Excerpted from Cleveland Clinic Magazine, Winter 2004
Using robotic technology – a new innovation in surgery – heart surgeons can maneuver four thin robotic arms through small incisions in the chest that are no larger than the size of a pencil in diameter. Tiny instruments and a camera the size of a dime are attached to the robotic arms, which are manipulated by the surgeon from a computer console 10 feet away from the patient. The entire operation is performed via an image projected on a computer.
“Contrast this technique with conventional open heart surgery, where surgeons must cut open the chest and perform the operation by manually manipulating larger instruments and it’s a whole new ballgame,” says Douglas Boyd, M.D., Chief of Cardiothoracic Surgery at Cleveland Clinic Florida. In fact, it was the option of having this new type of surgery that sent Philip Carr, a former FBI agent, to see Dr. Boyd.
One day when his routine of exercise and speed walking was interrupted by burning in his chest and tingling in his arms, Philip headed straight to his physician at Cleveland Clinic. He consulted with several doctors before it was determined that he needed open heart bypass surgery. At first, he balked, remembering the stories his friends had shared about their open heart surgeries. “For one thing, they experienced intense pain every time they moved or coughed,” he says. “And the recovery was a long one.”
Philip, mentally tough and meticulous – holdover traits from his crime-fighting career and investigations – decided to look for other options.
What he found was a relatively new procedure that in some cases can be performed instead of traditional open heart surgery. The procedure, called robotic-assisted heart surgery, is a rapidly growing phenomenon in minimally invasive heart surgery.
Traditional open heart bypass surgery involves placing the patient on a heart-lung bypass machine to circulate oxygenated blood during surgery. The surgery is performed through a six-to-eight inch incision on a stopped heart. With minimally invasive bypass surgery, the surgery is done through an incision about three to four inches long. Depending on the technique, the surgeon may or may not stop the heart and use the heart-lung bypass machine. Because no bones are broken with minimally invasive surgery, there’s less pain, minimal scarring and a lower rate of complications. There’s also a faster recuperation period: After conventional heart surgery, it typically takes patients about three months to return to 80 percent normal. With minimally invasive surgery, they’re feeling better within days.
Using robots in minimally invasive surgical procedures allows surgeons to have better control over the surgical instruments and a better view of what they are doing.
“Robotic surgery makes it easier for surgeons to maneuver instruments,” explains Dr. Boyd, the heart surgeon to whom Philip was ultimately referred. “Using conventional, larger instruments through such tiny holes would be like trying to sign your name accurately while holding a foot-long pencil by the eraser,” he says. “The system also filters out human tremors and allows for more accurate surgery.”
Dr. Boyd is one of the world’s leading experts in robotic-assisted surgery. Formerly the director of the National Center for Advanced Surgery and Robotics at the London Health Sciences Center in Ontario, Canada, Dr. Boyd completed the world’s first closed-chest, beating-heart coronary artery bypass surgery in 1999.
Because Philip was fit and the targeted artery was on the surface of his heart, he was a good candidate for the procedure. Still, he didn’t immediately agree to it. “I gave it a lot of thought,” he says. “When [Dr. Boyd] told me that he was a pioneer of the procedure, both my daughter and my son-in-law, who is a research scientist, helped confirm this through Internet research. They also went along with me for a consultation.”
Dr. Boyd reassured Philip that if he started the procedure and was unable to complete it with robotics, then he would opt for the usual open heart bypass surgery. Trying the robotic surgery first would not prevent a successful traditional surgery if that became necessary.
Philip had his robotic-assisted bypass on a Tuesday, had two stents implanted on Wednesday, and on Friday morning was released from the hospital. “The day after I got out I was walking 20 minutes twice a day,” he says.
Dr. Boyd says Philip’s recovery time is typical. “It’s less invasive, so it’s less traumatic.”
According to Dr. Boyd, the future of robotic-assisted surgery looks promising. “Because of today’s technology and their active participation in video games, medical students have better video hand and eye coordination than we ever had. There will be a whole future of robotic surgeons better than my peers and me because they’re being brought up with this kind of visual-motor processing. The new age of telesurgery is upon us.”
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