Robot cuts away woman's tumor: Surgeon guides device at distance, avoiding open-chest operation

By KAWANZA L. GRIFFIN and JOHN FAUBER
of the Journal Sentinel staff
August 24, 2002

It seems almost too Space Age to be true: The slim hands of a robot removed a tumor from behind the heart of a Racine woman at St. Luke's Medical Center.

But that's just what cardiothoracic surgeon Daniel O'Hair did to eliminate the golf-ball-size mass inside Bessie Jones' chest Friday.

Using the da Vinci surgical system, designed by Intuitive Surgical, O'Hair sat about 10 feet from the patient at a computer console that looked like a gigantic microscope - complete with foot pedals for focusing. He guided the arms of the robot by moving his fingers, connected by Velcro rings to a master controller that translated his movements into smooth, real-time motion of the surgical instruments inside the patient.

The procedure required three tiny, linear incisions for the placement of each robotic arm. The left and right hands held the surgical instruments, while a center hand held a camera that provided a 3-D image of the surgical field.

After 3 1/2 hours of manipulating the surgical instruments to free the tumor, O'Hair declared victory, dropped the tumor into a tiny Ziploc bag and pulled it from the body.

"Normally, the only approach to get it out would be to use a saw to open the sternum and then take it out," O'Hair said. The da Vinci system "not so much reduces the time of surgery, but reduces the size of the incision and doesn't require cutting the breastbone, therefore making recovery much more rapid."

For example, a typical open-chest procedure would require "a month or so" for recovery compared with "a few days" with the new surgical system, he said.

Jones, 63, said she had been having chest pains and heart flutters that made her seek medical attention. Although all of her heart tests came back normal, she was still experiencing the same symptoms.

Earlier this month, physicians determined her pains were caused by the tumor and told her she needed surgery soon.

"It kind of bothered me because I didn't know if it was going to be cancerous," Jones said. "When you're going through something like this, you just don't know how it's going to turn out."

Results from tests on her tumor weren't available yet.

Jamie Hursey, a clinical specialist with Intuitive, said the system is available at approximately 130 hospitals and surgical centers nationwide and in Europe.

Originally developed in the 1980s to allow military surgeons to operate at a safe distance from the battlefield, the system has evolved and is now used for general laparoscopic surgery, removal of gall bladders, elimination of gastric reflux, isolation of internal mammary arteries for bypass, radical prostate removal and reattachment of fallopian tubes, he said.

Future applications include repairs to the mitral heart valve, and colon cancer and cardiac bypass surgery, Hursey said.

St. Luke's purchased the equipment in October 2001 for about $1 million.

So far, it has been used on about 50 patients, mostly to harvest blood vessels for coronary artery bypass surgery, to perform biopsies on chest tumors and to place pacemakers.

O'Hair said the machine allows for more precision and more comfort for patients because the incision is smaller.

"It's kind of like immersing yourself in the body," he said. "But all you see is the area you're working with."

Ultimately, the equipment will prove most beneficial in bypass surgery, he said.

St. Luke's hopes to perform its first bypass operation using the device in the near future. That first operation still will require that a surgeon make a manual incision to allow the robotic arms to reach into the chest cavity.

However, he said, eventually the device will be used in bypass operations without the need for a full incision.

He guessed that, within five years, 30% of bypass operations will be done using robotic devices.

"This is going to open up an entirely new field of technology," he said.

Earlier this year, a surgeon in New York performed the first closed-chest bypass operation using the device.

A device made by another medical firm also is in use at the University of Wisconsin Hospital and Clinics.

So far, the equipment has been used mainly to harvest vessels and in animal research, said Pat Cochran, a UW professor of surgery.

In addition to eventually being used in bypass surgery, the device may someday be used to do valve surgery, he said.

With the arrival of such devices, doctors are at the beginning of a new era of surgery, he said.

"I think it's going to be 10 years before it's in every hospital," Cochran said.