Groundbreaking robotic heart surgery takes place at USC University Hospital

LOS ANGELES, May 3, 2001—Cardiothoracic surgeons from the Keck School of Medicine of the University of Southern California have become the first in Southern California to perform heart surgery remotely using a robot.

Vaughn Starnes, M.D., professor and chair of cardiothoracic surgery at the Keck School, and his team of surgeons, Daniel Schwartz, M.D., and Ross Bremner, M.D., Ph.D., repaired the mitral valve of patient Lotte Henderson on April 27 at USC University Hospital using the da Vinci Surgical System. Henderson will be released from the hospital today.

"Robotic surgery is going to revolutionize cardiothoracic procedures," Starnes said. "This is truly the next advance in heart surgery."

Traditional mitral valve surgery involves a long incision, and surgeons must split the breast bone to reach the heart. Even using advanced techniques, the incision can be four inches long. But through the small punctures and tiny instruments involved in minimally invasive robotic surgery, patients experience shorter incisions, less pain and trauma and a quicker recovery time.

The da Vinci Surgical System, a product of Intuitive Surgical (based in Mountain View, Calif.), teams the honed skills of a surgeon with computer-enhanced robotic technology. USC is one of several sites in the United States in a Food and Drug Administration-approved trial to evaluate the use of the da Vinci Surgical System to repair the heart’s mitral valve.

Surgeons repair the mitral valve to treat leakage of the valve, which helps pump blood through the heart. The valve separates the heart’s left atrium (upper chamber) from its left ventricle (lower chamber). A weakened valve can cause blood to back up into the lungs, causing the ventricle to pump more blood and producing symptoms of shortness of breath and tiredness.

During the procedure, Starnes sat at a console about eight feet away from the patient, while a three-armed, 1,000-pound robot was positioned beside her. Starnes grasped and moved highly sensitive instruments at the console while viewing Henderson’s heart—greatly magnified—on a screen. The robot precisely matched Starnes’ natural hand and wrist movements, translating them to the tiny instruments placed inside the patient through small puncture incisions.

The procedure required three small incisions between the ribs, two for the insertion of interchangeable instruments and another for a thin, cylindrical video camera, called an endoscope. Starnes shaped and sutured tissue into place, shortening a chord (a sort of "heart string") that supports the heart valve. He also sewed a ring into place to brace the valve.

Team member Daniel Schwartz, assistant professor of cardiothoracic surgery, assisted in the procedure.

"Mitral valve repairs, technically, are among those requiring the most skill from a surgeon," Schwartz said. "This is a procedure not many people across the country do, even without a robot."

"The robot is able to perfectly mimic the surgeon’s hand," Schwartz added, "all in a very small area. The robot can be so delicate you can carefully place sutures the size of a human hair."

Starnes and his team are optimistic about the robot’s potential in heart and chest surgery. They will continue to perform mitral valve procedures, and plan to approach the FDA for approval to perform other procedures outside of the current mitral valve trial.