon is comfortable with."
Indeed, robotic cardiac surgery is still in its infancy. Robotic surgery researchers expected it to revolutionize the field of cardiac surgery, but it hasn't turned out that way - at least not yet, said Dr. Randall Wolf, a former Ohio State University and University of Cincinnati professor who led the da Vinci machine's clinical trials.
While robotic surgery has become standard practice for some procedures, like prostate removal and to a lesser extent mitral valve repair, it hasn't yet become practical for many heart procedures.
Somewhere between 1,000 and 2,000 people had robot-assisted heart surgery in the United States last year, a sliver of the 300,000 to 400,000 people who underwent cardiac procedures.
Dr. Wolf said robotic surgery systems cannot yet replace conventional techniques because they lack the sense of touch. Because the incisions are so small, surgeons must also rely heavily on visuals provided by the surgical cameras.
"It feels strange. There's no touch feedback, so you really have to rely on your sense of sight for the whole operation," Dr. Schwann said. But, he added, "it works beautifully."
For Dr. Marc Gillinov, a surgeon at Cleveland Clinic who specializes in valve repairs, it took three months of training to get the hang of performing surgery with the machine.
Dr. Gillinov would go to work early, around 5:30 a.m., to practice using the da Vinci machine before the hospital needed it for surgery. He started with "skill drills," in which he practiced controlling the machine's robotic arms from the operating console. After that, he and his surgical assistants went to a training center in North Carolina to perform simulated robotic surgeries on cadavers and watch an expert surgeon operate.
"It was a long, involved process," he said. "Robotic surgery is not for every surgeon."
It's not for every hospital, either - one da Vinci machine costs $1.6 million, and training for surgeons and staff costs thousands more each year. The machines save health systems money by shortening patients' hospital stays, but unless a hospital performs a large number of robotic procedures, the cost of training nurses, surgical assistants, and anesthesiologists can be prohibitive, Dr. Gillinov said.
Of the roughly 165 hospitals in Ohio, 20 have da Vinci machines.
In the Toledo area, there are four: St. Vincent's, St. Luke's, University of Toledo Medical Center, and Toledo Hospital. About 10 surgeons in the area can perform surgery using the machines, said Jamie Lewis, Intuitive Surgical's sales manager for the Toledo area.
Dr. Wolf said robotic surgery will revolutionize medicine once researchers overcome its current limitations.
"Technology is changing exponentially. Look how quickly we've gone from long-playing records to cassettes, to 8-tracks, to CDs, to the iPod. That's all happened in our lifetime," Dr. Wolf said. "We're seeing this effect in surgery as well. This is just the tip of the iceberg."
Contact Gabe Nelson at: gnelson@theblade.com or 419-724-6076.
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