The Johns Hopkins Division of Cardiac Surgery has recently initiated clinical use of the da Vinci Surgical Robotic System to perform minimally-invasive cardiac surgical operations. Traditionally, cardiac surgery is performed through a sternotomy, a large incision extending down the center of the breastbone, providing access to the heart. The disfigurement and pain associated with this extensive incision has been a longstanding but heretofore acceptable part of cardiac surgery.
Manufactured by Intuitive Surgical, Inc., based in Sunnyvale, California, the da Vinci system is currently the most technologically advanced surgical robotic system in the world and is designed to perform complex operations through incisions that are much smaller and less traumatic than those used with traditional surgical approaches. There is evidence to suggest that, compared to patients undergoing standard open-chest cardiac operations, this minimally-invasive approach may translate into
- less pain
- better wound cosmesis
- fewer wound complications
- shorter hospital stays
- shorter recovery time
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David D. Yuh, MD | William A. Baumgartner, MD |
The first robot-assisted cardiac operation at Johns Hopkins Hospital, performed in June 2003 by Drs. David D. Yuh and William A. Baumgartner, consisted of successfully placing a biventricular pacemaker lead on a beating heart. Dr. Yuh is an Assistant Professor of Surgery within the Division of Cardiac Surgery and Director of Cardiac Surgical Research and Robotic Cardiac Surgery at the Johns Hopkins Hospital. He completed his undergraduate, medical school, surgical residency, and research training at Stanford University and served as a clinical consultant during the early development of the da Vinci robotic system. Dr. Baumgartner is the Director of Research Laboratory for the Division of Cardiac Surgery.
Dr. Yuh has assembled a team of dedicated staff fully trained in using the da Vinci robot to perform minimally invasive robotic cardiac procedures and is prepared to offer several carefully selected cardiac procedures to patients desiring a minimally-invasive approach. These operations include mitral valve repair, atrial septal defect closure, and biventricular epicardial pacing lead placement. Other robot-assisted cardiac procedures under development include coronary artery bypass surgery, transmyocardial revascularization, and ablative procedures for atrial fibrillation.
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The surgeon's console with | |
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The da Vinci Surgical System (Intuitive, Inc., | |
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The da Vinci robot consisting of two manipulation |
The Intuitive Da Vinci Robotic System
The da Vinci robotic system is comprised of four principal components: a surgeon console, a computerized control system, two instrument "arms," and afiberoptic camera. The surgeon sits at the console and views the heart in three-dimensions through the InSiteTM fiberoptic stereoscopic camera system while manipulating the instinctive operating controls.The surgeon's hand motions are relayed to a computer processor, which digitizes and relays them to the fine instrument tips placed into the chest cavity through small 1 cm port incisions. This computerized robotic system enhances the surgeon's ability to perform minimally invasive cardiac surgery in several ways. First, the computer interface permits the accurate translation of the surgeon's hand motions to a dexterous endoscopic "wrist" (EndoWristTM) placed within the chest cavity, conferring much higher degrees of freedom and precision than could be achieved with traditional hand-operated instruments. Second, the da Vinci's advanced two-camera stereoscopic optics provides unprecedented magnified, high-definition, full-color images of the heart and its structures in three-dimensions. This visualization provides much greater detail of the heart than is generally possible with the surgeon's eye. Since the first da Vinci operation was performed in 1999, more than 300 robotic mitral valve repair procedures and 150 atrial septal defect closures have been performed successfully in the United States and Europe.
Robotic Mitral Valve Repair
The da Vinci Surgical Robotic System for mitral valve repair is now available at The Johns Hopkins Hospital. Mitral valve repair is one of the first cardiac surgical operations performed with the da Vinci system and for which FDA approval was obtained. Pioneered in Europe and further refined in the United States, repair of leaking mitral valves due to myxomatous disease, chordal rupture, or annular dilatation, exploits the technical advantages provided by the da Vinci system. The mitral valve can be accessed by a small 6 to 8 cm right thoracotomy and two 1 cm instrument ports. Excellent visualization of the mitral valve with the da Vinci InSiteTM robotic camera system is usually obtained, greatly facilitating its repair. Posterior quadrangular resections and/or "sliding-plasty" repairs are generally performed.
Click here to view Video of minimally-invasive robot-assisted mitral valve repair using the da Vinci robotic surgical system.
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The da Vinci robot's fine instrument tips allows the surgeon to project a mechanical wrist into the chest through very small incisions. |
If you are a patient with isolated mitral insufficiency who would like to be evaluated for this minimally invasive approach to mitral valve repair, ask your doctor for a referral to The Johns Hopkins Hospital. If you are a doctor and would like to discuss or refer a patient who may be a good candidate for robot-assisted mitral valve repair, please feel free to contact our offices directly at (410) 955-9780.
Robotics Research at Johns Hopkins
Dr. Yuh is the director of the Johns Hopkins Cardiac Surgical Research program. His current research with the da Vinci system, in close collaboration with Dr. Allison Okamura in the Johns Hopkins Department of Mechanical Engineering, is focused on developing robotic sensory feedback capabilities. Dr. Yuh believes that bestowing the "sense of touch" to the da Vinci system would permit cardiac surgeons to perform delicate operations more safely and efficiently with the robotic system. Dr. Yuh also is developing methods for training physicians and residents in the use of the da Vinci system using mathematical modeling, which he hopes will ultimately lead to improved surgical training techniques and better-trained robotic surgeons.
Read more about robotics in open heart surgery in Johns Hopkins International Physicians Update.
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Researchers at Johns Hopkins, led by Drs. David Yuh and Allison Okamura, use a force-measurement device to compare forces applied by human hands and the da Vinci robotic system. |
