Surgical future for heart patients in Canada's isolated towns and villages, will lie increasingly in the hands of robots

The surgical future for heart patients in Canada's northlands or in isolated towns and villages, will lie increasingly in the hands of robots, says Dr. Alan Menkis.

Dr. Menkis presented a study on advances in robotic surgery today at the Canadian Cardiovascular Congress 2004, hosted by the Heart and Stroke Foundation of Canada and the Canadian Cardiovascular Society. "What we all need to understand is that long distance heart surgery with a robot is not a substitute for the human factor. It is an intensification of the human factor, says Dr. Menkis. Heart and Stroke Foundation spokesperson Dr. Paul Hendry agrees. "Even with the technology, a skilled surgeon is required.

Although robotic surgery may be a viable "long distance" option, in some cases it's just not appropriate, or it might make sense to fly the patient to a hospital for care." Still, long distance surgery using robots may be a reality in Canada in the not too distant future. "For example, we have been involved in research where a surgeon in a hospital on the west coast of the United States controlled the robotic camera during surgery at our centre and vice versa," says Dr. Menkis. "Similar simulations have been done between the North America and Europe."

So far Dr. Menkis has yet to work on the heart of patients outside his hospital, or indeed outside of his operating room. But, with fibre optic cable, 10 feet away could as easily be 100,000 kilometers. Dr. Menkis was reporting on the first 11 patients in Canada who underwent mitral valve repair in February 2004 to August 2004 using the DaVinci surgical robot. "There were no complications and all the patients are doing well," says Dr. Menkis.

Mitral valve repair is usually an open heart operation to treat the narrowing or leaking of the "inflow valve" of the left side of the heart. The function of the mitral valve is to keep the blood flowing in one direction through the left side of the heart, and to prevent back flow of blood towards the lungs when the heart contracts. "In preparation for this fully robotic approach we started doing mitral valve repair using a robotically controlled camera approximately three years ago and had performed surgery on 32 patients" he recalls.

Dr. Menkis's first robot simply held the camera and everything else was done manually, using special hand instruments. Now the main portion of the operation is done with the robotic arms inside the cavity of the heart. "The surgeon controls every movement that the robot makes," says Dr. Menkis.

The robot does not have the human problem of hand tremor and the surgeon has greater operational latitude because of motion scaling - which means the surgeon can move a hand an inch but the arms within the body only move a millimeter. Although this type of surgery is still experimental and not generally available, the anticipated advantages are many:

• The procedure uses very small incisions so there is no need to open the breast bone to reach the heart
• There is only minor bruising and a few small incisions to heal
• There is less risk of infection
• The risk of hemorrhage and blood transfusions is minimal
• Recovery and return to normal activities is faster with less cost to the healthcare system
• There is less scarring

Dr. Richard Wiesel, who will deliver this year's Wilfred Bigelow Lecture to the Congress, says that robotic surgery should get patients out of hospitals faster and make it less likely that they would ever need to return for further surgery. "The cardiac surgeons of the future are going to have to combine with basic scientists, cardiologists and specialized rehab teams to deliver big savings in time and long term effectiveness," says Dr. Wiesel. Latest reports on robotic surgery in Europe suggest that cardiac operating times can be dramatically curtailed, he says. Procedures that currently take six hours can be reduced to one hour.

The Heart and Stroke Foundation is a leading funder of heart and stroke research in Canada. Our mission is to improve the health of Canadians by preventing and reducing disability and death from heart disease and stroke through research, health promotion and advocacy.

Congress Web Site: www.cardiocongress.org